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Background: Virtual reality (VR) offers much potential for learning, but it challenges learners' orientation. Objectives: This paper investigates whether it is possible to use light or movement cues to facilitate orientation in a search task in a desktop‐VR environment so that participants can better attend to the learning content presented simultaneously. Methods: In two pre‐registered online experiments, we investigated the effects of cueing (light and movement) on search time, learning, and several evaluation variables. Participants were asked to find tools in a virtual workshop, while information about the respective tool was narrated. Experiment 1 (N = 60) used a within‐subject design, that is, the objects were alternately highlighted by light, movement or not. For Experiment 2 (N = 159) the narration was substantially shortened, and a between‐subject design was used. Cognitive load and presence were measured additionally. Results and conclusions: In Experiment 1, only the movement cue decreased search time, indicating automatic guidance of learners' attention. There was no effect of cueing on learning, which may be due to the average search time being substantially shorter than the narration, leaving sufficient time to attend to the narration exclusively. In Experiment 2 search times were significantly faster for both cueing methods, but only the light cue resulted in better learning outcomes, which could be explained by the slightly lower presence in the movement cue condition. Implications: Results imply that it is important to develop cues that automatically guide attention without reducing presence. Lay Description: What is already known about this topic: Virtual reality (VR) offers a lot of opportunities for the integration of educational scenarios.VR is challenging for learners with regard to orientation in a 360° environment.Regarding learning outcomes, research on the effects of cues to highlight important content in a 360° environment is still rare.Presence, defined as the feeling of being there in a VR environment, is an important prerequisite for learning in VR. What this paper adds: The influence of light and movement cues on search times and learning outcomes in a desktop‐VR environment was tested.Movement cues can reliably reduce search times (indicating successful orientation), whereas light cues only reduced search times in predictable scenarios.In a predictable scenario, light cues enhanced learning outcomes compared with movement cues.Movement cues reduced presence, which is one potential reason why movement cues did not improve learning. Implications for practice and/or policy: Using light cues might assist orientation and enhance overall performance in predictable scenarios (i.e., when learners know what kind of cue to expect).In an unpredictable setting with variable cues, light cues did not facilitate orientation, whereas movement cues did.However, movement cues reduced presence, which may have negatively affected learning outcomes. It is important to develop cueing methods that also work in more unpredictable settings, but that do not reduce presence. [ABSTRACT FROM AUTHOR]

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

Background: Effective learning in computer programming courses has been a constant challenge for university teachers and has become a relevant competence for current professionals. The literature on gamification in learning presents mixed results, mainly due to problems in instructional design and inconsistency in gamification. Studies with positive empirical results on computer programming formative activities and showing under what conditions gamification is effective still need to be included. Objectives: This study aimed to quantify the effects of gamification techniques in software tools that support computer programming learning applied to data‐structures university students. The study focused on determining whether there are differences in learning when using gamification techniques in online exercising formative activities. The effects of gamification on learning objectives with diverse complexity are studied. Methods: The study was conducted on computer engineering university students following a pretest‐intervention‐posttest design. They were divided into control and experimental groups, where both used a bank of exercises in Moodle to support learning. The experimental group considered gamification techniques, including points, leaderboards, and badges. Results and Conclusions: Gamification techniques significantly outperformed in learning gains in exercising activities without gamification. Regarding learning complexity, increasing taxonomic complexity did not negatively affect gamification learning effects. Lay Description: What is currently known about the subject matter?: Gamification has been explored as a strategy to enhance learning motivation in various educational contexts, including computer programmingLiterature shows mixed quantitative results on learning improvements under gamification.Few studies cover formative exercises, deal with computer programming tasks, or use a LMS like Moodle.Lack of literature exploring the conditions for effective gamification use, and involving learning objective complexity. What does this paper add to the existing body of research?: Quantifies the impact of gamification techniques on learning outcomes, specifically focusing on computer‐programming in university.Provides empirical evidence on gamification significantly improving learning gains compared to non‐gamified data‐structures exercisesGamification is effective in tasks of diverse levels of taxonomic complexity, with consistent effectiveness regardless of learning difficulty. Implications of study findings for practitioners: Gamification techniques, can be used in higher education to enhance student engagement and learning outcomes in computer programmingThe gamification information (e.g. points and ranking) do not require an automatic update, can be processed manually and published daily.It is effective to use gamification for learning tasks of medium‐high difficulty in Moodle on computer programming topics.It is key a thoughtful instructional design when applying gamification, ensuring alignment with learning objectives and task complexity. [ABSTRACT FROM AUTHOR]

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

Background Study: The effects of the flipped classroom (FC) on students' academic performance remain ambiguous, and the use of pre‐class videos may be one of the main factors hindering students' progress. A software package called GeoGebra has been proposed as a substitute for pre‐class videos to aid students' learning. Objective: This study investigates the effect of the FC using GeoGebra (FCG) on mathematical performance and memory among senior secondary students. Methods: One hundred and sixty students of a senior high school in China were selected. A quasi‐experimental design was implemented in which the classes were split into the intervention group (FCG), control group A (FCV) and control group B (TL) by random assignment. Pretest, Post‐test 1 and Post‐test 2 were introduced. Results and Conclusion: The results indicate that both the FCG and the FC with pre‐class videos (FCV) were more effective than traditional lectures in enhancing students' academic test scores, and that the effect of the FCG was comparable to its video counterpart, F(2, 136) = 3.752, ρ = 0.026, η2 = 0.052. Although their effects were similar, the qualitative results revealed some hidden benefits associated with the replacement of pre‐class video with GeoGebra. Furthermore, although they were equally effective in promoting students' performance in the short‐term, the long‐term effects on academic performance of both forms of FC were non‐significant when compared with traditional lectures. Lay Description: What is already known about this topic: Flipped classroom is an effective strategy in teaching mathematics.Among those challenges, video may be one of the main factors hindering the effect of flipped classroom. What this paper adds: GeoGebra could be an effective alternative to video.Effect between the flipped classroom using GeoGebra and the flipped classroom using video were similar.Both the flipped classroom with GeoGebra and the flipped classroom with videos were more effective than traditional lectures. Implications for practice and/or policy: Students' short‐term performance could be enhanced by visualisation provided by flipped classroom.To enhance students' long‐term performance, an appropriate amount of homework is suggested. [ABSTRACT FROM AUTHOR]

Background: Morphological awareness (MA) is the awareness and ability to manipulate morphemes, the smallest units of meaning in a language. It is identified as a strong cognitive precursor of word reading and reading comprehension. The current MA instructions are limited to classroom settings and delivered by teachers or experimenters. Few studies have included technology and its novel features to deliver MA instructions. Objectives: This study proposes a gamified learning approach embedded with self‐regulated learning support for MA learning and examines its effects on improving English reading performance and intrinsic motivation among junior secondary grade students who learn English as a foreign language. Methods: This study adopted a randomized controlled trial design. Participants (N = 104) were randomly assigned into one of three conditions: self‐regulated gamified programme, gamified programme, or non‐gamified programme. Students received 16 sessions of instructions (30 min/session) and were evaluated on reading abilities (i.e., MA, word reading and reading comprehension) and intrinsic motivation before and after the programme implementation. Results and conclusions: Results from repeated measures ANOVA and follow‐up ANCOVA showed that while the two gamified groups demonstrated greater improvement in MA (i.e., near transfer effect) and intrinsic motivation than non‐gamified group, only the self‐regulated gamified group showed more gains in multisyllabic word reading (i.e., far transfer effect) than non‐gamified group. There was no significant time X group interaction effect on reading comprehension. Implications: Taken together, this research suggests gamification leads to better morphology learning and increases students' intrinsic motivation. The incorporation of self‐regulated learning in gamification is recommended to achieve the far transfer effect on multisyllabic word reading. Lay Description: What is already known about this topic: Morphological awareness is an important reading‐related skill that predicts students' word reading and reading comprehension. However, existing morphological awareness instructions are mostly delivered by teachers or experimenters.Gamification, which is emerging as an effective approach that enhances learning and motivation, has not yet been widely applied to improve students' reading‐related skills, such as morphological awareness.Gamification is usually implemented in online learning environments where students' self‐regulated learning critically affects their online learning performance. However, few studies have provided self‐regulated learning support in a gamified learning environment. What this paper adds: We proposed a self‐regulated gamified approach specifically targeting morphological awareness and compared its effectiveness with gamified learning and non‐gamified learning.The two gamified groups led to significant gain in students' morphological awareness and intrinsic motivation than the non‐gamified group.Only the self‐regulated gamified group led to significant gain in multisyllabic word reading than the non‐gamified group. Implications for practice and/or policy: The self‐regulated gamified approach represents an effective way for learning morphological awareness. [ABSTRACT FROM AUTHOR]

