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Background: Aims: To investigate the developmental trajectory of the rate and perceptual assessment of oral diadochokinesis (DDK) in typically developing children compared with adults. Also to examine the characteristics of DDK productions in children with speech sound disorders (SSD) and the relationship between DDK production and percentage of consonants correct (PCC). Methods & Procedures: Participants were 316 typically developing children and 90 children with SSD from 3 to 9 years old, as well as 20 adults with normal speech. The mono‐, bi‐ and trisyllabic nonsense strings containing Korean tense consonants and the vowel [a] were used for DDK tasks. The number of iterations per s was measured as the DDK rate for each stimulus. The perceptual assessment of DDK productions was also performed for regularity, accuracy and rate. Outcomes & Results: The DDK rates increased throughout childhood, but the oldest children, 9‐year‐olds in the current study, did not achieve adult‐like rates for all mono‐ and trisyllabic strings. Children with SSD also did not show significant differences from typically developing children when the DDK productions were analysed using only accurate tokens. The PCC of children with SSD showed higher correlations with regularity, accuracy and rate of perceptual ratings than the timed DDK rate. Conclusions & Implications: This study highlighted the fact that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills. WHAT THIS PAPER ADDS: What is already known on the subject: Rates of DDK reflect the motor skills of the articulatory systems independently of phonological skills; therefore, the tasks are widely used in the diagnostic evaluations of speech disorders in both children and adult populations. However, a substantial number of studies have questioned the validity and usefulness of DDK rates for evaluating speech abilities. Also, the literature suggested that the measure of DDK rate alone does not provide a clear and useful indication of children's oral motor skills. DDK tasks should be analysed in terms of accuracy and consistency as well as rate. What this paper adds to the existing knowledge: The literature reporting normative DDK performance has mainly been based on English speakers. As different consonants have different temporal characteristics, the linguistic and segmental features of DDK tasks can impact the DDK rate. This study established a norm for DDK rate for Korean‐speaking children and investigated the developmental trajectory of DDK performance in typically developing children compared with adults. This study suggested that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills by examining the characteristics of DDK productions in children with SSD. What are the potential or actual clinical implications of this work?: This study provided normative data of young Korean‐speaking children aged 3–9 years. Normative data in children under 5 years of age are valuable given that the majority of children referred for speech difficulty assessments are between 3 and 5 years of age, but only a few studies have provided the normative data in young children. This study showed that many children could not complete DDK tasks correctly and provided additional support for the notion that other aspects of DDK performance, including accuracy and regularity, may yield more useful diagnostic indications than timed DDK rates alone. [ABSTRACT FROM AUTHOR]

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

Safety concerns for women are prevalent and influence their likelihood to exercise outside. While some women modify their exercise behaviour due to safety concerns, others exercise outside more freely. In this paper, two experiments are reported with women runners to examine whether making their identity as a runner or a woman salient changed their self‐reported likelihood of exercising outside, sense of safety and personal safety anxiety. While study 1 (n = 153) found no significant experimental effect, it revealed a trend: women whose runner identity was made salient were more likely to self‐report their willingness to exercise outside than those in the gender identity condition. Study 2 (n = 236) was conducted to examine this trend further. The second study employed a larger sample size and a more robust manipulation of social identity salience. A significant effect of the experimental condition on women's sense of safety was observed. Specifically, women in the runner identity salience condition had significantly greater feelings of safety than women in the gender identity salience condition. A similar trend emerged for self‐reported likelihood to exercise outside. These findings corroborate prior research on the impact of identity salience on intention to engage in health behaviours. They contribute to the existing body of literature on the intricate interplay between women's physical activity intentions and safety concerns. Furthermore, these findings could aid in the development of interventions to increase women's physical activity levels. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Background: Leaderboards are a highly popular gamification component used in student learning to enhance motivation, attentional engagement, and learning performance. However, few studies have examined the effects of individual leaderboard elements on English vocabulary learning through video lectures. Objectives: The present study aimed to examine how different leaderboard elements (i.e., points and rank) may affect students' English vocabulary learning through video lectures. Methods: A total of 34 students were assigned to groups using different leaderboard elements in a counterbalanced order. Participants' motivation, eye movements, and learning performance were measured and analysed. Results and Conclusions: Students' leaderboard rank was shown to increase their motivation regardless of whether other elements were present. Eye movement tracking revealed that the presence of the leaderboard increased students' saccades between the questions and the options, and lengthened their dwell time on the learning materials while reducing their dwell time on the non‐learning‐related screen areas. Presenting students' rank alone also improved their learning performance. Implications: Our findings strongly support the use of video lectures for English vocabulary learning, with the following recommendations: (1) Instructors should present students' rank on the leaderboard to enhance students' motivation and engagement; (2) Instructors should present only the students' rank on the leaderboard to also enhance students' learning performance. Lay Description: What is already known about this topic: While learning English vocabulary from video lectures, students might experience low levels of motivation and engagement, and pay less attention to the lectures.Leaderboards are a highly popular gamification component used in student learning to enhance motivation, attentional engagement, and learning performance.It remains unclear which leaderboard elements (i.e., points or rank) contribute most significantly to the effectiveness of the leaderboards. What this paper adds: Leaderboard elements have different effects on English vocabulary learning.The rank on the leaderboard benefited students' motivation and engagement.The rank also enhances students' confidence and learning performance. Implications for practice and/or policy: Instructors should present students' rank on the leaderboard to enhance students' motivation and engagement.Instructors should present only the students' rank on the leaderboard to also enhance students' learning performance. [ABSTRACT FROM AUTHOR]

Background: Taiwan's higher education institutions prioritize interdisciplinary knowledge and cultural competence in cultural design, emphasizing the value of immersion in the local environment to develop cultural competence. However, challenges arise from the disappearance of traditional local lifestyles and limitations of traditional outdoor lectures such as group size and learning environment. Mobile augmented reality technology serves as a personal learning tool to overcome these challenges, enabling learners to uncover hidden knowledge in scenic locations and improving learning efficiency. Objective: The study utilized learning analytics to investigate the impact of using mobile augmented reality on enhancing learners' cultural competence. Methods: The study used both qualitative and quasi‐experimental quantitative research to evaluate the effects of mobile augmented reality on cultural competence. A total of 78 third‐year university students participated in the study, with 37 of them using mobile augmented reality to learn about culture. The researchers utilized both the Mann–Whitney U test and interviews to compare the effectiveness of mobile augmented reality with that of a 'real' tour guide in field courses. Results: The experimental results indicate that learners were able to continuously seek and find information about local culture through field exploration with mobile augmented reality, resulting in similar effects to those of attending a live lecture. Conclusions: It showed that incorporating mobile AR into field visits can create gamified and active learning scenarios that enhance immersion and drive active learning in local culture. The results in greater cultural knowledge and understanding, leading to the development of cultural competence in students. Lay Description: What is already known about this topic: There is a heightened emphasis on cultivating and demonstrating cultural competence across various fields due to the significantly grow of cultural and creative industries.Relying solely on traditional classroom teaching for learning about local culture may result in a diminished impact, as a comprehensive understanding of culture necessitates a keen sense of life.To address the limitations of traditional classroom lectures, educators continuously strive to enhance teaching methodologies by developing innovative approaches, such as experiential learning and community‐based learning, which involve hands‐on activities and real‐world engagement to foster increased learning motivation and improved effectiveness.Augmented reality (AR), a technology that overlays virtual images onto real scenes in real time, has gained extensive usage in diverse fields such as medicine, national defence, education, and entertainment, offering interactive gaming experiences and providing an opportunity to experience the culture and past lives of locals in the field, enhancing learners' understanding of cultural history and creating immersive encounters during visits.Particularly in digital learning, the integration of AR enables learners to engage with additional content through mobile devices, fostering an immersive and gamified learning experience. What this paper adds: The use of the AR app for learning about the local culture yielded comparable outcomes to traditional guided tours.Participants actively engaged in self‐directed learning and demonstrated a sense of initiative while utilizing AR.The flexibility and autonomy provided by field learning, which extended beyond the course period, allowed participants to revisit the field and explore at their own pace using AR.Demonstrates that participants took control and responsibility for their own learning, leading to an enhancement in learner autonomy.Participants who utilized the Roaming Jingliao AR system to explore cultural scenarios exhibited enhanced knowledge and attitudes regarding cultural competence, specifically in areas such as cultural understanding, rice food cultural knowledge, Songjiang folk arts, and skills and practices, which can be attributed to the immersive and autonomous nature of AR‐based knowledge learning in outdoor guided courses, minimizing the influence of external environmental factors and facilitating a deeper understanding of the content compared to traditional guided tours. Implications for practice and/or policy: The findings of this study highlight the importance of considering the limitations associated with a relatively small sample size when conducting research within a university curriculum. To enhance the validity and reliability of future studies, practitioners and policymakers should prioritize the inclusion of larger and more diverse samples, enabling a more comprehensive understanding of the impact of AR technology on cultural learning and informing evidence‐based practices and policies.The study's focus on a specific group of participants and their contextual background highlights the need for future research to include participants from diverse educational settings and cultural backgrounds, ensuring that the findings are more applicable and relevant to a broader population. Practitioners and policymakers should consider the importance of inclusivity and diversity when designing and implementing cultural learning interventions using AR technology.The recognition of technological limitations highlights the importance of considering the specific AR system used in cultural learning interventions. Practitioners and policymakers should be cautious when adopting AR technologies and recognize that different AR systems or platforms may yield different outcomes. Future research should focus on evaluating the effectiveness of various AR systems and platforms to inform decision‐making regarding the selection and implementation of AR technologies for cultural learning initiatives. [ABSTRACT FROM AUTHOR]

