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Background: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. Aims: To compare the impact of standard parent‐based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. Methods and Procedures: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent‐based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20‐week period. Participants received one of two interventions: (1) Standard Care – indirect group PBI – (PBI) (2) Enhanced Care: indirect group enhanced PBI – (EPBI). Both standardised and non‐standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure – Speech & Language Therapy (PAM‐SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well‐being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. Outcomes and Results: One hundred fifty‐five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur‐Bates Communicative Development Inventories Sentence Length, from pre‐intervention to post‐intervention and 6 months post‐intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval –0.02 to 0.76), although wide variation was found. Conclusions and Implications: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS: What is already known on the subject: Speech, language and communication needs (SLCN) have a knock‐on effect on emotional well‐being, school readiness, literacy and school attainment, putting children at increased risk of long‐term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge: Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work?: This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes. [ABSTRACT FROM AUTHOR]

Background Study: Virtual reality (VR) is becoming a popular technology for safety training in construction. Several VR training prototypes have been designed and tested, which show they can perform better than traditional training tools. However, most of these existing tools are not underpinned by clear pedagogical theory, and studies assessing the impact of pedagogical theories on the effectiveness of VR prototypes are still rare in the literature. Objectives: This study aims to investigate if and how the productive failure theory and the directive instruction theory have an impact on the effectiveness of VR safety training for confined space workers. Methods: The study used a randomized controlled method involving 74 participants. The effectiveness of these two training methods was assessed in terms of knowledge acquisition and retention. Results and Conclusions: The results illustrate that the productive failure training design performed better in terms of knowledge acquisition and retention. This paper introduces the Productive Failure Theory and shows the great potential of this approach for self‐service VR safety training in the field of construction. Lay Description: What is already known about this topic: PF has been proven effective in classroom‐based teaching practice.PF has been proven effective in non‐immersive virtual training.DI is a commonly used pedagogical method for VR training. What this paper adds: The present paper investigates the feasibility of applying PF theory in VR safety training.The present paper examines the pedagogical impacts of the two pedagogical approaches within VR serious games. Implications for practice and/or policy: PF can be applied to self‐help VR safety training, reducing the demand for resources such as teaching staff and venues.PF training design performed better in terms of knowledge acquisition and retention.PF has great potential for self‐help VR safety training in various fields. [ABSTRACT FROM AUTHOR]

An important cause of stunting is limited consumption of complementary foods, in terms of both quantities and nutrients. Although existing studies show a positive association between fathers' engagement and children's diet, programmes designed to improve complementary feeding practices often only target mothers. In response to this, maternal behaviour change communication (BCC), paternal BCC and food voucher programmes were designed and implemented in Ethiopia using a clustered randomized controlled trial design. The paternal BCC programme included gender‐equal messages to increase fathers' participation in childcare, household labour and decision making. The research reported in this paper is an examination of the BCC programmes, characterizing the behavioural, normative and control beliefs of both mothers and fathers in BCC households compared to those in control households. In this study, a total of 40 participants were included, with 13 mother–father pairs in the BCC + food voucher group, and seven pairs in the control group. Each participant was interviewed separately. We found that BCC mothers showed more gender‐equal tendencies than the control mothers despite being more rural in location. By contrast, the beliefs of BCC and control fathers were similar overall, suggesting men are more resistant to gender‐equal BCC. More work is needed to develop and test effective methods for changing fathers' beliefs and practices. Key messages: Mothers in behaviour change communication (BCC) group mothers held more gender‐equal beliefs than control mothers, while BCC and control fathers shared similar views, suggesting a male resistance to gender equality.Mothers found fathers' involvement in childcare socially acceptable but often perceived them as inexperienced, which limited their participation.Control mothers' traditional view on household chores maintained the conventional labour division, influencing fathers' involvement.Fathers typically resisted maternal control of resources; however, they agreed that the more knowledgeable should lead decision‐making. BCC mothers showed greater confidence in making household decisions as effectively as fathers. [ABSTRACT FROM AUTHOR]