Background: Performance monitoring plays a key role in self‐regulated learning, but is difficult, especially for complex visual tasks such as navigational map reading. Gaze displays (i.e. visualizations of participants' eye movements during a task) might serve as feedback to improve students' performance monitoring. Objectives: We hypothesized that participants who review their performance based on screen recordings that also display their gaze would have a higher monitoring accuracy and increase in post‐test performance and would remember more executed actions than participants who review based on a screen recording only (i.e. control condition). Methods: Sixty‐four higher education students were randomly assigned to a gaze‐display or control condition. After watching an instruction video, they practiced five navigational map‐reading tasks and then reviewed their performance while thinking aloud, either prompted by a screen recording with gaze display or a screen recording only. Before and after reviewing, participants estimated the number of correctly solved tasks and finally made a five‐item post‐test. Results and conclusions: Analyses with frequentist and Bayesian statistics showed that gaze displays did not improve monitoring accuracy (i.e. estimated minus actual performance), post‐test performance, or the number of reported actions. It is concluded that scanpath gaze displays do not provide useful cues to improve monitoring accuracy in this task. Takeaways: Gaze displays are a promising tool for education, but scanpath gaze displays did not help to enhance monitoring accuracy in a navigational map‐reading task. Lay description: What is currently known?: Monitoring performance is central in self‐regulated learning.Monitoring is often difficult for learners, in particular in complex visual tasks.Gaze displays visualize viewing behaviour that was measured with eye tracking.Gaze displays can improve task performance, but effects on monitoring are unknown. What does the paper add?: We expected gaze displays to help learners to monitor their performance on a map‐reading task.However, dynamic gaze displays did not help to improve monitoring accuracy in this study.Further research should investigate whether other types of gaze displays improve monitoring. Implications for practitioners: Eye tracking provides promising ways to support monitoring and learning.However, not all forms of using gaze displays enhance monitoring or learning.The specific implementation of gaze displays might matter. [ABSTRACT FROM AUTHOR]

Background: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. Aims: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. Methods and Procedures: In total, 43 UK families of 2–4‐year‐olds were recruited to the study, half of whom completed an 8‐week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait‐list controls. Results and Outcomes: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait‐list controls. Conclusions and Implications: We conclude that pre‐verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. What This Paper Adds: What is already known on the subject: Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds: This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work?: Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need. [ABSTRACT FROM AUTHOR]

Background: Though pedagogical artificial agents are expected to play a crucial role in the years to come, earlier studies provide inconsistent results regarding their effect on learning. This might be because their potential for exhibiting subtle nonverbal behaviours we know from human teachers has been untapped. What is more, there is little evidence of the processes underlying the effect of nonverbal behaviours of teachers (either human or artificial) on learning, so as to better guide their practical application. Objectives: The aims of the current research were threefold: firstly, to examine the effect of an artificial agent's vocal expressiveness on non‐verbal immediacy (teachers' ability to increase psychological closeness through nonverbal communication). Secondly, to test whether an artificial agent showing strong vocal expressiveness will enhance affective and cognitive learning (perceived and actual), as compared to an artificial agent that shows weak vocal expressiveness. Thirdly, to examine whether the underlying mechanisms of motivation and attention explain the effect of immediacy (and thereby also of vocal expressiveness) on the two learning outcomes. Methods: The study used a between‐participants design, with the participants being randomly assigned to one of the two experimental conditions: artificial modelling with strong expressiveness and artificial modelling with weak vocal expressiveness. Results and conclusions: Results showed that an artificial agent with strong vocal expressiveness increased affective and perceived cognitive learning. Partial support was found for actual cognitive learning. What is more, our findings revealed that vocal expressiveness is related to affective and perceived cognitive learning because it promotes nonverbal immediacy. Finally, results provided evidence of motivation as a mediator of the path from immediacy to affective learning. Major takeaways: The current findings verify the important role of nonverbal immediacy found in traditional educational settings. However, showing that these results also apply to artificial teachers is essential, given that the educational landscape is changing and reshaping by artificial intelligence. Thus, taking into consideration the role of vocal expressiveness in the development of artificial teachers or voice assistants like Alexa, Siri, and Google assistant, as a way to enhance immediacy and affective experience of learners is of imperative value, since they will be found more and more in our societies. Lay Description: What is currently known about the subject matter: There is a positive effect of nonverbal cues of human teachers on students' learningThe artificial agent's voice is important for learning. What their paper adds to this: Provides strong evidence of the positive effect of vocal expressiveness of artificial agents on learning outcomes.Reveals that vocal expressiveness is related to learning outcomes because it enhances immediacy.Examines the proposed mechanisms of motivation and attention as mediators of the path from immediacy to affective and cognitive learning. Implications of study findings for practitioners: Taking into consideration vocal expressiveness of artificial agents during the design process is essential for increased learning.The combination of the vocal parameters of pitch and speech rate is effective for constructing vocal expressiveness.By showing the underlying mechanisms of artificial agents' nonverbal cues (i.e., vocal cues) on learning, it helps designers to make a better decisions during construction.The study's findings are also pertinent for human teachers in improving students' learning in traditional educational settings. [ABSTRACT FROM AUTHOR]