Aims: Empirical investigations reveal that, in comparison to their typically developing peers, children with histories of prenatal alcohol exposure experience deficits in writing but not drawing skills, both of which require fine motor control. This study examines drawing skills in this clinical group by assessing simple free‐form spiral drawings with indices of spectral features and structural organization. Methods: Children with (n = 15) and without (n = 24) prenatal alcohol exposure used their dominant and nondominant hands to draw a series of spirals using a wireless pen stylus that either provided concurrent visual feedback in the form of a black ink trace or left no visible ink trace of each drawing. Spirals were drawn on a sheet of paper placed on a digitizing table, which facilitated online data acquisition. The data were assessed by power spectral density function analysis and sample entropy analysis. Results: In comparison to their typically developing peers, children with prenatal alcohol exposure produced spirals with a lower mean frequency and less spectral variability. Spirals in the prenatally exposed group were also lower in complexity and structural organization than in the control group. These results occurred independently of hand dominance or the availability of visual feedback. Conclusions: The drawing skills of children with prenatal alcohol exposure have inherent signal characteristics that differ significantly from those produced by typically developing peers. Simple tasks requiring fine motor control may be useful in identifying individuals with fetal alcohol spectrum disorders. [ABSTRACT FROM AUTHOR]

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

The aim of this study was to investigate the effect of using dynamic geometry software (GeoGebra) on the eighth‐grade students' conceptual understanding and the retention of learning regarding linear equations and slope. In this study, a quasi‐experimental design with pre‐test, post‐test and delayed post‐test was employed. This study was conducted with 52 eighth‐grade Turkish students (experimental group, n = 25; control group, n = 27). While GeoGebra software‐supported instruction was carried out in the experimental group, textbook‐based direct instruction was continued in the control group. Data were collected with the conceptual understanding test (CUT) which consists of 38 questions including open‐ended, multiple choice and fill in the blanks. CUT was applied to the experimental and control groups as a pre‐test and post‐test at both the beginning and the end of the instruction, respectively. Seven weeks after the instruction, CUT was applied to both groups as a retention test. Data were analysed through SPSS 17.0 statistical software by using a t‐test and ANCOVA test. It was indicated in the study results that GeoGebra software‐supported instruction for eighth‐grade students regarding linear equations and slope did significantly improve both their conceptual understanding and retention of learning in comparison to textbook‐based direct instruction. Lay Description: What is already known about this topic?: The subject of functions and their graphs are the basis of many mathematical concepts and subjects such as logarithm, limit, derivative and integral.It is indicated in many studies that middle‐grade students have some misconceptions and difficulties in learning the concept of a straight line and slope.It was determined in previous studies conducted at different grade level that using dynamic geometry software (DGS) increases students' mathematics achievement according to traditional instruction.There is a need for research investigating the effect of using GeoGebra software on eighth grade students' conceptual understanding and retention of learning regarding linear equations and slope. What this paper adds?: A quasi‐experimental design with pre‐test, post‐test and delayed post‐test was conducted.Using GeoGebra software had positive effects on eighth‐grade students' conceptual understanding regarding linear equations and slope.The learning environment with GeoGebra software increased the retention of learning. The implications of study findings for practitioners: This research provided evidence regarding the effects of using GeoGebra software on eighth‐grade students' conceptual understanding and retention of learning in mathematics.In future studies, the long‐term effects of GeoGebra on other mathematics topics and other learning outcomes within similar settings should be examined. [ABSTRACT FROM AUTHOR]

Online search involves multitasking and may demand better working‐memory capacities (WMC) and additional cognitive aids. Given the constraints of human cognition, we tested the effectiveness of note‐taking strategies on university students' online search performance. Also examined were the profile configurations of WMC tests in silence and in irrelevant speech as well as its interaction effects with note‐taking strategies on online search performance. Among the participants of 60 university students, we found a four‐group WMC profile composition that differed significantly across WMC scores in both silence and irrelevant speech. Results showed that WMC profiles, note‐taking groups and their interaction effect were significant factors on online search performance. Both Free Note and Matrix Note were beneficial for the students in low silent WMC profile groups. Study results have both theoretical and practical implications, advancing our understanding of the interrelationship of WMC under different conditions and informing instructional practice of online search performance. Lay Description: What is already known about this topicWorking memory capacity is fundamental to multitasking ability.Online search is a typical multitasking behavior that requires constant switching between different information sources.Students who take note perform better than those who do not while reading materials with seductive but irrelevant information.What this paper addsStudents working memory capacity is examined under silent and irrelevant speech conditions.Students exhibited different profile patterns in their working memory capacity under silent and irrelevant speech conditions.Taking note, either in matrix form or free form, can significantly improve students' online search performance for those with high WMC ONLY in irrelevant speech or for those with low WMC in both silent and irrelevant speech conditions.Implications for practiceNote‐taking as auxiliary support may facilitate students' integration and evaluation of the online information across multiple sources during their online search.Instructions on how to self‐construct matrix note are needed to help students develop advanced note‐taking skills for their learning involving online search. [ABSTRACT FROM AUTHOR]

Objective The primary goal was to determine whether a composite measure of pain and activity is a more responsive assessment of analgesic effect than pain alone or activity alone in patients with osteoarthritis ( OA) of the knee. Design We conducted a randomized, double-blind, placebo-controlled, 2-period, crossover study of celecoxib vs. placebo in subjects with chronic pain due to knee OA. Patients with knee OA and baseline pain intensity score ≥4 on a 0-10 numerical rating scale ( NRS) before each period were randomized. Pain endpoints included in-clinic pain score (24-hour and 1-week recall), daily paper diary pain score, current pain on an electronic pain diary (each on NRS), and WOMAC pain subscale. Activity measures included WOMAC function subscale and actigraphy using a device. Three composite pain-activity measures were prespecified. Results Sixty-three patients were randomized and 47 completed the study. The WOMAC pain subscale was the most responsive of all five pain measures. Pain-activity composites resulted in a statistically significant difference between celecoxib and placebo but were not more responsive than pain measures alone. However, a composite responder defined as having 20% improvement in pain or 10% improvement in activity yielded much larger differences between celecoxib and placebo than with pain scores alone. Actigraphy was more responsive than the WOMAC function scale, possibly due to lower placebo responsiveness. Conclusion We have identified composite pain-activity measures that are similarly or more responsive than pain-alone measures in patients with OA. Further research is warranted to determine the optimal method for computing these composites. [ABSTRACT FROM AUTHOR]

Malaysia is a multi-ethnic country with Malay, Chinese and Indian being the dominant ethnic groups. This paper investigates the three ethnic cultures in Malaysia by examining the individual-level values of managers and professionals. Based on 528 responses to a Schwartz Value Survey ( SVS) questionnaire, the paper identifies partial convergence of the value systems of Malay, Chinese and Indian people. It was found that the three ethnic groups do not differ significantly in the individualistic value dimensions of Self-enhancement and Openness-to-change. However, Malays are found to be more conservative and less self-transcendent than Chinese or Indians, while Chinese and Indians attribute the same importance to these two sets of values. [ABSTRACT FROM AUTHOR]