Background: Indirect speech and language therapy, such as parent‐implemented intervention, has been shown to be an effective approach for young children with speech and language disorders. However, relatively few studies have compared outcomes of parent‐directed therapy with child‐directed intervention, that is, individual therapy of a child delivered by a speech and language therapist (SLT). Although speech and language therapists (SLTs) regard parental engagement as imperative for successful intervention, currently they predominantly use child‐directed intervention. Aim: To evaluate the effect of parent‐ versus child‐directed speech–language therapy embedded in usual care intervention for young children with developmental language disorder (DLD). Methods & Procedures: In a randomized trial, forty‐six 3‐year‐old monolingual children with DLD were assigned to parent‐directed intervention or child‐directed intervention groups. In addition, all children received usual care in special‐language daycare centres. Outcomes included children's language development and functional communication, parents' language output, parents' perceptions and their self‐efficacy. These were assessed at three time intervals, that is, at baseline, immediately after 6 months of treatment, and 1 year after baseline. The parent‐directed intervention consisted of twelve 50‐min sessions every 2 weeks with parent and child, consisting of parental training with immediate feedback by (SLTs. Children in the child‐directed intervention group received individual speech–language therapy in weekly 30‐min sessions for 6 months. Outcomes & Results: Intervention in both groups was equally effective. All children improved significantly in receptive and expressive language measures as well as in functional communication at all intervals. All parents used significantly more language support strategies and were less concerned about their child's participation in communication. Parents in the parent‐directed intervention group reported increased self‐efficacy in stimulating their child's language development. In contrast, parents in the child‐directed intervention group reported a decrease in self‐efficacy. Though modest, these group differences were significant in both the short and long terms. Both parents and SLTs were positive about the parent‐directed intervention. Conclusions & Implications: The effects of parent‐ and child‐directed intervention for young children with DLD are similar. The parent‐directed intervention adds to treatment options for parents as well as for SLTs and creates choices for shared decision‐making. WHAT THIS PAPER ADDS: What is already known on the subject: Language therapy for young children with DLD comprises various delivery models. Two of these are child‐ and parent‐directed therapy by SLTs. Compared with no treatment, both delivery models are effective, but it is unclear if one of these results in better language outcomes than the other. SLTs value child‐directed intervention more highly than indirect approaches where treatment is delivered by others. This study aims to compare the relative effectiveness of parent‐directed intervention with child‐directed intervention, both parts of multi‐component usual care intervention. What this paper adds to existing knowledge: This randomized trial indicates that a parent‐directed intervention model is as effective as child‐directed intervention by SLTs for children's language development and functional communication. Parents' use of language support strategies was also similar in both intervention models, in the short and long terms. Like in child‐directed therapy, parent‐directed intervention reduces parents' concerns. Contrary to child‐directed treatment, parent‐directed intervention increases parents' self‐efficacy, that is, supporting their child's language development. What are the potential or actual clinical implications of this work?: Though SLTs predominantly choose a child‐directed intervention model, the study results show that they can consider parent‐directed approaches too. There are no significant differences in children's language outcomes as a function of parent‐ or child‐directed intervention. Furthermore, parents and SLTs were positive about the parent‐directed intervention program and the SLTs evaluated it as valuable and feasible. [ABSTRACT FROM AUTHOR]