Background: The feedback offered to students in audience response systems may enhance conformity bias, while asking closed‐type questions alone does not allow students to externalize and elaborate on their knowledge. Objectives: The study explores how writing short justifications and accessing peer justifications as collective feedback could affect students' performance, confidence and opinions in multiple‐choice audience response systems that apply the Peer Instruction model of voting/revoting. Methods: For 8 weeks, 98 students, enrolled in an undergraduate course, attended each lecture following a flipped classroom approach. At the beginning of each lecture, students participated in a quiz with eight multiple‐choice questions. Four of these questions included a justification form in which students could elaborate on their answers. The students were randomly grouped into two conditions according to the collective feedback they received: the Shared group (n = 54) could see both the percentage each question choice received from the class and the respective peer justifications, while the Unshared group (n = 44) could only see the percentage information. Results: Analysis showed that students in both groups performed significantly better in questions with the justification form being available. Also, the two groups were comparable in terms of performance and self‐reported level of confidence suggesting no main effect for making peer justification available. Despite this, students in the Shared group expressed a significantly more positive opinion in the end‐of‐activity questionnaire in terms of perceived learning gains and the helpfulness of writing justifications for their answers. Take Away: Writing short justifications can have a positive impact on students' academic performance. Lay Description: What is currently known about the subject matter: Audience response systems (ARS) typically include closed‐type items.Therefore, students do not have the opportunity to elaborate on their answers.Externalizing and elaborating on one's answer could enhance understanding. What their paper adds to this: Integration of short justifications alongside multiple‐choice questions.System feedback includes percentage, confidence and peer justifications.Analysis on how writing/reading justifications affect performance in ARS. Implications of study findings for practitioners: Writing short justifications enhances student performance.Being able to read peer justifications does not affect student performance.Being able to read peer justifications increases activity acceptance. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the current study was to investigate the robustness of the human movement effect and its stability over time by comparing the effectiveness of dynamic and static presentations on acquisition and retention of a gross motor skill. Methods: One hundred and seven first‐year students studying for the certificate in Physical Education course were randomly divided into three groups: (i) static pictures (N = 32), (ii) enriched static pictures with arrows (N = 34), and (iii) video (N = 41). They were instructed to observe the demonstration of the Ippon‐Seoi‐Nage (a Judo technique) and reproduce it during the acquisition phase or after a delay of 1 week during the retention phase. Results and Conclusions: The results showed that enriched static pictures (with arrows) resulted in more efficient learning than the static pictures (without arrows). Most importantly, it was shown that learners receiving the video presentation outperformed learners receiving the static presentations, with regard to acquisition and retention, indicating therefore a robust human movement effect. Implications: These findings provide confirmation of the superiority of video presentations for teaching and learning motor skills involving the entire human body. Lay Description: What is already known about this topic:External visualizations are broadly used in Physical education (PE) and sport context.Static visualizations are regarded as the fundamental tools used by PE teachers to communicate visual information that is difficult to verbally describe.Increasing use of dynamic visualizations such as videos largely supplanted the use of static pictures in PE contextWhat this paper adds:Comparing the effectiveness of static pictures and digital videos in tactical learningExploring the human movement effect and its stability over timeImplications for practice and/or policy:The human movement effect is a robust phenomenon not only when it is evaluated immediately after the learning phase but also after a notable delay.Dynamic visualizations remain the most powerful computer‐based technique by which people can learn complex motor skills. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapy often involves handwriting acquisition practices that include the non‐dominant hand when improvements in the dominant hand function are not possible because of trauma or stroke. This study explored whether character tracing and using a pegboard can effectively improve the handwriting of the non‐dominant hand. Methods: A randomised controlled trial involving 60 healthy university students aged ≥18 years was conducted. Participants were randomly assigned to the writing group, peg group or control group. The character recognition rate was evaluated by computer software. Furthermore, character quality and writing speed were evaluated by humans using global legibility scales. Evaluations were performed before the intervention (baseline) and on days 5 and 10 of the intervention. Using the non‐dominant hand, the writing group traced characters on paper with a ballpoint pen, and the peg group used a pegboard for 15 min/day for 10 days. Results: Compared with the peg and control groups, the writing group showed significant improvements in the character recognition rate and global legibility scale score. However, the global legibility scale score did not improve to the same level as that achieved with the dominant hand. None of the evaluation scores of the peg group showed significant improvements compared with those of the control group. There were no significant differences in improvements in the writing speed of the writing and peg groups compared with the control group. Conclusion: Tracing characters can improve the handwriting ability of the non‐dominant hand, but using a pegboard may be less effective. Future research is needed to examine how much practice is necessary to improve the handwriting ability of the non‐dominant hand sufficiently. [ABSTRACT FROM AUTHOR]

Background: Many people with aphasia have word‐finding difficulties, with some showing particular difficulties with verbs. Picture‐naming therapy is often used to improve naming, but gains are usually limited to therapy items and do not transfer to conversation. Therapy where words are produced in sentences and in real‐life activities may be more effective. Aims: The current pilot study investigated whether an activity‐oriented therapy approach would be accepted and viable if implemented in a community setting, and whether communicating whilst cooking was more beneficial than using paper‐based activities. If successful, it would be expected that verb production would improve in structured and unstructured tasks in both naming and narrative tasks. Methods & Procedures: The study employed a case‐series repeated‐measures design, with testing of treated and control items. Seven adults with anomia participated, although only five completed the full programme. Participants were divided into two groups and each group completed both treatments, but in different orders. Each treatment was employed for six 2‐h sessions over a 3‐week period. Outcomes & Results: Naming of both treated and untreated verbs showed a statistically significant improvement following both treatments and this continued into the maintenance phase. There was a numerical but not statistically significant gain in the variety of verbs used in spoken narratives. Participants predominantly chose positive terms to describe their experience of the programme, but did not prefer one therapy over the other. Conclusions & Implications: Preliminary findings suggest that an activity‐oriented therapy approach, whether it involves carrying out tasks or paper‐based activities, can result in clinically meaningful improvements for people with chronic aphasia. Further research using a randomized control trial is required to determine whether cooking therapy alone is effective. [ABSTRACT FROM AUTHOR]

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

The present study defined three levels of contextualized media and investigated their influences on students' science attitudes, comprehension, and argumentation. To achieve the purpose, an online game‐based science argumentation (OGSA) program was developed for the experiments (N = 148). The OGSA included three versions for student argumentation regarding the use of contextualized medias: the mildly, moderately, and highly contextualized medias. For each version, the students had to play two types of games, find‐the‐fault and find‐the‐difference games, to complete one topic of argumentation learning. We found that the highly contextualized group students had the best performances of their science learning and argumentation. However, to produce highly contextualized media was a time‐consuming task although it provided the students with contextualization cues to connect the learning to their prior knowledge. Lay Description: What is already known about this topic: Teaching argumentation has become increasingly prevalent and also an essential goal for science education.The use of images in learning plays an important role in facilitating students' understanding of science concepts and theories, because it makes the learning contextualizing and can boost the learning outcomes. However, the explanation on the relationship among the use of images, contextualized environment, and learning outcomes remain few.A number of online learning environments were developed to support students' science argumentation. However, few studies based on the elements of gameplay for the design. What this paper adds: The present study defined three levels of contextualized images and investigated their influences on students' science attitudes, comprehension, and argumentation.High school students needed images that are at least moderately contextualized and related to their prior knowledge in order to achieve high‐quality (that is, rational and evidence‐based) argumentation in terms of claims, warrants, rebuttals, and questions.We found that contextualized level of image is a factor significantly affecting on students' learning of science attitudes, comprehension of science concepts, and argumentation. Implications for practice and/or policy: The integration of multiple types of game‐based learning (e.g., find fault and find difference) into the development of online learning environments would constitute an innovative approach for educational instructions.We provided an example on how to integrate different images in terms of their contextualized level into the development of online game‐based program for the learning of science argumentation. [ABSTRACT FROM AUTHOR]

Background/aim Engagement in desired occupations can promote health and wellbeing in older adults. Assessments of engagement often measure frequency, amount or importance of specific activities. This study aimed to develop a scale to measure older adults' evaluation of the extent to which their everyday activities are contributing to their health and wellness. Methods Eighteen items, each scored with a seven-point rating scale, were initially developed by content experts, covering perceptions of how daily activities contribute to physical and mental health, as well as satisfaction and activity participation in the last six months. Rasch analysis methods were used to refine the scale using the pencil and paper responses of 460 community-living older adults. Results Initial Rasch analysis indicated three unlabelled rating scale categories were seldom used, reducing measurement precision. Five items were conceptually different by misfit statistics and principal component analysis. Subsequently, those items were removed and the number of rating scale steps reduced to 4. The remaining 13-item, 4-step scale, termed the Activity Significance Personal Evaluation ( ASPEn), formed a unidimensional hierarchy with good fit statistics and targeting. Person separation reliability (2.7) and internal consistency (.91) indicated the tool is appropriate for individual person measurement. Relative validity indicated equivalence between Rasch measures and total raw scores. Conclusions ASPEn is a brief, easily administered assessment of older adults' perception of the contribution of everyday activities to personal health and wellness. ASPEn may facilitate occupational therapy practice by enabling clinicians to assess change in meaning of an older adult's activity over time. [ABSTRACT FROM AUTHOR]