Open Educational Resources (OER) aim to provide equal access to education. Yet, as the language level used in OER presents a barrier to many learners, there is a need to make these resources more comprehensible. This study combined eye‐tracking methodology and comprehension assessment to explore the effect of text simplification on English second language (L2) users, while also accounting for text organizational structure and individual predispositions. A total of 37 adult English L2 users took part in the study. They had to read either an authentic narrative, authentic expository OER or their linguistically simplified versions. The analysis showed that simplification led to better text comprehension, and text narrativity facilitated text recall, particularly at lower English proficiency levels. Eye‐tracking measures revealed that text simplification led to an increase in processing time during the initial reading of the text and a decrease in processing time during text re‐inspection. These findings have strong practical applications for online teaching with OER. Lay Description: What is already known about this topic: Open Educational Resources (OER) aim to increase access to education to all.Language level of OER in English was found to be very difficult, particularly to English L2 users.Text simplification that reduces the difficulty level of OER to English L2 users might be a potential solution.There is a lack of research that controls for the type of texts, individual predispositions and uses diverse behavioural measures to explore the effect of text simplification on English L2 users. What this paper adds: Text simplification led to better text comprehension, and text narrativity facilitated text recall, particularly at lower English proficiency levels.Text simplification slowed down processing during the initial reading of the text, and sped up processing during text re‐inspection.Final sentences, which were the likely locations for the integration of text information, received extended overall processing time in the simplified condition.Language proficiency played an important role both in text comprehension and text processing. Implications for practice and/or policy: Linguistic simplification of an OER text where possible – using higher frequency lexis, splitting long sentences, avoiding passive voice – benefits English L2 users, particularly at lower proficiency levels.There should be more narrative elements and cohesive links within and between sentences in the academic texts and OER, as these structures seem to be retained in readers' memory longer.OER publishers and material designers should be motivated to include the possibility for OER learners to access a simplified version of the OER materials [ABSTRACT FROM AUTHOR]

Migraine has close associations with depression and anxiety. Catastrophizing, an alarmist reaction to pain, has been proposed as one of the mediators in the relationship between headache and emotional distress. However, much experimental evidence is needed to make such a view more validated. The aims of this study are to examine the effects of mood induction on the pain responses and to investigate the role of pain catastrophizing in the relationship between pain and mood amongst a sample of patients with migraine. For this purpose, 60 patients with migraine were recruited from a headache clinic in Tehran-Iran and were randomly assigned into one of three groups: negative mood induced group, positive mood induced group and control group. The following instruments and measures were used in this study: mood induction by presenting different types of films (positive, negative), a computerized cognitive task to elicit pain, Beck Depression Inventory and Pain Catastrophizing Scale. The results showed that while the induction of depressed mood increased the pain intensity, the induction of positive mood reduced it significantly ( p < 0.05). Further analyses revealed that catastrophizing is as a confounding factor in the relationship between pain and mood. Once catastrophizing scores were entered into the analyses as a covariate, the significant effect of mood on the pain intensity reduced. In conclusion, both mood and catastrophizing are important factors in understanding the migraine pain. Clinical implications of these findings are discussed in the paper. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Pain-related catastrophizing and mood induction are important factors in understanding pain intensity amongst patients with migraine pain., Catastrophizing as a confounding factor in the relationship between pain and mood may partially mediate the relationship between mood and pain., Therapeutic interventions should focus on the reduction of depression and catastrophizing. [ABSTRACT FROM AUTHOR]

The present paper examines cross-national differences in the utilisation of work-family resources at the organisational level and the relationships between these resources and work-to-home interference ( WHI) and satisfaction with work-family balance ( SWFB) among professional and non-professional service sector employees in five Western European countries. Further, it explores cross-national variations in the gap between professionals and non-professionals with respect to both outcome variables. Professional service sector employees were consistently found to experience higher levels of WHI and lower levels of SWFB. The use of organisational work-family resources differed across welfare state regimes and levels of national gender equality. It was highest in Sweden and the Netherlands and lowest in Portugal. A family-supportive supervisor and a family-supportive organisational culture differentially affected WHI of professional and non-professional workers, with a family-supportive supervisor being more beneficial to non-professionals and a family-supportive organisational culture being more beneficial to professional employees. Finally, the gap between professionals and non-professionals was also found to vary across countries for WHI but not for SWFB. It was significantly larger in the UK and in Sweden than in the other three countries. [ABSTRACT FROM AUTHOR]

Aims This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy ( MMT) clinics in China. The intervention effects on both service providers and clients are reported. Design The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. Settings Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. Participants A total of 41 providers and 179 clients were sampled from the six clinics. Measurements At baseline and three-, six-, and nine-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, MMT knowledge, perceived job-related stigma and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. Findings Significant intervention effects for providers were found in improved MMT knowledge, provider-client interaction and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared with the standard care group. Conclusions The MMT CARE intervention targeting providers in methadone maintenance clinics can improve providers' treatment knowledge and their interaction with clients. The intervention can also reduce clients' drug-using behavior through motivational interviewing sessions conducted by trained providers. [ABSTRACT FROM AUTHOR]

Objective: Although anorexia nervosa (AN) in males has recently gained attention, knowledge of its psychological and physiological outcomes is still scarce. We explore sex‐specific characteristics of long‐term remitted AN with respect to residual eating disorder (ED) psychopathology, body image, and endocrinology. Method: We recruited 33 patients with AN in remission for at least 18 months (24 women, 9 men) and 36 matched healthy controls (HCs). Eating disorder psychopathology and body image ideals were assessed via clinical interviews, questionnaires, and an interactive 3D body morphing tool. Plasma levels of leptin, free triiodothyronine, cortisol, and sex hormones were quantified. Univariate models controlled for age and weight were used to test for the effects of diagnosis and sex. Results: Both patient groups showed residual ED psychopathology but normal weight and hormone levels relative to HCs. Male remitted patients demonstrated significantly stronger muscularity‐focused body image ideals, evident in interviews, self‐reports, and behavioural data, than both female patients and HCs. Conclusions: Sex‐specific body image characteristics in patients with remitted AN point towards the need to adjust test instruments and diagnostic criteria to male‐specific psychopathology. In the future, sufficiently powered studies should evaluate the risk of men with AN developing muscle dysmorphia in the long term. Highlights: Sex‐specific residual symptoms have been identified in long‐term remitted anorexia nervosa (AN) patients, particularly regarding body image disturbance.The drive for muscularity (DMS) in male remitted patients suggest a possible risk of transition from male AN to muscle dysmorphic disorder.Sex‐specific criteria, especially muscle‐oriented behaviour, need to be included in the description of diagnoses and symptoms in male patients. [ABSTRACT FROM AUTHOR]

An active transport mode provides an opportunity for integrating physical activity into one's daily life through walking, cycling, and the use of public transportation. The purpose of this study was to compare urban adults with chronic conditions who used active and inactive transport modes and to find differences in their health outcomes. A cross‐sectional study was conducted from September 2019 to May 2020. Participants were urban adults who self‐reported being overweight or obese, or having a diagnosis of chronic disease. Anonymous structured self‐reported questionnaires were used for data collection, including the World Health Organization Quality‐of‐Life Scale, International Physical Activity Questionnaire Short‐Form, and the frequency of eight modes of transportation. According to differences between the frequency score of weekly active and inactive transportation, participants were categorized into inactive, balanced, and active transport modes. In total, 617 valid responses were obtained. Participants who engaged in an active transport mode were found to have significantly less sedentary time, and better comprehensive, social, and environmental aspects of quality of life than those with an inactive transport mode. Engaging in active transportation and avoiding inactive transportation are recommended for urban adults with chronic diseases. [ABSTRACT FROM AUTHOR]

Background: There is increasing worldwide interest in person‐centred care in haemodialysis and home haemodialysis (HHD). Intradialytic fluid management is a vital component of haemodialysis, and often a shared decision, yet patients' perspectives and experience of related decisions are largely unexplored. Objectives: To explore the perspectives of patients receiving home or incentre haemodialysis (IHD), in relation to intradialytic fluid management. Design: A multicentre cross‐sectional survey. Participants: Eight hundred and thirty‐nine patients receiving IHD and 99 patients receiving HHD, across six English renal units. Measurements: Self‐reported measures of understanding, experiences and control of fluid management, and willingness to achieve target weight. An objective test of patients' ability to relate common signs and symptoms to fluid overload or excessive ultrafiltration. Results: Patients receiving HHD had greater knowledge than those receiving IHD (66.1% vs. 42.3%, p < 0.001) about causes of common signs and symptoms which remained when controlling for age, education and years since beginning haemodialysis. Patients receiving HHD felt more in control of and had greater self‐reported adherence to fluid management (p < 0.01), yet knowledge gaps existed in both cohorts. Conclusions: Greater patient knowledge and its practice in HHD may contribute to improved fluid balance and outcomes. Whilst patient selection may contribute towards these differences, the training patients receive when opting for HHD and subsequent experience are likely to be key contributing factors. Integrating aspects of education on fluid management from HHD training programmes should be considered in IHD, and further targeted, robust education remains an unmet need. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of four different oral hygiene protocols involving adjunctive interdental devices in terms of plaque and bleeding scores in periodontitis‐affected patients. Material and methods: This was a randomized clinical trial with a 5‐week follow‐up, including previously treated periodontitis patients not undergoing any supportive care. Patients were randomly allocated to 4 groups: manual toothbrush (group TB); toothbrush plus dental floss (group TB/F); toothbrush plus interdental brushes (group TB/IDB) and toothbrush plus rubber interdental picks (group TB/RIDB). Oral hygiene instructions (OHI) were provided at baseline (T‐7) and at T0 (1‐week) then bi‐weekly (T14/T28). At T0, supragingival professional cleaning was delivered. Plaque and bleeding indexes were taken at all timepoints by a single calibrated examiner, blind to group allocation. Results: At T‐7, patients were comparable for age, body mass index (BMI) and all clinical parameters, exceptions for the Interdental Angulated Bleeding Index. At T28, significant reductions of plaque and gingival inflammation were noted in all groups (p < 0.001) and within the expected ranges. Intergroup comparisons identified that group TB/IDB and group TB/RIDB achieved lower levels of plaque and inflammation than group TB (p < 0.05). Group TB/IDB and group TB/RIDB showed lower levels of plaque and lower inflammation as measured by angulated bleeding index than group TB/RIDB (p < 0.05). Conclusion: Interdental brushes and rubber interdental picks were more efficient than toothbrushing alone and toothbrushing and floss in reducing plaque and gingival inflammation measured in a periodontitis‐affected population. [ABSTRACT FROM AUTHOR]