Background: A promising way to obtain vocal economy and efficiency is by semi‐occluding the vocal tract while phonating. Current knowledge about the immediate effects of semi‐occluded vocal tract (SOVT) phonation on the laryngeal function and configuration is based mainly on computer modelling or excised larynges studies. In in vivo SOVT studies, electroglottography (EGG) has been the most commonly used laryngeal outcome, showing contradictory results between studies. Therefore, exploring these aspects by direct visualisation of the human larynx during SOVT phonation using strobovideolaryngoscopy (SVL) is needed. Aims: The aim of this study was to investigate and compare the immediate effects of straw phonation (SP) in air, SP in 2 cm water, and SP in 5 cm water (with stirring straws), on the laryngeal function and configuration of a homogeneous group of vocally healthy female speech‐language pathology students, visualised with flexible SVL. Methods & Procedure: A randomised controlled trial was used. Fifty‐two female speech‐language pathology students (mean age: 18.7 years, SD: 0.6) were assigned randomly to one of three experimental groups or a control group: (1) SP in air, (2) SP in 2 cm water, (3) SP in 5 cm water or (4) [u] phonation with similar soft onset and slightly pursed lips as in SP but without a straw (control group). The participants underwent flexible SVL during habitual [u] phonation, followed by the specific SOVT exercise of their group assignment. All video samples were evaluated randomly and blindly by two experienced investigators using the Voice‐Vibratory Assessment with Laryngeal Imaging (VALI) rating form, first independently and then by consensus. Outcome & Results: Compared to habitual phonation, the vibrational amplitude decreased during SP in 5 cm water and SP in 2 cm water, being more prominent in the first, more flow‐resistant exercise. The mucosal wave also decreased during SP in 5 cm water. The anteroposterior (AP) supraglottic compression similarly increased during SP in air, SP in 2 cm water, and SP in 5 cm water. Further, a rise in mediolateral (ML) compression and a decrease in phase symmetry and regularity were found during SP in 2 cm water. A similar decrease in regularity was observed during SP in 5 cm water. Conclusions & Implications: Both SP in air and SP in water cause positive immediate laryngeal effects for voice training opportunities. More AP supraglottic activity found during each SP exercise might indicate epilarynx narrowing, an economic phenomenon associated with SOVT. Immersing the straw in water additionally diminished the vibrational amplitude, lowering vocal fold impact stress and risk for phonotrauma during the exercise. The decreased regularity of the vibrational cycles during SP in water might be due to the varying back pressure created by the water bubbling. The impact of SP in water on ML supraglottic compression needs further investigation. What This Paper Adds: What is already known on the subject: A promising way to obtain vocal economy and efficiency is by semi‐occluding the vocal tract while phonating. Current knowledge about the immediate effects of semi‐occluded vocal tract (SOVT) phonation on the laryngeal function and configuration is based mainly on computer modelling or excised larynges studies. In in vivo SOVT studies, electroglottography (EGG) has been the most commonly used laryngeal outcome, showing contradictory results between studies. Therefore, exploring these aspects by direct visualisation of the human larynx during SOVT phonation using strobovideolaryngoscopy (SVL) is needed. What this paper adds to existing knowledge: Group results of the current study generally support earlier computer modelling and in vivo studies, strengthening the current SOVT knowledge. Both SP in air and SP in water cause positive immediate laryngeal effects for voice training opportunities. More anteroposterior (AP) supraglottic activity found during each SP exercise might indicate epilarynx narrowing, an economic phenomenon associated with SOVT. Immersing the straw in water additionally diminished the vibrational amplitude, lowering vocal fold impact stress and risk for phonotrauma during the exercise. The decreased regularity of the vibrational cycles during SP in water might be due to the varying back pressure created by the water bubbling. The impact of SP in water on ML supraglottic compression needs further investigation. What are the potential or actual clinical implications of this work?: Current results support that both SP in air and SP in water can be useful exercises in voice training. SP in water has shown the additional gain of lowering the vibrational amplitude during the exercise, hence supporting its appropriateness for vocal warm‐ups by minimising vocal fold impact stress and the risk of phonotrauma. In the future, large‐scale randomised controlled trials in other subgroups of voice users, including dysphonic patients, are needed to support evidence‐based practice. SVL can facilitate the search for individualised training and therapy approaches. [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: Digital game‐based learning is gaining increased attention from both researchers and educators for improving mathematics instruction. However, the evidence for game‐based learning is mixed and research with rigorous research design and analyses are limited. Objective: Here, in a pre‐registered randomized controlled study, we investigated whether a fraction game designed collaboratively by educational experts and professional game developers may serve as a useful tool to enhance students' fraction knowledge. Methods: We assigned French fifth graders to either an experimental group who used the game (n = 110) or a control group (n = 78) who received traditional instruction on fractions. Fraction knowledge was assessed pre‐ and post‐intervention. Results: Results show that students in the active control group had superior overall fraction performance than students in the experimental group at the end of intervention. However, the game had a positive effect on decimal learning. We also found a positive relation between game performance and overall fraction knowledge scores at post‐test. Contribution: The study highlights the importance of game metrics as indicators of personalized assessment tools. Given the increased usage of games in learning mathematics and the equivocal results on the effectiveness of these games, our study also highlights the importance of pre‐registration and randomized controlled studies. Lay Description: What is already known about this topic: Digital game‐based learning (DGBL) is gaining popularity in mathematics teaching.DGBL shows potential for teaching difficult abstract concepts such as fractions.However, research evaluating DGBL for fractions is limited. What this paper adds: The study examines a fraction game designed by education experts and game designers.Students fraction knowledge is assessed using paper‐based test.Challenges associated with DGBL in the classroom are discussed in the paper. Implications for practice: The results will guide educators in designing effective fraction instruction in classroom.The study highlights the critical role of instructional support in DGBL for fractions.Game based metrics can be used to individualize instruction in the classroom. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Restricted randomization, such as blocking or minimization, allows for the creation of balanced groups and even distribution of covariates, but it increases the risk of selection bias and technical error. Various methods are available to reduce these risks but there is limited evidence about their current usage, and there are also indications that reporting of these methods may not be adequate. This review aims to identify how frequently different methods of restriction are being used and to assess the reporting of these methods against established reporting standards. Methods 82 reports of randomized controlled trial were reviewed. For each trial, the reported method of randomization was recorded and the reporting of randomization was assessed. Where the method of randomization was not clear from the main paper, protocols and other published materials were also reviewed, and authors were contacted for further information. Results For 11% of trials the method of randomization was not reported in either the paper or a published protocol, and in a further 39% of cases the report omitted key details so that the predictability of the method could not be evaluated. In total, 88% of trials appear to have used some form of restricted randomization, and all of those that report the exact methods used either blocking or minimization. 15% of trials reported using blocks of six or less and 4% used minimization with no random element reported, both of which are highly predictable. Conclusion Our results indicate that the majority of trials use some form of restriction, with many using relatively predictable methods that put them at greater risk of selection bias and technical error. Reporting of randomization methods often falls short of the minimum requirements set out by the CONSORT statement, leaving the reader unable to make an informed judgement about the risk of bias. [ABSTRACT FROM AUTHOR]