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

Previous studies have shown that the school-based physical activity programme entitled "11 for Health" has been effective in improving the physical fitness, well-being and overall health profile of European children. The main purpose of the present study was to examine whether the "11 for Health" programme can have a positive impact on the physical fitness of primary school pupils in China. A total of 124 primary school pupils aged 9-11 years were included in the experiment, randomly divided into the experimental group (EG, n = 62) and the control group (CG, n = 62). EG carried out three weekly 35-minute sessions of small-sided football for a total of 11 weeks. All data were analysed by a mixed ANOVA with the Student-Newman-Keuls post hoc test. The results showed greater improvements (p<0.001) in EG than CG in relation to systolic blood pressure (-2.9 vs +2.0 mmHg). Moreover, greater improvements (all p<0.05) were observed in postural balance (13 vs 0%), standing long jump (5.0 vs 0.5%), 30-metre sprint (4.1 vs 1.3%) and Yo-Yo IR1C running performance (17% vs 6%). In both EG and CG, physical activity enjoyment was observed to be higher (P<0.05) compared to the start of the intervention with increases of 3.7 and 3.9 AU respectively. In conclusion, the study revealed that the "11 for Health" programme has positive effects on aerobic and muscular fitness, and it appears to be a relevant tool in the physical activity promotion in the Chinese school system. [ABSTRACT FROM AUTHOR]

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

This paper reports on a study investigating the potential effect of synchronous and asynchronous text-based computer-mediated communication ( CMC) on oral fluency development of second-language ( L2) learners. Sixty-three intermediate learners of English were randomly assigned to one of three groups (two experimental groups and one control group), each consisting of 21 participants. The participants in the experimental groups completed four communicative tasks under two different instructional environments: synchronous text-based CMC environment and asynchronous text-based CMC environment. The average length of pauses, the articulation rate, the fluent-run, the phonation-time ratio and the speaking rate served as dependent variables. The study found that the participants in synchronous CMC group improved their L2 oral fluency significantly compared with their peers in the other two groups. The results also revealed the students in asynchronous CMC group obtained higher mean scores than those in the control group, although the differences between groups were not statistically significant. [ABSTRACT FROM AUTHOR]

Background: Sensitive responsiveness is an important aspect in affect‐regulation of people with severe to profound intellectual disabilities. Aim: This randomized controlled trial evaluated the Attune & Stimulate‐checklist, a tool for detecting subtle and idiosyncratic communicative behaviours and responding adequately. Methods: Effects on the sensitive responsiveness of professional caregivers and the arousal and valence of adults with severe to profound intellectual disabilities were investigated. Video recordings of 102 interactions were analysed with several observation instruments. Results: Although no significant effect was found on the checklist‐suggestions of responsive behaviours (d = 0.33, p =.052), the intervention increased caregivers' sensitive responsive and affective behaviour (d = 0.94 – 1.10, p <.001) and clients' optimal arousal (d = 0.48, p =.019) and interactive engagement (d = 0.40 – 0.48, p =.018 ‐.050). Conclusion: This low‐intensity intervention had a medium to large immediate effect on the interaction. Future research should investigate medium‐ and long‐term effects. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to compare performance 5 h after a 90‐min endurance training session when either carbohydrate only or carbohydrate with added whey hydrolysate or whey isolate was ingested during the first 2 h of the recovery period. Methods: Thirteen highly trained competitive male cyclists completed three exercise and diet interventions (double‐blinded, randomized, crossover design) separated by 1 week. The 90‐min morning session (EX1) included a 60 min time‐trial (TT60). Immediately and 1 h after exercise, participants ingested either (1) 1.2 g carbohydrate∙kg−1∙h−1 (CHO), (2) 0.8 g carbohydrate∙kg−1∙h−1 + 0.4 g isolate whey protein∙kg−1∙h−1 (ISO) or (3) 0.8 g carbohydrate∙kg−1∙h−1 + 0.4 g hydrolysate whey protein∙kg−1∙h−1 (HYD). Additional intakes were identical between interventions. After 5 h of recovery, participants completed a time‐trial performance (TTP) during which a specific amount of work was performed. Blood and urine were collected throughout the day. Results: TTP did not differ significantly between dietary interventions (CHO: 43:54 ± 1:36, ISO: 46:55 ± 2:32, HYD: 44:31 ± 2:01 min). Nitrogen balance during CHO was lower than ISO (p < 0.0001) and HYD (p < 0.0001), with no difference between ISO and HYD (p = 0.317). In recovery, the area under the curve for blood glucose was higher in CHO compared to ISO and HYD. HR, VO2, RER, glucose, and lactate during EX2 were similar between interventions. Conclusion: Performance did not differ after 5 h of recovery whether carbohydrate only or isocaloric carbohydrate plus protein was ingested during the first 2 h. Correspondingly, participants were not in negative nitrogen balance in any dietary intervention. [ABSTRACT FROM AUTHOR]

Aims: Determine efficacy of "KARER" educational intervention on caring ability and burden of caregiving relatives of disabled patients with stroke and cardiovascular diseases. Design: Clinical, randomized, controlled and double blinded trial with a mixed approach. Methods: Study population will be made up of 96 caregiving relatives of patients of home‐hospitalized care programs in the cities of Bogotá and Bucaramanga, (Colombia), between March 2021 and March 2022. Participants will be randomly assigned into two groups, either intervention (n = 48) or control (n = 48). The intervention is interdisciplinary and multi‐component: B‐Learning modality and clinical simulation. Follow‐up of participants will last 8 weeks from intervention period start‐out, and measurements will be taken and analysed in masked form. The main results will be the mean score changes of care ability and caregiver burden. Discussion: Caregiving relatives will show better adaptation to their role through effective use of caring abilities as they look after disabled persons with chronic diseases. [ABSTRACT FROM AUTHOR]

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

Background: Sleep disturbance negatively affects recovery and survival of patients in intensive care units (ICUs). Aims and Objectives: This study aimed to measure the noise levels and evaluate the impact of a white noise app on the sleep quality of critically ill patients. Design: A quasi‐experimental time series pre‐test–post‐test control group design with repeated measures was adopted. Methods: The study was conducted in the high dependency unit (HDU) of a selected tertiary care hospital in Mangalore, Karnataka State, India. Conscious oriented patients with systolic blood pressure ranging from 100/70 to 140/90 mm Hg and hearing acuity of at most 20 dB in both ears were included in the study. Noise levels in the HDU were measured using calibrated sound level meter on weekdays/weekends in three different shifts and an average of 24 readings was obtained per shift. A 4‐point Likert scale was used to assess the sleep quality. The intervention included administration of white noise app twice a day, for three consecutive days by using different masking sounds such as white noise on day 1 which resembles to a humming AC conditioner, pink noise on day 2 which resembles to the sound of ocean waves and brown noise on day 3 which resembles a steady rainfall. The app was used with the help of JBL earphones C10SI an excellent noise cancellation and noise isolating earphone. Results: Among the 54 subjects, the mean age of the patients was 40.28 years, majority 34 (63%) were males. The noise level in the ICU was more than 60 dB. There was a significant difference in the sleep quality after the application of the white noise app in the experimental group on Day 1 (Z = −3.996; P =.001), Day 2 (Z = −3.302; P =.001), and Day 3 (−2.822; P =.005) compared to the control group. Conclusion: Adoption of technology driven noise reduction applications would enhance the quality of sleep among the ICU patients. Relevance to clinical practice: The use of a technology‐driven application helps control noise levels which promotes improved sleep quality among critically ill patients in the intensive care units. [ABSTRACT FROM AUTHOR]