Background: After giving birth, women experience significant changes related to maternal self‐efficacy and social support and are at risk of experiencing postpartum anxiety and depression. Problem: No studies have focused on the relationship between parity and infant age and their impact on psychosocial outcomes, particularly in a Canadian context. Aim: To explore the relationship between parity and infant age on perceived maternal self‐efficacy, social support, postpartum anxiety, and postpartum depression. Methods: Women from three Canadian provinces within the first 6 months postpartum completed standardized online questionnaires. Multivariate analysis of covariance was used to examine the primary aim. Findings: A total of 561 women (56.5% primiparous, 55.1% infant 0‐3 months) participated. There were significant main effects for both parity (P <.001) and age of infant (P <.001), but no significant interaction (P =.463). Primiparous women had lower maternal self‐efficacy (P =.004) and higher postpartum anxiety (P =.000) than multiparous women. Women with younger infants had more perceived social support (P =.002). Women with older infants had higher levels of postpartum anxiety (P =.003) and depression (P =.000). Discussion: The transition that women experience, independent of parity, within the first six months is dynamic with women of older infants experiencing more postpartum mental health concerns and less perceived social support. Our findings emphasize that postnatal support should extend beyond the typical six‐week follow‐up period. Conclusions: Additional studies are warranted to determine ways to provide ongoing support throughout the first six months and beyond to improve maternal well‐being and address postpartum needs. [ABSTRACT FROM AUTHOR]

Ethnic and cultural diversity is an increasing reality in the US workplace. The current study highlights the importance of acknowledging the culturally heterogeneous nature of ethnic groups, and the need to focus on social identity characteristics such as cultural values when assessing group differences. We demonstrate that cultural values (i.e., individualism) contribute to employees' experiences of work-family conflict beyond the effects of ethnicity. Specifically, we introduce a model informed by social identity theory that explains why acculturation is related to work-family conflict. The model was tested with a sample of 309 employed Caucasian and Hispanic Americans. An empirical test of our model provides evidence that individualism mediates the relationship between language- and social-based acculturation and work-family conflict, even when controlling for ethnicity. Additionally, alternative models further reveal that the effects of acculturation and individualism contribute to work interfering with family. As an implication of the current study, we suggest that researchers and organizational managers should consider the cultural values of their diverse workforce when implementing policies that affect conflict between work and family. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: A substantial proportion of preschool children referred to speech and language therapy (SLT) services have social communication difficulties and/or autistic spectrum disorders (SC&/ASD) that are not identified until late childhood. These 'late' diagnosed children miss opportunities to benefit from earlier targeted interventions. Prior evidence from a follow‐up clinical sample showed that preschool performance on the Early Sociocognitive Battery (ESB) was a good predictor of children with social communication difficulties 7–8 years later. Aims: The aims were three‐fold: (1) to determine the impact of child/demographic factors on ESB performance in a community sample of young children; (2) to assess the ESB's concurrent validity and test–retest reliability; and (3) to use cut‐offs for 'low' ESB performance derived from the community sample data to evaluate in a clinical sample the predictiveness of the ESB at 2–4 years for outcomes at 9–11 years, including parent‐reported SC&/ASD diagnosis. Methods & Procedures: A community sample of 205 children aged 2–4 years was assessed on the ESB and a receptive vocabulary test. A subsample (n = 20) was retested on the ESB within 2 weeks. Parents completed a questionnaire providing background child/demographic information. The clinical sample from our previous study comprised 93 children assessed on the ESB at 2;6 to < 4;0 whose parents completed the Social Responsiveness Scale (SRS), our measure of social communication, when the children were 9–11 years. Cut‐offs for 'low' ESB performance derived from the community sample were used to determine the predictive validity of 'low' ESB scores for social communication outcomes and parent‐reported SC&/ASD diagnosis according to age of ESB assessment. Outcome & Results: Findings from the community sample confirmed the ESB as psychometrically robust, sensitive to age and language delay, and, in contrast to the receptive vocabulary measure, unaffected by bilingualism. While overall associations between ESB performance and later social communication difficulties in the clinical sample were particularly strong for the youngest age group (2;6 to < 3;0; r =.71, p <.001), 'low' ESB performance was equally predictive across age groups and overall identified 89% of children with 'late' SC&/ASD diagnoses (sensitivity), and 75% of those without (specificity). Conclusions & Implications: Results indicate that the ESB is a valid preschool assessment suitable for use with children from diverse language backgrounds. It identifies deficits in key sociocognitive skills and is predictive of social communication difficulties in school‐age children that had not been identified in preschool clinical assessment, supporting earlier targeted interventions for these children. [ABSTRACT FROM AUTHOR]

Abstract: Maternal eating behaviours such as cognitive restraint, uncontrolled, and emotional eating styles can have important implications for both maternal own weight, and the weight and eating behaviour of her children. Maternal eating style can affect her feeding interactions with her child, which in turn can influence their weight and eating behaviour. However, despite a body of research examining these relationships, research examining differences in maternal eating behaviour between ethnic groups is sparse with much of the research, particularly in the UK, conducted with White British samples. The aim of the current research was therefore to explore how maternal eating behaviour may differ between ethnic groups in the UK; 659 UK mothers with a child aged 5–11 years completed a self‐report questionnaire. Items included ethnicity, demographic data, and the 3‐factor eating questionnaire to measure maternal cognitive restraint, uncontrolled, and emotional eating. Mothers from Chinese backgrounds were significantly higher in cognitive restraint and lower in emotional and uncontrolled eating compared with all groups. Conversely, mothers from South Asian backgrounds were the highest in emotional and uncontrolled eating and lower in cognitive restraint than all other groups. Black mothers were also higher in uncontrolled eating compared with White British and Chinese mothers. Variations in maternal eating behaviours vary between ethnic groups. Understanding how cultural factors may influence these variations is important, as maternal eating behaviours can influence her own and her child's weight. Maternal eating behaviour may therefore be a contributor to higher levels of overweight among South Asian and Black children living in the UK. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To examine the association between the types of involvement in bullying and the time perspective among Japanese adolescents. Methods: A questionnaire was conducted among Japanese junior high school students at eight public schools that were located in two cities in Shizuoka Prefecture, Japan. Shirai's Experiential Time Perspective Scale was used, which comprises four subscales: goal‐directedness, hopefulness, self‐fulfillment, and acceptance of the past. An analysis of covariance was applied, with the time‐perspective subscales as the objective variable, type of involvement in bullying as a fixed factor, and grade, family structure, and economic status as the covariates. Results: The analysis sample included 2630 adolescents (valid response rate: 88.6%). The bullying rate of the boys was 10.8% and 4.1% for the girls, for the male victims it was 10.1% and 14.5% for the female victims, and for both the bully and the victim, it was 8.5% and 5.4%, respectively. The students who were not involved in bullying had the highest scores of hopefulness, self‐fulfillment, and acceptance of the past. For both sexes, bullying was significantly associated with hopefulness, self‐fulfillment, and acceptance of the past. Goal‐directedness was not associated with the type of involvement in bullying. Conclusions: The victims of bullying had low time perspectives of hopefulness, self‐fulfillment, and acceptance of the past. Providing support that increases hopefulness, self‐fulfillment, and acceptance of the past might help to prevent pessimistic decision‐making, such as that seen in cases of suicide. [ABSTRACT FROM AUTHOR]