Background: In an Australian randomized controlled trial (RCT), two techniques for intrapartum fetal surveillance were compared: ST analysis (STan) as an adjunct to cardiotocography (CTG), compared with CTG alone. The aim was to determine whether CTG + STan could reduce emergency cesarean birth rates while maintaining or improving neonatal outcomes. Secondary aims were to compare clinical, economic, and psychosocial outcomes. The purpose of this paper was to present psychosocial outcomes from one cohort enrolled in the trial. Methods: The study was conducted at one tertiary referral hospital. Participants who had taken part in the trial from the outset were invited to complete a questionnaire between March 2018 and January 2020, approximately 8 weeks after giving birth. Outcomes included depression, psychological distress, health‐related quality of life, and infant feeding practices. Analysis was by intention to treat. Results: N = 207/527 participants completed the questionnaire (n = 113, STan; n = 94, CTG alone). Overall, no statistically significant or clinically meaningful differences were found in the two groups for symptoms of depression, psychological distress, quality of life, or infant feeding. A statistically significant difference was observed for the subscale of pain‐discomfort, where scores were higher on average in the CTG alone arm relative to that in the CTG + STan arm. Conclusions: Although STan as an adjunct to CTG constitutes a different clinical technology from CTG alone, both monitoring types appeared to produce similar results in terms of postnatal psychosocial outcomes for women. Findings from this study provide service users and staff with a comprehensive assessment of STan that can be used to make evidence‐informed decisions about monitoring options should STan become more widely available. [ABSTRACT FROM AUTHOR]