Frontal plane postures during the ultimate step of sidestepping are linked to increased anterior cruciate ligament injury risk. However, there is a lack of research detailing the kinematic strategies present in the penultimate step. This study, therefore, investigated penultimate and ultimate step kinematics of planned sidestepping (pSS) and unplanned sidestepping (upSS) to further understand the effect of planning time on known ultimate step kinematic and kinetic differences. Sixty male amateur Australian Rules football players performed three trials of straight‐line running (RUN), pSS, and upSS in a randomized order. Mediolateral foot placement and three‐dimensional joint kinematics for the knee, pelvis, and trunk were measured at final foot contact of the penultimate step and initial foot contact of the ultimate step. Peak knee moments were measured during the weight acceptance phase of the ultimate step. In pSS, at the penultimate step final foot contact, the support foot was placed across the midline of the center of mass, in the frontal plane, contralateral to the sidestep direction. Greater trunk lateral flexion toward the sidestep direction and greater negative pelvic lateral tilt were observed in pSS compared with upSS and RUN. Differences between pSS and upSS frontal plane kinematics at penultimate step final foot contact suggest preparatory reorientation strategies are likely constrained by the amount of planning time available. As there are clear differences in preparatory kinematics, we recommend that planning time be considered when training and assessing sidestepping maneuvers and planned and unplanned maneuvers not be treated as interchangeable skills. [ABSTRACT FROM AUTHOR]

Objective: To participate in shared decision making (SDM), patients need to understand their options and develop trust in their own decision‐making abilities. Two experiments investigated the potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference‐sensitivity (Study 1) and showing possible personal motives for decision making (Study 2) in addition to providing information about the treatment options. Methods: Participants (Study 1: N = 117; Study 2: N = 217) were put into two scenarios (Study 1: cruciate ligament rupture; Study 2: contraception), watched a consultation video and were randomized into one of three groups where they received additional information in the form of (a) narrative patient testimonials; (b) non‐narrative decision strategies; and (c) an unrelated text (control group). Results: Participants who viewed the patient testimonials or decision strategies felt better prepared for a decision (Study 1: P <.001, ηP2 = 0.43; Study 2: P <.001, ηP2 = 0.57) and evaluated the decision‐making process more positively (Study 2: P <.001, ηP2 = 0.13) than participants in the control condition. Decision certainty (Study 1: P <.001, ηP2 = 0.05) and satisfaction (Study 1: P <.001, ηP2 = 0.11; Study 2: P =.003, d = 0.29) were higher across all conditions after watching the consultation video, and certainty and satisfaction were lower in the control condition (Study 2: P <.001, ηP2 = 0.05). Discussion: Decision aids that explain preference‐sensitivity and personal motives can be beneficial for improving people's feelings of being prepared and their perception of the decision‐making process. To reach decision certainty and satisfaction, being well informed of one's options is particularly relevant. We discuss the implications of our findings for future research and the design of DAs. [ABSTRACT FROM AUTHOR]

While it is widely recognized that value perception increases when individuals engage in making physical objects, the impact of peer presence on value perception during production or consumption has not been studied. Peer production is prevalent for information products, which are the focus of the present study. Most research to date has focused on value as perceived by consumers, while consumers are increasingly involved in online processes of information production. Information, being intangible and experiential, is a unique type of good. This study places participants in the position of producing or consuming information in order to assess effects of peer group size on value perceptions. Six hundred and fifty one participants took part in 16 information consumption and production experiments. Consumers read information and producers created the same information. Consumers' willingness‐to‐pay and producers' willingness‐to‐accept payment were measured before or after peer consumption and production. Results indicate that value perception is highest when participants consume information individually, declining in small and medium‐sized groups and growing in mass consumption. Generally, post‐consumption values are higher. In production, point of measurement is cardinal. Before production, value perceived individually is lowest, however, having experienced peer production, individuals ascribe the highest value to self‐production. Value perceptions in massive groups converge. [ABSTRACT FROM AUTHOR]

Background: Speech pathology students can experience low confidence when communicating with people with aphasia. Communication partner training (CPT) is one method to increase confidence and skills when communicating with people with aphasia. There is a paucity of research exploring the effects of delivering CPT to students via technology, such as telepractice. Aims: To explore the feasibility (acceptability, demand, implementation, practicality, limited efficacy) of a conversation with a person with aphasia via telepractice as part of a CPT programme with speech pathology students. A secondary aim was to explore the effects of feedback from the people with aphasia (i.e., patient feedback) on students' perceived confidence and proficiency in communicating with people with aphasia. Methods & Procedures: A Phase II feasibility study design was used, where both quantitative and qualitative data were collected. A total of 33 speech pathology students attended a lecture about the strategies used to communicate effectively with people with aphasia. They then participated in a 10‐min conversation via videoconferencing with a person with aphasia 1 week later. Students were randomly allocated to patient feedback or no patient feedback conditions. They completed a custom designed questionnaire pre‐ and post‐conversation. Outcomes & Results: The study had a low recruitment rate but good retention. The programme was delivered as intended. Students reported that they found the conversations to be a positive but challenging experience. Post‐conversation, statistically significant increases were found in students' self‐rated confidence communicating with people with aphasia, proficiency at engaging in an everyday conversation and proficiency obtaining a case history (all p < 0.001). There were no significant differences for these ratings between the groups according to feedback condition (all p > 0.01). Conclusions & Implications: CPT involving a conversation with a person with aphasia via telepractice is feasible and can provide a valuable learning experience for students. Further research is required. [ABSTRACT FROM AUTHOR]

Objectives: To compare 3 mouthwashes: 0.20% chlorhexidine (CHX) with Anti‐Discoloration System (ADS), 0.20% CHX and 0.12% CHX with 0.05% cetylpyridinium chloride (CPC), in terms of reduction of plaque and gingival bleeding and side effects. Methods: Mild gingivitis patients were randomly divided into three Groups: they underwent professional oral hygiene and received instructions: oral rinse with 10 mL for 1', twice a day, 30' after tooth brushing, for 14 days. Primary outcomes were plaque and gingival bleeding, assessed with Plaque Control Record and Gingival Bleeding Index. Feedback questionnaire and spectrophotometer evaluated secondary outcomes: adverse events. Timing of the study was T0 (baseline), T1 (professional oral hygiene) and T2 (14th day after mouthwash use). Results: Sixty‐six patients were recruited, two patients dropped out, and 64 patients completed the study. PCR T1‐T2 mean variation was 30.67 (SD = 15.22; 95% CI 23.55 to 37.80; P = 0.000), 19.93 (SD = 11.03; 95% CI 14.90 to 24.95; P = 0.000) and 16.24 (SD = 15.35; 95% CI 9.60 to 22.88; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. GBI mean variation (T0‐T2) was −9.82 (SD = 9.27; 95% CI −5.48 to 14.16; P = 0.000), −19.31 (SD = 11.33; 95% CI −14.15 to −24.47; P = 0.000) and −21.13 (SD = 12.56; 95% CI −15.70 to −26.56; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. Statistical significance was found in lower efficacy of 0.2% CHX + ADS Group. Patients tolerated 0.12% CHX + CPC mouthwash better in bleeding perception (95.5%; P = 0.046), burning sensation (13.6%; P = 0.006), and mouthwash taste (100%; P = 0.000). Results on staining were no statistically significant (P = 0.106). Conclusions: Addition of CPC allows reduction of CHX percentage in mouthwash formulation while keeping equal efficacy and less side effects. ADS addition decreases CHX efficacy in reducing plaque and bleeding, while resulting more tolerated than CHX. [ABSTRACT FROM AUTHOR]