Abstract: Background: The ability to generate words that follow certain constraints, or verbal fluency, is a sensitive indicator of neurocognitive impairment, and is impacted by a variety of variables. Aims: To investigate the effect of post‐stroke aphasia, elicitation category and linguistic variables on verbal fluency performance. Methods & Procedures: Twenty‐eight persons with aphasia (PWA) with a single left‐hemisphere lesion and 40 age‐matched neurotypical community‐dwelling adults were administered three verbal fluency tasks: two semantic (animals and actions) and one phonemic (the letters F, A and S). Data analysis included comparison of total scores, clusters and perseverations. Individual responses were coded for frequency of occurrence, age of acquisition and syllable length to investigate qualitative differences in word generation. Outcomes & Results: PWA performed worse than neurotypical participants across all verbal fluency tasks, and animal fluency scores were farthest from neurotypical performance. PWAs’ animal and action fluency were correlated with other language measures, while phonemic fluency was uncorrelated with language measures. While some PWAs showed dissociations between verbal fluency tasks, the dissociations did not pattern along with aphasia fluency. PWAs produced fewer clusters and responses with higher word frequency across all three verbal fluency tasks. Responses had earlier age of acquisition and shorter word length for animal and phonemic fluency, but not action fluency. Conclusions & Implications: Verbal fluency, particularly animal fluency, is sensitive to even mild aphasia. PWA produced lexically simpler responses than their neurotypical peers. This study identifies the relevance of qualitative analysis of verbal fluency responses. [ABSTRACT FROM AUTHOR]

Educational outcomes, such as knowledge, confidence in performance, ability in nursing practice, and satisfaction with learning methods in caring for children with croup, were compared between groups of students that received education through simulation combined with pre-education, simulation only, and pre-education only. In this quasi-experimental design, the educational intervention for the experimental group was the pre-education modality. Data from a convenience sample of 127 senior nursing students were drawn from three nursing schools in South Korea. There were significant differences in the mean scores of knowledge, confidence in performance, satisfaction with the learning method, and ability in nursing practice between the three groups. Pre-education with simulation significantly enhanced students' knowledge, confidence in performance, ability in nursing practice, and satisfaction with learning methods compared with pre-education or simulation alone. Simulation strategies should focus more on enhancing nursing students' learning outcomes. [ABSTRACT FROM AUTHOR]

Aim This cross-sectional study aims to analyse cortisol and dehydroepiandrosterone ( DHEA) levels in gingival crevicular fluid ( GCF) and saliva in generalized aggressive periodontitis ( GAP) and generalized chronic periodontitis ( GCP) patients, as well as in periodontally healthy individuals (C). Material and Methods A total of 92 patients (31 C, 34 GCP and 27 GAP) were included in the study. Clinical parameters including plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level; psychosocial measurements including Beck depression inventory and state-trait anxiety inventory; and hormone levels in GCF and saliva including cortisol and DHEA were evaluated. Results Gingival crevicular fluid cortisol and GCF/saliva DHEA values were significantly higher in the GAP group when compared to the other two groups ( p < 0.05). The lowest values were in the C group and the difference between the GCP and GAP groups was statistically significant ( p < 0.05). Salivary cortisol levels were comparable for the GAP and GCP groups ( p > 0.05), and the C group had the lowest values in comparison with the other two groups ( p < 0.05). Conclusions Within the limits of this study, salivary/ GCF cortisol and DHEA levels were suggested to be related with more severe and aggressive forms of periodontal disease. [ABSTRACT FROM AUTHOR]

ABSTRACT This study analyzed a cross-section of patients with severe chronic wounds and multiple comorbidities at an outpatient wound clinic, with regard to the cost-effectiveness and cost-benefit of negative pressure wound therapy (intervention) vs. no negative pressure wound therapy (control) at 1 and 2 years. Medicare reimbursement charges for wound care were used to calculate costs. Amputation charges were assessed using diagnosis-related groups. Cost-benefit analysis was based on ulcer-free months and cost-effectiveness on quality-adjusted life-years. Undiscounted costs, benefits, quality-adjusted life-years, undiscounted and discounted incremental net health benefits, and incremental cost-effectiveness ratios were calculated for unmatched and matched cohorts. There were 150 subjects in the intervention group and 154 controls before matching and 103 subjects in each of the matched cohorts. Time to heal for the intervention cohort was significantly shorter compared to the controls (270 vs. 635 days, p = 1.0 × 10−7, matched cohorts). The intervention cohort had higher benefits and quality-adjusted life-year gains compared to the control cohort at years 1 and 2; by year 2, the gains were 68-73% higher. In the unmatched cohorts, the incremental net health benefit was $9,933 per ulcer-free month at year 2 for the intervention; the incremental cost-effectiveness ratio was −825,271 per quality-adjusted life-year gained (undiscounted costs and benefits). For the matched cohorts, the incremental net health benefits was only $1,371 per ulcer-free month for the intervention, but the incremental cost-effectiveness ratio was $366,683 per quality-adjusted life-year gained for year 2 (discounted costs and benefits). In a patient population with severe chronic wounds and serious comorbidities, negative pressure wound therapy resulted in faster healing wounds and was more cost-effective with greater cost-benefits than not using negative pressure wound therapy. Regarding overall cost-effectiveness, the intervention was still expensive, but that is the reality amidst limited treatment options for such serious cases of chronic wounds. [ABSTRACT FROM AUTHOR]

Aim To investigate the clinical and microbiological effects of local disinfection with 0.5% sodium hypochlorite (NaOCl) with or without systemic antimicrobials (amoxicillin and metronidazole, AM) during basic periodontal therapy (BPT). Material and Methods In a randomized clinical trial (four groups), 110 chronic periodontitis patients received BPT plus local irrigation with saline (BPT + S), local disinfection with NaOCl (BPT + DIS), BPT + DIS + AM or BPT + S + AM. The outcome was analysed at baseline, 3, 6 and 12 months. Results There was no difference in clinical attachment level gain at 12 months between the four groups. BPT + DIS showed no additional improvement compared to BPT + S; BPT + DIS + AM showed fewer sites with probing pocket depth (PPD) ≥7 mm versus BPT + S only up to 6 months ( p = 0.037). In factorial analyses, additional clinical reduction for PPD ( p = 0.023) and number of sites with PPD ≥5 ( p = 0.007), ≥6 ( p = 0.002) and ≥7 mm ( p < 0.001) were found when AM was added to BPT, but not when DIS was applied. In all groups, a comparable decrease in targeted bacteria was found. AM caused adverse events in 22% of the patients. Conclusion Local disinfection with NaOCl, also in combination with AM, showed, after 1-year follow-up, no additional clinical and microbiological effects compared to BPT alone. [ABSTRACT FROM AUTHOR]

Objectives To compare the use of sonic powered or manual toothbrush in patients with intellectual disability ( ID) in terms of plaque (PlI) and gingival ( GI) indices and adverse effects. Material and Methods Subjects with ID were recruited for this cluster-randomized, single blinded (examiner), 6-month clinical trial, comparing powered versus manual toothbrushing. Outcome variables included PlI and GI, evaluated at baseline and 3 months after supervised toothbrushing and after 3 additional months of unsupervised used. Clinical outcome variables were analysed by repeated measures ANCOVA considering time and group as factors and respective baseline values as covariates (generalized linear model). Results Sixty-four patients (34 male, mean age 34.5) in six clusters were included in the study. No statistically significant effect of toothbrushing group was observed for PlI or GI. A significant effect of time was identified ( p < 0.001) with mean reductions ranging 0.44-0.45 for PlI and 0.30-0.36 for GI from baseline to 3-6 months. No relevant adverse effect or technical problems were observed. Conclusion The tested sonic powered toothbrush was as effective and safe as the manual toothbrush. The use of powered or manual toothbrushes, together with fluoride toothpaste, may improve plaque and gingivitis levels, in patients with mild to limit ID. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the family functioning of Spanish parents of patients with an eating disorder (ED) with that of carers of patients with substance-related disorders (SRDs) and families of healthy controls (HC). This cross-sectional study included 48 mothers and 45 fathers of 48 adolescent patients with an ED, 47 mothers and 37 fathers of 47 patients with an SRD and 66 mothers and 50 fathers of 68 HCs. Families of ED patients reported lower levels of criticism, symptom accommodation and negative caregiving experience than families of SRD patients. However, relatives of both ED and SRD patients reported similar levels of quality of life related to their mental health. Furthermore, families of HCs generally exhibited better scores on all scales assessing their caregiving experiences. Regarding gender differences, there was a tendency in mothers, primarily those from the ED group, to report more adverse experiences as caregivers compared with fathers. Symptoms characteristic to each disorder may be associated with differential patterns of family functioning and may require specifically tailored family interventions. Early family intervention in adolescence is crucial, as relatives' quality of life does not seem to have been badly affected at this point in the course of the illness. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Dialectical behaviour therapy (DBT)-informed skills training for borderline personality disorder (BPD) aims at the development of specific emotion regulation skills in patients, particularly with regard to the regulation of problematic anger. While the effects of dialectical behaviour skills training have been shown, their processes of change are rarely examined. Neacsiu, Rizvi and Linehan (2010) found that patient's self-reported use of emotion regulation skills was a mediator of therapeutic change in these treatments; however, they found no effect for problematic anger. From an integrative perspective on anger (Pascual-Leone & Greenberg, 2007; Pascual-Leone & Paivio, 2013), there are several forms of anger, varying in their degree of therapeutic productivity. The present add-on randomized controlled trial included n = 41 patients with BPD ( n = 21 DBT-informed skills training versus n = 20 treatment as usual). The first study examined the outcome of the DBT-informed skills training encompassing basic components of training in mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation. Results showed that symptom reduction was significantly greater in the DBT-informed skills training, compared with the treatment as usual. The second study used process assessment, for which all patient completers underwent a 50-min-long psychological interview both early and late in treatment, which was rated using the Classification of Affective Meaning States. DBT-informed skills training produced increased levels of primary 'assertive' anger, as compared with the treatment as usual, whereas no effect was found for 'rejecting' secondary anger. Most importantly, we showed that changes in assertive anger mediated the reported symptom reduction, in particular in patient's social roles. We discuss these results in the context of underlying mechanisms of change in DBT skills group treatments, in particular towards developing more productive forms of anger in this patient population. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message A 20-session dialectical behaviour therapy (DBT)-informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role., Increases in assertive anger mediate the effects of DBT-informed skills training, whereas rejecting anger remains unchanged over the course of treatment., Short-term objectives for intervention might involve the specific increase of assertive anger in BPD, by using DBT-informed skills training; long-term objectives for intervention might involve a specific decrease of rejecting anger in BPD. [ABSTRACT FROM AUTHOR]