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

Background: Virtual reality (VR) offers significant potential for hands‐on learning environments by providing immersive and visually stimulating experiences. Interacting with such environments can bring numerous benefits to learning, including enhanced engagement, knowledge construction, and higher‐order thinking. However, many current VR studies in hands‐on learning tend to utilise one‐way learning materials, limiting participants' ability to interact with and reflect on their actions and learning experiences. Moreover, these studies often neglect to assess learners' capacity to transfer their skills from VR learning to real‐world scenarios. Therefore, this study aims to investigate participants' engagement, learning outcomes, higher‐order thinking, and their ability to apply acquired skills in real‐world contexts. Method and Objective: Participants were immersed in a hands‐on learning environment in VR, where they received feedback and engaged in reflection during the learning process. This study recruited 68 university students to participate in the experiment, employing a quasi‐experimental design. Participants experienced learning units both with and without reflection on the feedback. The theme of these learning units was related to embedded systems, encompassing topics such as the assembly of embedded components and Python programming. The investigation aimed to assess whether reflection in VR could enhance cognitive levels, engagement, real‐world hands‐on tasks abilities, and higher‐order thinking. Results: The research results indicate that in the VR hands‐on learning environment, participants engage in reflection through the provided feedback, effectively enhancing their engagement, cognitive levels, and hands‐on task abilities. Simultaneously, it also successfully assists participants in developing problem‐solving skills and critical thinking in higher‐order thinking. Conclusions: Participants actively engaged in reflection on their own learning tasks and actions within the hands‐on learning environment, enabling them to develop a deeper understanding of the learning material and enhance their real‐world hands‐on tasks abilities, we encourage the integration of reflection strategies in VR learning environments for hands‐on learning, as they can yield positive benefits for learners. Lay Description: What is already known about this topic: Virtual reality learning environments can enhance students' cognitive levels.Higher‐order thinking has a significant impact on hands‐on learning.Reflection has an important influence on the cognitive process. What this paper adds: Providing reflection through feedback in a virtual reality environment increases learning engagement and promotes higher‐order thinking.Reflection in virtual reality enhances cognitive levels and practical abilities. Implications for practice and/or policy: We demonstrated the effectiveness of providing reflection through feedback in a VR hands‐on learning environment.Learners, through reflection in VR, enhance higher‐order thinking, engagement, cognitive levels, and practical abilities. What are the 1 or 2 major takeaways from the study: Providing reflection in VR learning environments used for training or hands‐on learning can effectively promote cognitive levels, engagement, higher‐order thinking abilities, and practical skills.Through VR reflection, we reveal the potential of cultivating higher‐order thinking through VR. [ABSTRACT FROM AUTHOR]

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

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

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

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

Training design for automatic skills has a vast domain of application, such as education, physical and cognitive rehabilitation, as well as sports, arts and professional training. Gamification concept used in technology‐assisted training has the potential to increase motivation, engagement and adherence to the training programme. Currently, the general gamification models of learning, did not take into account the temporal specificity of the game elements for automaticity acquisition training. In order to address this problem, an extensive overview of the key training attributes that impact automaticity acquisition was carried out. Then, based on this review, the three steps of a proposed model were presented. The first step of this model, named Task Analytics, helps with task‐specific training decisions. The second step provides descriptive and prescriptive approaches for the three phases of automaticity acquisition (fast learning, slow learning and automatization). The descriptive part characterizes each phase using psychological and performance‐related qualities, while the prescriptive part recommends the appropriate training elements for each phase. Based on the prescriptive part, a game‐design model is proposed in the third step, which classifies the game mechanics and maps them onto each phase of automaticity acquisition. Finally, to validate this approach, a mobile game was designed based on the proposed gamification model, and it was compared to control design. The two approaches are tested with 49 participants. The results showed that the experimental group had a significantly better engagement and higher performance. Furthermore, the experimental group showed significantly better performance in a multitasking challenge designed to evaluate the automaticity. The main contribution of this article is the proposed game design model that takes into account the temporal specificity of game elements during the acquisition of automaticity. Lay Description: What is already known about this topic: Automaticity is omnipresent in our daily lives. It includes a wide variety of physical or cognitive abilities.Training principles for knowledge acquisition are different from automaticity acquisition.Fostering automaticity needs a substantial amount of repetition, which in turn, requires motivation and engagement.Game‐based approaches can improve motivation and engagement. However, their designs have remained largely arbitrary and do not follow clear design guidelines. What this paper adds: Current serious game‐design models target knowledge acquisition or learning in general. However, the presented model focuses specifically on automaticity acquisition.This paper provides an updated and comprehensive overview of the key training elements required for the acquisition of automatic skills.This three‐step model is proposed based on the evidence in the literature; it suggests the appropriate training elements, and game mechanics for each phase of automaticity acquisition.The results of the experimental study validated the effectiveness of the proposed model. Implications for practice and/or policy: Medical conditions, in which an automatic skill (physical or cognitive) is affected, can greatly benefit from this serious game design model.In designing serious games, a differentiation should be made between knowledge acquisition and skill acquisition (including automaticity acquisition).Automaticity acquisition goes though phases and this should be reflected in both training design, as well as, serious game design.Some training design choices are task‐specific or depend on the target group (e.g., age). Hence, their designs should follow recommendations extracted from the literature. [ABSTRACT FROM AUTHOR]