Abstract: Background: Constraint‐induced (language) aphasia therapy (CIAT), based on constraint usage of the language channel only, massed practice and shaping through therapeutic language games, has been suggested as a more efficient therapy approach than traditional aphasia therapies. Aims: To examine the comparative efficacy of CIAT and a traditional therapy approach on expressive language ability, with the intensity of therapy controlled and matched, in the treatment of post‐stroke aphasia. Methods & Procedures: Two successive 4‐week blocks of intense (1 h, 5 days a week) of aphasia therapy programmes were delivered in a randomized within‐subject crossover design: one therapy block consisted of stimulation aphasia therapy (SAT, a common traditional therapy approach), another of CIAT. Twenty consecutive patients, up to 1 year after stroke, were randomly assigned either to have SAT followed by CIAT (S1C2 group) or to have CIAT followed by SAT (C1S2 group). Measurements of naming (Boston Naming Test) and spontaneous sentence production (Cookie Theft Picture description task) were carried at the baseline, following the first therapy block, following the second therapy block and 4 weeks following the last therapy block. Outcomes & Results: Both groups of patients significantly improved in all variables of expressive language skills; the improvement was maintained 1 month post‐treatment. However, patients who started with CIAT and continued with SAT (C1S2 group) tended to have higher final improvement than the patients who started with SAT and continued with CIAT (S1C2 group). This was particularly pronounced for naming. Moreover, when CIAT was the first therapy (the C1S2 group) the improvement achieved in naming following CIAT significantly exceeded the improvements achieved following SAT, not only in the same group (when SAT was the second) but also in the S1C2 group (when SAT was the first). In addition, the improvement in naming following CIAT in the C1S2 group exceeded the one in the S1C2 group, too. Similarly, the improvement in the total number of sentences produced following each therapy was quite clear and significant in the C1S2 group (when CIAT was the first), while in the S1C2 group it was much more modest and not significant. Conclusions & Implications: Results suggest that the maximization of quantity and frequency of language therapy have a significant impact on the improvement of expressive language ability. Moreover, if practised early in aphasia therapy, the constrained usage of the language modality, as practised in CIAT, confers an additional benefit to massed practice, particularly on naming ability. [ABSTRACT FROM AUTHOR]

Objectives Psychological treatment of depression in end-stage renal disease ( ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural intervention ( CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. Design For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. Methods Depression and anxiety symptoms were screened in 152 subjects (18-60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life ( Qo L), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method ( p < .05 was considered significant). Results At follow-up, depression, anxiety, and cognitive distortions had decreased, and Qo L had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. Conclusions A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving Qo L in ESRD haemodialysis patients. Practitioner points A brief, systematic and structured cognitive behavioural intervention ( CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease ( ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically., This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD., The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim This study aimed to investigate the effects of a peer education on cardiac self-efficacy ( CSE) and readmission of the patients undergoing bypass surgery. Background Self-efficacy is an antecedent vital factor in both initiating and maintaining healthy behaviours. It significantly improves after effects of heart attacks, anxiety and diminishes the possibility of readmission. Design This study is a randomized-controlled trial. Method Sixty patients undergoing bypass surgery were chosen and assigned equally into the control and intervention groups. While routine education was presented to the patients in the control group, intervention group were taught using the peer education in two sessions. CSE of all the selected patients was assessed orderly in 5 days, 4 weeks and 8 months after surgery. Moreover, their readmission was investigated after 8 months from surgery. Data was collected using demographic and the CSE scale. Data were also analysed by using χ2, Kolmogorov-Smirnov and repeated measures analysis of variance tests. Results The mean score of CSE in the intervention group was significantly different from the corresponding number in the control group in all three stages of data collecting ( p < 0·001). Compared to the control group, a smaller number of the patients in the intervention group were readmitted to the hospitals after 8 months ( p = 0·011). Conclusions Implementation of peer education has positive effects on CSE in patients who have bypass surgery and reduces their hospital readmission. It can be beneficial to apply this method as an educative-supportive approach in cardiac surgery fields. Relevance to clinical practice Implementation of peer education has positive effects on CSE in these patients and reduces their hospital readmission. [ABSTRACT FROM AUTHOR]

Background: Postnatal maternal depressive symptoms are consistently associated with reduced quality of mother- infant interaction. However, there is little research examining the role of maternal cognitive factors (e.g. rumination) in the relationship between depressive symptoms and mother-infant interaction quality. This study investigated the hypotheses that: dysphoric mothers would demonstrate less sensitive behaviour towards their infants compared with nondysphoric mothers; mothers induced to ruminate would be less sensitive towards infants; rumination would moderate the relationship between maternal depressive symptoms and maternal sensitivity and the impact of the rumination induction would increase following a stressor (still face) task. Method: Mothers (N = 79; 39 dysphoric and 40 nondysphoric) and their infants were randomised to either a rumination induction or a control condition. Maternal sensitivity in mother-infant interactions was assessed before and after the induction using the CARE Index. In the second interaction task, mothers also completed the still-face procedure as a stressor. Results: Extending previous research, mixed measures ANOVAs demonstrated that dysphoric mothers had reduced quality of interaction with their infant compared with nondysphoric mothers and that mothers in the rumination condition exhibited reduced sensitivity towards their infants relative to mothers in the control condition. Further, maternal sensitivity worsened further after the still-face procedure in the rumination condition, but not in the control condition. Conclusions: This study suggests that the repetitive, internal focus of a ruminative state is causally implicated in mother-infant interaction quality, regardless of the level of depressive symptoms. This research extends understanding of specific mechanisms involved in the quality of the mother-infant relationship. [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]

Background Exercise under hypoxic conditions represents an additional stress in relation to exercise in normoxia. Hypoxia induces oxidative stress and inflammation as mediated through tumour necrosis factor ( TNF)-α release that might be exacerbated through exercise. In addition, vitamin E supplementation might attenuate oxidative stress and inflammation resulting from hypoxia during exercise. The present study aimed to evaluate the effects of vitamin E supplementation (250 mg) on inflammatory parameters and cellular damage after exercise under hypoxia simulating an altitude of 4200 m. Methods Nine volunteers performed three sessions of 60 min of exercise (70% maximal oxygen uptake) interspersed for 1 week under normoxia, hypoxia and hypoxia after vitamin E supplementation 1 h before exercise. Blood was collected before, immediately after and at 1 h after exercise to measure inflammatory parameters and cell damage. Results Percentage oxygen saturation of haemoglobin decreased after exercise and recovered 1 h later in the hypoxia + vitamin condition ( P < 0.05). Supplementation decreased creatine kinase (CK)-TOTAL, CK-MB and lactate dehydrogenase 1 h after exercise ( P < 0.05). The exercise in hypoxia increased interleukin (IL)-6, TNF-α, IL-1ra and IL-10 immediately after exercise ( P < 0.05). Supplementation reversed the changes observed after exercise in hypoxia without supplementation ( P < 0.05). Conclusions We conclude that 250 mg of vitamin E supplementation at 1 h before exercise reduces cell damage markers after exercise in hypoxia and changes the concentration of cytokines, suggesting a possible protective effect against inflammation induced by hypoxia during exercise. [ABSTRACT FROM AUTHOR]