Background An increased plasma lipopolysaccharide ( LPS) concentration may favour metabolic disorders such as insulin resistance. The meal composition influences plasma LPS concentrations. The present study aimed to investigate the effect of the acute consumption of a high-fat meal (49% of energy from fat) containing conventional or high-oleic peanuts on post-prandial LPS concentrations and its relationship with lipaemia and insulinaemia in overweight and obese men. Methods The test meal consisted of a shake containing conventional peanuts ( CVP; n = 21), high-oleic peanuts ( HOP; n = 23) or a control biscuit ( CT; n = 21). Blood samples were collected in the fasting state and 1, 2 and 3 h post-prandially. LPS, insulin, lipids and glucose concentrations were assessed. Results LPS concentrations were lower in CVP [mean (SE) 0.7 (0.5) EU mL−1] and HOP [1.0 (0.9) EU mL−1] groups compared to CT [1.6 (1.2) EU mL−1] at 3 h post-prandially. Triacylglycerol and insulin concentrations increased in all groups. Triacylglycerol started to increase only after 2 h in the CVP and HOP groups. LPS correlated positively with triacylglycerol. Insulin returned to basal concentrations at 3 h only in the CVP and HOP groups. Conclusions The acute consumption of peanuts delayed the increase in serum triacylglycerol and favoured the quicker return of insulin to basal concentrations, especially in the CVP group. Our results suggest that the consumption of conventional or high-oleic peanuts may help to reduce the risk of endotoxaemia and metabolic disorders. [ABSTRACT FROM AUTHOR]

Background Children with specific language impairment (SLI) often experience word-learning difficulties, which are suggested to originate in the early stage of word learning: fast mapping. Some previous research indicates significantly poorer fast mapping capabilities in children with SLI compared with typically developing (TD) counterparts, with a range of methodological factors impacting on the consistency of this finding. Research has explored key issues that might underlie fast mapping difficulties in children with SLI, with strong theoretical support but little empirical evidence for the role of phonological short-term memory (STM). Additionally, further research is required to explore the influence of receptive vocabulary on fast mapping capabilities. Understanding the factors associated with fast mapping difficulties that are experienced by children with SLI may lead to greater theoretically driven word-learning intervention. Aims To investigate whether children with SLI demonstrate significant difficulties with fast mapping, and to explore the related factors. It was hypothesized that children with SLI would score significantly lower on a fast mapping production task compared with TD children, and that phonological STM and receptive vocabulary would significantly predict fast mapping production scores in both groups of children. Methods & Procedures Twenty-three children with SLI (mean = 64.39 months, SD = 4.10 months) and 26 TD children (mean = 65.92 months, SD = 2.98) were recruited from specialist language and mainstream schools. All participants took part in a unique, interactive fast-mapping task whereby nine novel objects with non-word labels were presented and production accuracy was assessed. A non-word repetition test and the Peabody Picture Vocabulary Test-Fourth Edition (PPVT-IV) were also administered as measures of phonological STM capacity and receptive vocabulary, respectively. Outcomes & Results Results of the fast-mapping task indicated that children with SLI had significantly poorer fast mapping production scores than TD children. Scores from the non-word repetition task were also significantly lower for the SLI group, revealing reduced phonological STM capacity. Phonological STM capacity and receptive vocabulary emerged as significant predictors of fast mapping performance when the group data were combined in a multiple regression analysis. Conclusions & Implications These results suggest that the word-learning difficulties experienced by children with SLI may originate at the fast mapping stage, and that phonological STM and receptive vocabulary significantly predict fast mapping ability. These findings contribute to the theoretical understanding of word-learning difficulties in children with SLI and may inform lexical learning intervention. [ABSTRACT FROM AUTHOR]

Background: A developmental improvement of symptoms in attention-deficit/hyperactivity disorder (ADHD) is frequently reported, but the underlying neurobiological substrate has not been identified. The aim of this study was to determine whether white matter microstructure is related to developmental improvement of ADHD symptoms. Methods: A cross-sectional magnetic resonance imaging (MRI) analysis was embedded in a prospective follow-up of an adolescent cohort of ADHD and control subjects (NeuroIMAGE). Mean age at baseline was 11.9 years, mean interval of follow-up was 5.9 years. About 75.3% of the original cohort was retained successfully. Data of 101 participants with ADHD combined type at baseline and 40 healthy controls were analysed. ADHD symptoms were measured with semistructured, investigator-based interviews and Conners' questionnaires, on the basis of DSM-IV criteria. Fractional anisotropy (FA) and mean diffusivity (MD) indices of white matter microstructure were measured using whole brain diffusion tensor imaging at follow-up only. In a dimensional analysis FA and MD were related to change in ADHD symptoms. To link this analysis to DSM-IV diagnoses, a post hoc categorical group analysis was conducted comparing participants with persistent (n = 59) versus remittent (n = 42) ADHD and controls. Results: Over time, participants with ADHD showed improvement mainly in hyperactive/impulsive symptoms. This improvement was associated with lower FA and higher MD values in the left corticospinal tract at follow-up. Findings of the dimensional and the categorical analysis strongly converged. Changes in inattentive symptoms over time were minimal and not related to white matter microstructure. Conclusions: The corticospinal tract is important in the control of voluntary movements, suggesting the importance of the motor system in the persistence of hyperactive/impulsive symptoms. [ABSTRACT FROM AUTHOR]

Anaemia affects 46% of preschool‐aged children in Nepal. A cluster‐randomised study was conducted in rural Nepal to test whether providing micronutrient powders (MNP) in addition to enhanced homestead food production (EHFP) programme, consisting of home gardens, poultry and nutrition education, could lead to a higher reduction in anaemia compared with providing only EHFP. This sub‐study enrolled 335 children aged 6–9 months into one of three groups: (1) EHFP + MNP; (2) EHFP; or (3) control. The EHFP + MNP group received 60 sachets of MNP for flexible consumption at the start and 6 months later for a total supplementation period of 11 months. The MNP contained 15 micronutrients including iron (10 mg encapsulated ferrous fumarate). Haemoglobin and anthropometry were measured at baseline and post‐MNP supplementation. Mean ± SE haemoglobin concentration increased significantly in all groups, with a slightly higher but non‐significant increase in the EHFP + MNP and EHFP compared with control (difference‐in‐differences: 4.1 g L−1 for EHFP + MNP vs. control; 3.6 g L−1 for EHFP vs. control; 0.5 g L−1 for EHFP + MNP vs. EHFP). Anaemia decreased at a slightly higher magnitude in the EHFP + MNP [51.5 percentage points (PP)] than the EHFP (48.6 PP) and control (39.6 PP), with adjusted odds ratios (95% CI) at post‐supplementation of 0.52 (0.25–1.12) for EHFP + MNP and 0.69 (0.35–1.36) for EHFP, compared with control. There was no impact on child growth. Combining EHFP and MNP programmes yielded a marginally significant reduction in anaemia among children. [ABSTRACT FROM AUTHOR]