Objective: Few studies evaluated low concentrations of hydrogen peroxide protocols. The aim of this paper was evaluated two application protocols using 4% hydrogen peroxide in at‐home bleaching. Materials and Methods: Eighty‐six patients with upper canines' shade A2 or darker were randomly allocated under two experimental conditions: two daily applications of 1 h each or a 2‐h single application. Color change was evaluated using Vita Classical, Vita Bleachedguide, and digital spectrophotometer weekly and 1 month after the bleaching procedure through one‐way ANOVA. The risk and intensity of tooth sensitivity (TS) was assessed through visual and numeric rating scale and measured by Fisher's exact test, Mann–Whitney test and one‐way ANOVA respectively. Results: After 3 weeks, the mean difference for the ΔSGU Vita Classical (1.0; 95% CI −0.1 to 2.0), ΔEab (0.7; 95% CI −1.4 to 2.8), ΔE00 (0.1; 95% CI −1.4 to 1.6) and Wi (1.8; 95% CI ‐1.9 to 5.5) presented no difference (p > 0.08). The relative risk for TS was 0.91 (0.72 to 1.14) without significant difference neither in the risk (p = 0.6) nor in the TS intensity for both pain scales (p > 0.65). Conclusions: The application protocols evaluated (two daily applications of 1 h each or a 2‐h single application) for at‐home bleaching with 4% hydrogen peroxide did not showed differences in color change and tooth sensitivity. Clinical Relevance: Higher amount of active hydrogen peroxide in two daily applications for at‐home bleaching neither accelerate bleaching nor increase the risk or intensity of tooth sensibility. [ABSTRACT FROM AUTHOR]