Aims To examine the safety and effectiveness of buprenorphine + naloxone sublingual tablets (BUP, as Suboxone®) provided after administration of extended-release injectable naltrexone (XR-NTX, as Vivitrol®) to reduce cocaine use in participants who met DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. Methods This multi-centered, double-blind, placebo-controlled study, conducted under the auspices of the National Drug Abuse Treatment Clinical Trials Network, randomly assigned 302 participants at sites in California, Oregon, Washington, Colorado, Texas, Georgia, Ohio, New York and Washington DC, USA to one of three conditions provided with XR-NTX: 4 mg/day BUP (BUP4, n = 100), 16 mg/day BUP (BUP16, n = 100, or no buprenorphine (placebo; PLB, n = 102). Participants received pharmacotherapy for 8 weeks, with three clinic visits per week. Cognitive behavioral therapy was provided weekly. Follow-up assessments occurred at 1 and 3 months post-intervention. The planned primary outcome was urine drug screen (UDS)-corrected, self-reported cocaine use during the last 4 weeks of treatment. Planned secondary analyses assessed cocaine use by UDS, medication adherence, retention and adverse events. Results No group differences were found between groups for the primary outcome (BUP4 versus PLB, P = 0.262; BUP16 versus PLB, P = 0.185). Longitudinal analysis of UDS data during the evaluation period using generalized linear mixed equations found a statistically significant difference between BUP16 and PLB [ P = 0.022, odds ratio (OR) = 1.71] but not for BUP4 ( P = 0.105, OR = 1.05). No secondary outcome differences across groups were found for adherence, retention or adverse events. Conclusions Buprenorphine + naloxone, used in combination with naltrexone, may be associated with reductions in cocaine use among people who meet DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. [ABSTRACT FROM AUTHOR]

The question why some entrepreneurs self‐select out of entrepreneurial careers following exits from successful and failed businesses is of growing interest to entrepreneurship scholars. Using two studies and Regulatory Fit Theory as the theoretical lens, we address this question. Study 1 uses the experimental vignette methodology to test whether business exits under harvest and distress conditions diminished or intensified the serial entrepreneurship intentions of 74 experienced entrepreneurs. Study 2 examines the relationship between the serial entrepreneurship intentions of 196 entrepreneurs who exited businesses and their recall of prior experiences with business success or failure. In both studies, we find evidence of a negative relationship between prevention‐focused cognition and serial entrepreneurship intentions that intensifies from the regulatory fit of distress business exits. The results of both studies suggest that the cognitive lenses used by entrepreneurs to process their business exits play important roles in their intentions to pursue serial entrepreneurship. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The purpose of this study was to examine sex differences in response to a single dose of a psychomotor-stimulant medication (methylphenidate: MP) and to assess whether expected differences were moderated by binge-eating disorder (BED) status. It is anticipated that findings will shed light on factors that contribute to response variation in the use of stimulant pharmacotherapy to treat BED. Method The study employed a double-blind, drug-placebo, cross-over design in overweight/obese adults with BED ( n = 90) and without BED ( n = 108). Emotional/mood ratings were assessed every 15 minutes after oral administration of the drug/placebo, and appetite, cravings, and consumption were assessed during a laboratory-based snack-food challenge. Results Women reported earlier and more sustained 'overall' effects of the drug-including 'feeling high'-than the men. There was also a significantly greater suppression in appetite ratings, food cravings, and food consumption from the placebo to the drug condition among the women. Indeed, among men there were no significant differences between the two conditions on any of the food-related variables. BED status also did not moderate any of the drug-placebo differences. Discussion These findings are relevant to the use of stimulant pharmacotherapy for BED, and raise the possibility that overweight/obese men may be relatively less responsive to this form of treatment. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:473-481). [ABSTRACT FROM AUTHOR]

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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]

Previous research suggests that in contrast to invisible social support, visible social support produces exaggerated negative emotional responses. Drawing on work by Bolger and colleagues, this study disentangled social support visibility from negative social evaluation in an examination of the effects of social support on negative emotions and cardiovascular responses. As part of an anticipatory speech task, 73 female participants were randomly assigned to receive no social support, invisible social support, non‐confounded visible social support or visible social support as delivered in a 2007 study by Bolger and Amarel. Twelve readings, each for systolic blood pressure, diastolic blood pressure and heart rate were taken at 5‐min intervals throughout the periods of baseline, reactivity and recovery. Cardiovascular outcomes were tested by incorporating a series of theoretically driven planned contrasts into tests of stress reactivity conducted through piecewise growth curve modelling. Linear and quadratic trends established cardiovascular reactivity to the task. Further, in comparison to the control and replication conditions, the non‐confounded visible and invisible social support conditions attenuated cardiovascular reactivity over time. Pre‐ and post‐speech negative emotional responses were not affected by the social support manipulations. These results suggest that appropriately delivered visible social support may be as beneficial as invisible social support. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Successful prevention of eating disorders represents an important goal due to damaging long-term impacts on health and well-being, modest treatment outcomes, and low treatment seeking among individuals at risk. Mindfulness-based approaches have received early support in the treatment of eating disorders, but have not been evaluated as a prevention strategy. This study aimed to assess the feasibility, acceptability, and efficacy of a novel mindfulness-based intervention for reducing the risk of eating disorders among adolescent females, under both optimal (trained facilitator) and task-shifted (non-expert facilitator) conditions. Method A school-based cluster randomized controlled trial was conducted in which 19 classes of adolescent girls ( N = 347) were allocated to a three-session mindfulness-based intervention, dissonance-based intervention, or classes as usual control. A subset of classes ( N = 156) receiving expert facilitation were analyzed separately as a proxy for delivery under optimal conditions. Results Task-shifted facilitation showed no significant intervention effects across outcomes. Under optimal facilitation, students receiving mindfulness demonstrated significant reductions in weight and shape concern, dietary restraint, thin-ideal internalization, eating disorder symptoms, and psychosocial impairment relative to control by 6-month follow-up. Students receiving dissonance showed significant reductions in socio-cultural pressures. There were no statistically significant differences between the two interventions. Moderate intervention acceptability was reported by both students and teaching staff. Discussion Findings show promise for the application of mindfulness in the prevention of eating disorders; however, further work is required to increase both impact and acceptability, and to enable successful outcomes when delivered by less expert providers. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1024-1037). [ABSTRACT FROM AUTHOR]

Background Adequately developed fundamental movement skills, particularly object control dimensions, are considered essential to learn more complex movement patterns and to increase the likelihood to successfully participate in organized and non-organized sports during later years. Thus, the present randomized controlled trial aimed at improving object control dimensions at an early state in a kindergarten setting. Methods Catching, throwing, kicking, rolling and stationary dribbling were assessed via gross motor development 2 (TGMD-2) testing in 41 normally developed preschoolers. On a cluster-randomized basis [strata: age, sex and body mass index (BMI)], three kindergartens were randomly assigned to an intervention group (n = 22, INT, age: 4.6 ± 1.0 years; BMI: 16.2 ± 1.1 kg/m²) and three to a control group (n = 19,CON: age: 4.5 ± 1.2 years; BMI: 16.8 ± 1.2 kg/m²).Twelve structured training sessions were given within 6 weeks (12 sessions).The total training volume was 330 min. Results Moderate time × group interaction were observed for the total sum score (+22%, P = 0.05) and dribbling (+41%, P = 0.002). Adjusting for baseline differences analyses of covariance did not affect these results. Interestingly, likely to most likely practically worthwhile effects were detected for the total sum score, catching and dribbling. Conclusion Object control dimensions such as dribbling and catching that apparently rely on rhythmical movement patterns and anticipatory eye-hand coordination seem to benefit from short-term object control training. These skills are considered important for successful team-sport participation and appropriate sportive motor development. [ABSTRACT FROM AUTHOR]

Professional visual searches, such as those conducted by airport security personnel, often demand highly accurate performance. As many factors can hinder accuracy, it is critical to understand the potential influences. Here, we examined how explicit decision-making criteria might affect multiple-target search performance. Non-professional searchers (college undergraduates) and professional searchers (airport security officers) classified trials as 'safe' or 'dangerous', in one of two conditions. Those in the 'one = dangerous' condition classified trials as dangerous if they found one or two targets, and those in the 'one = safe' condition only classified trials as dangerous if they found two targets. The data suggest an important role of context that may be mediated by experience; non-professional searchers were more likely to miss a second target in the one = dangerous condition (i.e., when finding a second found target did not change the classification), whereas professional searchers were more likely to miss a second in the one = safe condition. [ABSTRACT FROM AUTHOR]