Context The fostering of diagnostic competence is an important goal of medical education. Worked-example cases with integrated errors represent a promising method of doing so. Objectives This study investigates whether the provision of self-explanation prompts and adaptable feedback fosters diagnostic competence in a computer-supported learning environment based on worked-example cases with integrated errors. Methods A total of 103 medical students participated in the study. After a test of prior diagnostic competence, learners studied worked examples with integrated errors for cases of heart failure of different causes in a computer-based learning environment. The worked examples started with the description of a clinical situation in which a student apprentice diagnoses a patient and commits errors in the conclusions he draws from the information presented. Participants were randomly assigned to four learning conditions that varied in two factors: self-explanation prompts and adaptable feedback. In the self-explanation prompts condition, students were prompted to reflect on the errors. Independently of the condition, the student apprentice in the worked example receives feedback on his diagnosis. In the adaptable feedback condition, students were able to adjust the level of elaboration of the feedback. A post-test of diagnostic competence was administered. Results Adaptable feedback had a positive effect on important aspects of diagnostic competence (strategic knowledge: F(1,93) = 4.15, p < 0.05, partial η2 = 0.04; decision-oriented practical knowledge: F(1,93) = 4.41, p < 0.05, partial η2 = 0.05), whereas self-explanation prompts did not further improve the effectiveness of the learning environment. Conclusions In the use of worked examples with integrated errors, the provision of adaptable feedback whereby learners have control over the amount of feedback they receive seems to be advantageous to the development of important decision-oriented aspects of diagnostic competence. Additional help to stimulate reflection about the error by self-explanation prompts does not seem to be critical. [ABSTRACT FROM AUTHOR]

Edentulism can negatively affect both masticatory performance and dietary intake by altering the patterns of biomechanical stress and strain, which in turn modifies the morphology of the different regions of the mandible. The morphological changes in the mandible caused by these stressors are unknown when comparing mandibles across varying dentition states. This study investigated differences in the morphology of human mandibles across various states of the dentition. In total, 498 mandibles of individuals between 20 and 80 yr of age at death were sourced from the Raymond A. Dart Collection of Human Skeletons. These included fully dentate ( n = 95), partially edentulous ( n = 333), and fully edentulous ( n = 70) mandibles. Twelve linear anthropometric measurements of the mandible were derived from digitized landmarks located on its external surface. Data analysis included geometric morphometrics and multivariate analyses. Compared with dentate and partially edentulous mandibles, fully edentulous mandibles showed a shorter alveolar height (−0.4 mm), a shorter mandibular body length (−4 mm), a larger gonial angle (+4°), a more obtuse mental angle (+4.7°), a broader bicondylar width (+3.8 mm), and a taller ramus height (+1.6 mm). Thus, edentulous states are associated with an altered mandibular morphology, which may result from a reduction in jaw function. [ABSTRACT FROM AUTHOR]

The article presents the randomized controlled study that explores on the effectiveness of development plan in improving the participation of patients in mental hospitals in Central Norway. The topics discussed include attributing factors of the failure of some development proposals, the advantages of user participation, and its implications on the experiences of patients.

Aims To examine the effectiveness of a personality-targeted intervention program (Adventure trial) delivered by trained teachers to high-risk (HR) high-school students on reducing marijuana use and frequency of use. Design A cluster-randomized controlled trial. Setting Secondary schools in London, UK. Participants Twenty-one secondary schools were randomized to intervention ( n = 12) or control ( n = 9) conditions, encompassing a total of 1038 HR students in the ninth grade [mean (standard deviation) age = 13.7 (0.33) years]. Interventions Brief personality-targeted interventions to students with one of four HR profiles: anxiety sensitivity, hopelessness, impulsivity and sensation-seeking. Measurements Primary outcome: marijuana use. Secondary outcome: frequency of use. Assessed using the Reckless Behaviour Questionnaire at intervals of 6 months for 2 years. Personality risk was measured with the Substance Use Risk Profile Scale. Findings Logistic regression analysis revealed significant intervention effects on cannabis use rates at the 6-month follow-up in the intent-to-treat sample [odds ratio (OR) = 0.67, P = 0.05, 95% confidence interval (CI) = 0.45-1.0] and significant reductions in frequency of use at 12- and 18-month follow-up (β = -0.14, P ≤ 0.05, 95% CI = -0.6 to -0.01; β = -0.12, P ≤ 0.05, 95% CI = -0.54 to 0.0), but this was not supported in two-part latent growth models. Subgroup analyses (both logistic and two-part models) reveal that the sensation-seeking intervention delayed the onset of cannabis use among sensation seekers (OR = 0.25, β = -0.833, standard error = 0.342, P = 0.015). Conclusions Personality-targeted interventions can be delivered effectively by trained school staff to delay marijuana use onset among a subset of high-risk teenagers: sensation-seekers. [ABSTRACT FROM AUTHOR]

Aims Ecological Momentary Assessment (EMA) captures real-time reports in subjects' natural environments. This experiment manipulated EMA frequency to estimate effects on abstinence and peri-cessation subjective experiences. Design In this randomized trial, subjects had an equal chance of being assigned to low-frequency (once) or high-frequency (six times) daily EMA for 4 weeks (1 week pre- and 3 weeks post-cessation). Participants completed six office visits over 5 weeks and 6- and 12-week follow-up telephone interviews. Setting Community participants were recruited from central New Jersey, USA. Participants One hundred and ten adult daily smokers seeking to quit smoking were included in intent-to-treat analyses of tobacco abstinence; 94 were available for secondary analyses of peri-cessation subjective ratings. Measurements Primary outcomes were cessation (abstaining at least 24 hours within 2 weeks of attempting to quit) and prolonged abstinence (no relapse between weeks 2 and 12 post-quit). Secondary outcomes were mean levels and growth in ratings of cigarette craving, affect and quitting motivation and self-efficacy. Findings EMA frequency was unrelated to cessation (odds ratio = 1.367, 95% confidence interval = 0.603-3.098) or prolonged abstinence (odds ratio = 1.040, 95% confidence interval = 0.453-2.388) in intent-to-treat analyses. High-frequency EMA was associated with lower craving (B = -0.544, standard error (SE) = 0.183, P = 0.004, anxiety ( B = -0.424, SE = 0.170, P = 0.015), anger (B = -0.474, SE = 0.139, P = 0.001), hunger (B = -0.388, SE = 0.170, P = 0.025) and positive affect (B = -0.430, SE = 0.196, P = 0.03). Conclusions In smokers trying to quit, more frequent ecological momentary assessment self-monitoring results in lower craving, anxiety, anger, hunger and positive affect. It is not clear whether this translates into higher rates of smoking abstinence. [ABSTRACT FROM AUTHOR]

Background Attention deficit hyperactivity disorder ( ADHD) is theorized to have temperamental precursors early in life. These are difficult to identify because many core features of ADHD, such as breakdowns in executive function and self-control, involve psychological and neural systems that are too immature to reliably show dysfunction in early life. ADHD also involves emotional dysregulation, and these temperamental features appear earlier as well. Here, we report a first attempt to utilize indices of emotional regulation to identify ADHD-related liability in infancy. Methods Fifty women were recruited in the 2nd trimester of pregnancy, with overselection for high parental ADHD symptoms. Measures of maternal body mass index, nutrition, substance use, stress, and mood were examined during pregnancy as potential confounds. Offspring were evaluated at 6 months of age using LABTAB procedures designed to elicit fear, anger, and regulatory behavior. Mothers completed the Infant Behavior Questionnaire about their child's temperament. Results After control for associated covariates, including maternal depression and prenatal stress, family history of ADHD was associated with measures of anger/irritability, including infant negative vocalizations during the arm restraint task ( p = .004), and maternal ratings of infant distress to limitations ( p = .036). In the regulation domain, familial ADHD was associated with less parent-oriented attention seeking during the still face procedure ( p < .001), but this was not echoed in the maternal ratings of recovery from distress. Conclusions Affective response at 6 months of age may identify infants with familial history of ADHD, providing an early indicator of ADHD liability. These preliminary results provide a foundation for further studies and will be amplified by enlarging this cohort and following participants longitudinally to evaluate ADHD outcomes. [ABSTRACT FROM AUTHOR]

Background Growing attention has been paid to the possibility of supporting early numeracy in at-risk kindergartners. Furthermore, it is assumed that language proficiency is an important prerequisite in early maths skills. Aims To examine whether remedial early numeracy education in kindergarten, which has been proven to be effective in general, is also beneficial for children with a language deficiency. Methods & Procedures Based on intensive selection, four different conditions were included: two groups received remedial education, one consisting of children being language proficient ( N = 86) and one of children with a language deficiency ( N = 26), and two groups followed the regular curriculum, one consisting of children being language proficient ( N = 51) and one of children with a language deficiency ( N = 24). Remedial education was for 1.5 school years (90 sessions, 30 min per session, twice per week), following the programme 'The Road to Mathematics'. During this period, the children receiving remedial education did not attend the regular maths lessons in the classroom, which were offered for at least 1 h per week. Effects were assessed for early numeracy and mathematical skills (operationalized as basic calculation fluency) in kindergarten and first grade. Outcomes & Results Three analyses of covariance (ANCOVAs) revealed that, when accounting for achievement at pre-test, children with a language deficiency who received remedial numeracy education performed better on early numeracy skills in kindergarten and first grade than kindergartners with a language deficiency that followed the regular curriculum. Furthermore, they were able to catch up with their language proficient peers in early numeracy. However, children with a language deficiency who received remedial numeracy education did not differ from children who followed the regular curriculum on mathematical skills, suggesting that benefits for numeracy did not generalize to more advanced skills of addition and subtraction. Conclusions & Implications Since, in general, it can be concluded that early numeracy education is indeed effective for kindergartners with a language deficiency, this study finds evidence that intensive support is desirable for children with delayed or impaired language development. [ABSTRACT FROM AUTHOR]

The present study aims to understand the mental health status of an understudied group of migrant children - children of migrant workers in China. A total of 1,466 children from Beijing participated in the study that compared migrant children (n = 1,019) to their local peers (n = 447) in public and private school settings. Results showed that overall, migrant children reported more internalizing and externalizing mental health problems and lower life satisfaction than local peers. However, public school attendance served as a protective factor for migrant children's mental health. The mental health status of migrant children attending public schools, including externalizing problems as well as friend and school satisfaction, was not different from local children. In addition, our data indicates that the protective effect of public school attendance for migrant children may be even more salient among girls than boys, and for younger children than older children. [ABSTRACT FROM AUTHOR]

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Recent research has suggested that simply providing each child with a computer does not lead to an improvement in learning. Given that dozens of countries across the world are purchasing computers for their students, we ask which elements are necessary to improve learning when introducing digital resources into the classroom. Understood the orchestration as the coordination of conventional and digital resources, we examine whether effective resource orchestration improves student learning. To do so, an 8-month study was undertaken across 17 schools in Uruguay, involving 544 fourth grade students. A treatment group worked under an orchestrated strategy, while a control group followed the national strategy, which includes the One Laptop per Child Computer ( XO). Our study confirmed that the national strategy alone is capable of producing significant progress in student learning. However, we also found that the orchestration produces a statistically significant improvement in the results when compared to the control group. The main finding indicates that when teachers have an orchestrated strategy to integrate digital and non-digital resources, student learning is enhanced in relation to the curricular objectives. Finally, we discovered that learning is improved in the treatment group when there is systematic use of resources, and when the school's infrastructure facilitates the use of the technology. [ABSTRACT FROM AUTHOR]

The objective of current study is to assess the relationship between characteristics of patients with acute ischemic stroke and clinical recurrences to identify predictors for the prognosis by modeling and simulation. Primary endpoint was clinical recurrence of ischemic stroke, and secondary endpoint was occurrence of any of the following clinical recurrence of ischemic stroke, transient ischemic attack, acute coronary syndrome, or vascular deaths. Time to event models were developed by NONMEM® using prospectively collected clinical data from 270 patients over 5 years, where 7.0% and 9.3% of them experienced lesion recurrence on MRI at 1 month (LR1M) and clinical recurrence, respectively. Exponential models best described the data. LR1M and diabetes mellitus history were significant predictors for primary endpoint. Times to recurrence for patients with LRIM (+) and diabetes mellitus (+) were predicted to be 0.095 and 0.317 of those for patients with LRIM (−) and diabetes mellitus (−), respectively. LR1M was only predictor for secondary endpoint with predicted time to recurrence in patients with LR1M (+) compared to 0.141 of LR1M (−). Quantitative prediction of clinical recurrence using MRI could improve personalized therapy by identifying patients at risk of recurrence, and could enable efficient clinical trials by stratifying the patients. [ABSTRACT FROM AUTHOR]

Background American evidence suggests women are not well informed about the optimal duration of pregnancy or the earliest time for safe birth. Similar evidence does not exist in Australia. Aims To explore pregnant women's beliefs about the duration of pregnancy and the earliest time for safe birth, and to compare the results with US data. Methods A cross-sectional survey of pregnant women attending antenatal clinics at four public hospitals in Sydney, Australia, included information on maternal and pregnancy characteristics, and two questions exploring women's beliefs about the duration of pregnancy, and the earliest time for safe birth. Responses were grouped as: late preterm (34-36 weeks), early term (37-38 weeks) and full term (39-40 weeks). Results Of the 784 surveyed women, 52% chose 39-40 weeks as the duration of a full-term pregnancy, while for the earliest time for safe birth, 10% chose 39-40 weeks and 57% chose 37-38 weeks. Some maternal characteristics were associated with women's beliefs, including having a medical and/or pregnancy complication, country of birth, level of education, employment status and attending a tertiary hospital. The associations were different for each question. In comparison with US studies, Australian women were more likely to choose later gestations for both the duration of pregnancy and the earliest time for safe birth. Conclusions A significant proportion of women believe that full-term pregnancy and earliest time for safe birth occur before 39 weeks, suggesting opportunities for better communication about the benefits and risks of birthing at different gestations. [ABSTRACT FROM AUTHOR]

Ninety-five dental care patients participated in a quasi-experiment in which they were interviewed twice about dental visits they had made during the past ten years. Objective truth was established by analysing their dental records. The main purpose of the study was to investigate to what extent context-specific cues could facilitate particularization (i.e., recollection of events and details) of repeated and similar events. A mixed design was employed and the effects of three types of cues were explored: two types of context-specific cues vs. cues commonly used in police practise when interviewing plaintiffs. In line with our hypothesis, context-specific cues tended to be more effective for recollection of individual events than the comparison cues. In addition, context-specific cues generated more details than the comparison cues and the difference was marginally significant. Rehearsal of the memories by telling them to others was associated with an increased number of recollected events and details. The results are discussed from a legal psychology perspective with focus on recollection of repeated abuse. [ABSTRACT FROM AUTHOR]

Objectives Viral load ( VL) monitoring is recommended, but seldom performed, in resource-constrained countries. RV288 is a US President's Emergency Plan for AIDS Relief ( PEPFAR) basic programme evaluation to determine the proportion of patients on treatment who are virologically suppressed and to identify predictors of virological suppression and recovery of CD4 cell count. Analyses from Uganda are presented here. Methods In this cross-sectional, observational study, patients on first-line antiretroviral therapy ( ART) (efavirenz or nevirapine + zidovudine/lamivudine) from Kayunga District Hospital and Kagulamira Health Center were randomly selected for a study visit that included determination of viral load ( HIV-1 RNA), CD4 cell count and clinical chemistry tests. Subjects were recruited by time on treatment: 6-12, 13-24 or > 24 months. Logistic regression modelling identified predictors of virological suppression. Linear regression modelling identified predictors of CD4 cell count recovery on ART. Results We found that 85.2% of 325 subjects were virologically suppressed (viral load < 47 HIV-1 RNA copies/ml). There was no difference in the proportion of virologically suppressed subjects by time on treatment, yet CD4 counts were higher in each successive stratum. Women had higher median CD4 counts than men overall (406 vs. 294 cells/μL, respectively; P < 0.0001) and in each time-on-treatment stratum. In a multivariate logistic regression model, predictors of virological suppression included efavirenz use [odds ratio ( OR) 0.47; 95% confidence interval ( CI) 0.22-1.02; P = 0.057], lower cost of clinic visits ( OR 0.815; 95% CI 0.66-1.00; P = 0.05), improvement in CD4 percentage ( OR 1.06; 95% CI 1.014-1.107; P = 0.009), and care at Kayunga vs. Kangulamira ( OR 0.47; 95% CI 0.23-0.92; P = 0.035). In a multivariate linear regression model of covariates associated with CD4 count recovery, time on highly active antiretroviral therapy ( ART) ( P < 0.0001), patient satisfaction with care ( P = 0.038), improvements in total lymphocyte count ( P < 0.0001) and haemoglobin concentration ( P = 0.05) were positively associated, whereas age at start of ART ( P = 0.0045) was negatively associated with this outcome. Conclusions High virological suppression rates are achievable on first-line ART in Uganda. The odds of virological suppression were positively associated with efavirenz use and improvements in CD4 cell percentage and total lymphocyte count and negatively associated with the cost of travel to the clinic. CD4 cell reconstitution was positively associated with CD4 count at study visit, time on ART, satisfaction with care at clinic, haemoglobin concentration and total lymphocyte count and negatively associated with age. [ABSTRACT FROM AUTHOR]