As pregnancy may trigger overweight in women, new means for its prevention are being sought. The aim here was to investigate the effect of individual dietary counselling during and after pregnancy on post‐partum weight and waist circumference up to 4 years post‐partum. A cohort of women (n = 256) were randomized to receive repeated individual dietary counselling by a nutritionist during and after pregnancy, or as controls not receiving dietary counselling, from the first trimester of pregnancy until 6 months after delivery. Counselling aimed to bring dietary intake into line with recommendations, with particular focus on the increase in the intake of unsaturated fatty acids instead of saturated. Pre‐pregnancy weight was taken from welfare clinic records. Weight and waist circumference were measured at 4 years after delivery. The proportion of overweight women increased from 26% prior to pregnancy to 30% at 4 years after delivery among women receiving dietary counselling, as against considerably more, from 32% to 57%, among controls. The prevalence of central adiposity was 31% in women receiving dietary counselling, 64% in controls. Likewise, both the risk of overweight (odds ratio: 0.23, 0.08–0.63, P = 0.005) and central adiposity (odds ratio: 0.18, 0.06–0.52, P = 0.002) were lower in women receiving dietary counselling compared with controls. Repeated dietary counselling initiated in early pregnancy can be beneficial in long‐term weight control after delivery. [ABSTRACT FROM AUTHOR]

Context Recent studies suggest that self-explanation ( SE) while diagnosing cases fosters the development of clinical reasoning in medical students; however, the conditions that optimise the impact of SE remain unknown. The example-based learning framework justifies an exploration of students' use of their own SEs combined with the study of examples. This study aimed to assess the impact on medical students' diagnostic performance of: (i) combining students' SEs with their listening to examples of residents' SEs, and (ii) the addition of prompts (specific questions) while working with examples. Methods This study consisted of a training phase and an assessment phase conducted 1 week later. In the training phase, 54 Year 3 medical students were randomly assigned to one of three groups. In all groups, students first solved four clinical cases using SE. Subsequently, Group 1 listened to examples of residents' SEs with prompts; Group 2 listened to examples of residents' SEs without prompts, and the control group solved word puzzles. Then, all students again solved the same four cases. One week later, all students solved four similar and four different cases. Students' diagnostic performance and diagnostic accuracy scores were assessed for each case at each time-point. Results Although all groups' diagnostic accuracy scores on similar cases improved significantly between the training and the assessment phase, Group 1 showed a significantly higher diagnostic performance score after 1 week than the control group (p = 0.037). On different cases, Group 1 obtained significantly higher diagnostic accuracy (p = 0.011) and diagnostic performance (p < 0.001) scores than the control group and a significantly higher diagnostic performance score than Group 2 (p = 0.018). Conclusions Self-explanation seems to be an effective technique to help medical students learn clinical reasoning. Its impact is increased significantly by combining it with examples of residents' SEs and prompts. Although students' exposure to examples of clinical reasoning is important, their 'active processing' of these examples appears to be critical to their learning from them. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Low-intensity exercise applied in anorexia nervosa patients has been shown to have a harmless effect on body composition and to effect short-term improvements in muscular strength and agility. The aim of this study was to determine the effects of a high-intensity resistance training program designed for adolescents to improve strength and agility in anorexia nervosa restricting-type patients (AN-R). Methods From a total of 36 female patients with AN-R, one group (intervention, n = 18) underwent a supervised high-intensity resistance training program lasting 8 weeks, and the other group with no exercise (control, n = 18). Body weight, body mass index, whole-body muscular strength, and agility were assessed before, after, and 4 weeks after training (detraining). Results Leg-press, bench-press, and lateral row tests improved significantly ( p < 0.001) after 8 weeks of training compared with controls. Improvements were maintained after the detraining period. The training program also showed beneficial effects on agility. Discussion A high-intensity resistance training program adapted to the recommendations for adolescents in AN-R patients was effective and safe, improving muscular strength in the whole body and the ability to perform daily tasks. However, long-term maintenance of gains seems to be linked to the continuance of training or the use of a maintenance program. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:601-609) [ABSTRACT FROM AUTHOR]

Objectives Low-dose stavudine therapy may have a lower toxicity profile compared with standard dose. A randomized controlled trial comparing these two doses of stavudine with tenofovir disoproxil fumarate (tenofovir DF) was performed to assess the effects on anthropometry, markers of inflammation, and lipid and glucose metabolism in Black South African patients. Methods Sixty patients were randomized 1:1:1 to either standard-dose (30-40 mg) or low-dose (20-30 mg) stavudine or tenofovir DF (300 mg), each combined with lamivudine and efavirenz, for 48 weeks. Anthropometry, markers of inflammation, and lipid and glucose metabolism were assessed using standard techniques. Results In all three treatment arms, there was a significant increase in lipid levels over the study period. At 48 weeks, fasting glucose level ( P < 0.005) and homeostasis model assessment ( HOMA) score ( P < 0.05) increased significantly in the standard-dose stavudine arm, as did insulin and C-peptide levels in both the standard- and low-dose stavudine arms. At week 48, a significant decrease ( P < 0.05) in adiponectin was noted in the standard-dose stavudine arm, but there was an increase ( P < 0.005) in the tenofovir DF arm. In both the stavudine arms, significant increases in anthropometric measures occurred at 24 weeks but these decreased by week 48. Mitochondrial toxicities occurred in both the stavudine arms. Immunological and virological outcomes were similar for all three arms. Conclusions This study highlights the occurrence of metabolic abnormalities with both stavudine and tenofovir DF treatment. Awareness of the potential increased cardiovascular risk should be of concern with the use of both these therapies. [ABSTRACT FROM AUTHOR]

Background Little evidence exists for the effectiveness of therapy for children with receptive language difficulties, particularly those whose difficulties are severe and persistent. Aims To establish the effectiveness of explicit speech and language therapy with visual support for secondary school-aged children with language impairments focusing on comprehension of coordinating conjunctions in a randomized control trial with an assessor blind to group status. Methods & Procedures Fourteen participants (aged 11;3-16;1) with severe RELI (mean standard scores: CELF4 ELS = 48, CELF4 RLS = 53 and TROG-2 = 57), but higher non-verbal (Matrices = 83) and visual perceptual skills (Test of Visual Perceptual Skills (TVPS) = 86) were randomly assigned to two groups: therapy versus waiting controls. In Phase 1, the therapy group received eight 30-min individual sessions of explicit teaching with visual support (Shape Coding) with their usual SLT. In Phase 2, the waiting controls received the same therapy. The participants' comprehension was tested pre-, post-Phase 1 and post-Phase 2 therapy on (1) a specific test of the targeted conjunctions, (2) the TROG-2 and (3) a test of passives. Outcomes & Results After Phase 1, the therapy group showed significantly more progress than the waiting controls on the targeted conjunctions ( d = 1.6) and overall TROG-2 standard score ( d = 1.4). The two groups did not differ on the passives test. After Phase 2, the waiting controls made similar progress to those in the original therapy group, who maintained their previous progress. Neither group showed progress on passives. When the two groups were combined, significant progress was found on the specific conjunctions ( d = 1.3) and TROG-2 raw ( d = 1.1) and standard scores ( d = 0.9). Correlations showed no measures taken (including Matrices and TVPS) correlated significantly with progress on the targeted conjunctions or the TROG-2. Conclusions & Implications Four hours of Shape Coding therapy led to significant gains on comprehension of coordinating conjunctions which were maintained after 4 months. Given the significant progress at a group level and the lack of reliable predictors of progress, this approach could be offered to other children with similar difficulties to the participants. However, the intervention was delivered one-to-one by speech and language therapists, thus the effectiveness of this therapy method with other methods of delivery remains to be evaluated. [ABSTRACT FROM AUTHOR]