Background: Successful communication is vital to quality of life. One group commonly facing speech and communication difficulties is individuals with intellectual disability (ID). A novel route to encourage clear speech is offered by mainstream smart speakers (e.g., Amazon Alexa and Google Home). Smart speakers offer four factors important for learning: reward immediacy, spaced practice, autonomy/intrinsic motivation and reduced social barriers. Yet the potential of smart speakers to improve speech intelligibility has not been explored before. Aims: To determine whether providing individuals with intellectual disabilities with smart speaker devices improved ratings of speech intelligibility for (1) phrases related to device use and (2) unrelated words via a semi‐randomized controlled trial. Methods & Procedures: In a semi‐randomized controlled trial, an intervention group of adults with ID (N = 21) received smart speakers, while a control group (N = 22) did not. Before and after about 12 weeks, participants were recorded saying smart speaker‐related phrases and unrelated words. Naïve participants then rated the intelligibility of the speech recordings. Outcomes & Results: The group that received smart speakers made significantly larger intelligibility gains than the control group. Although the effect size was modest, this difference was found for both smart speaker‐related phrases and unrelated words. Conclusions & Implications: While the mechanism of action remains to be determined, the presence of smart speakers in the home had a demonstrable impact on ratings of speech intelligibility, and could provide cost‐effective inclusive support for speech and communication improvement, improving the quality of life of vulnerable populations. What this paper addsWhat is already known on the subjectSpeech intelligibility is a key obstacle for social relationships and quality of life across several vulnerable populations (children with speech difficulties, older adults with dementia, individuals with ID). Anecdotal reports suggest mainstream smart speakers (e.g., Amazon Alexa, Google Home), could improve speech intelligibility.What this paper adds to existing knowledgeWe used a semi‐randomized controlled trial to show that using a smart speaker for about 12 weeks could improve ratings of speech intelligibility in adults with ID for both smart speaker‐related phrases and unrelated words.What are the potential or actual clinical implications of this work?These initial findings suggest that smart speaker technology could be a novel, and inclusive, route to improving speech intelligibility in vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: Almost no research has been published reporting on evaluations of the effectiveness of psychological interventions for people with severe to profound intellectual disabilities and depression. This paper describes the development and initial feasibility testing of an adapted Behavioural Activation therapy (BeatIt2) for this population. Method: Phase 1 of the study examined participant recruitment and willingness to be randomised in the context of a planned Randomised Controlled Trial (RCT). Phase 2 examined the feasibility of delivering the intervention. Results: Twenty adults with a severe or profound intellectual disability and clinically significant depression were recruited to Phase 1 of the study. In Phase 2, there was 100% participant retention for those recruited to the study at 6‐month follow‐up. The BeatIt2 therapy was reported to be acceptable for participants. Conclusion: COVID disruption meant that it was not possible to complete the planned feasibility RCT. The positive findings suggest that additional evaluation of BeatIt2 is warranted. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) is becoming increasingly accessible and being utilized in various organizations to meet education and training needs. Despite its potential, research regarding VR applications has focused on measuring the effectiveness of VR programs relative to non‐VR programs; consequently, the ways in which VR programs are effective remain unclear. Objectives: Recognizing this research gap, this study examined whether task type‐dependent differences in training outcomes exist between VR training and non‐VR training groups. Methods: To examine the effects of VR technology for training purposes in a military setting, we conducted a quasi‐experiment focusing on how the effects vary based on task characteristics. A total of 90 military personnel were randomly assigned to either an experimental group (VR) or a control group (non‐VR). After completing their respective training, the two groups participated in four tasks simulating real battle scenarios and designed to evaluate the effectiveness of the VR‐based training. We analysed primary data collected through survey instruments and performance evaluation using a one‐way between‐group analysis of covariance (ANCOVA) and supplementary interview data using thematic analysis. Results and Conclusions: The quantitative analysis showed that the VR group performed better than the control group on three tasks in which communication, interaction and immediate situational judgements were critical. No difference was found between the two groups in the other task, which involved the routine operation of physical objects. Additional interview data revealed the extent to which trainees perceived the VR training as effective in understanding in‐situ conditions, preparing and practising their own and their team's reactions to emergent situations and in manipulating virtual objects. Implications: Our findings provide insight into VR technology's potential to enhance human performance in various training contexts. VR is specifically effective in training that aim to improve immediate judgement and group coordination. Our findings provide useful information for those seeking to design and develop training environments that maximize the effects of VR. Lay Description: What is already known about this topic: Virtual reality training is widely used to train personnel in high‐risk/cost occupations (e.g. surgeons and military personnel).Virtual reality education and training help to improve cognitive and affective function as well as psychomotor skills.The success of technology adoption depends on how well the task characteristics are aligned with technological characteristics. What this paper adds: The current study helps verify the generalizability of the TTF theory and provides an in‐depth framework that can be used to classify task types to optimize VR training.VR training programs are more effective when assigned tasks involve solving problems in groups and/or require spontaneous decision‐making than individual physical operations. Implications for practice and/or policy: When considering VR integration to an existing or new training program, the types of tasks to be designed in the program should be well‐aligned with the technological characteristics.At the organizational level, strategic adoption of VR in the training field should be initiated instead of replacing the existence of areas in current/traditional training (i.e. individual physical operation in this study). [ABSTRACT FROM AUTHOR]

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

Background: 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: Eye movement modelling examples (EMME) are demonstrations in which learners' not only see a model's (e.g., a teacher's) task performance on a computer screen (as in regular video examples) but also the model's eye movements (represented as moving coloured dots overlaid on the screen). Thereby EMME help guide learners' attention towards the relevant information and can model cognitive strategies which are otherwise unobservable for learners. Objectives: This study investigated whether EMME can help to learn deductive reasoning strategies and how the presence/absence of a teacher's verbal explanation affects learning from EMME. Methods: Secondary education students (N = 137) were randomly assigned to study video examples under one of four conditions in a 2 (EMME: yes/no) x 2 (verbal explanations: yes/no) between‐subjects design. Results and Conclusions: Results revealed only a beneficial effect of the presence of verbal explanations on performance on the practice problems, but no pretest‐to‐posttest learning gains. Implications: Seeing the teacher's eye movements does not appear to enhance learning of deductive reasoning. The presence/absence of the teacher's verbal explanation does not seem to affect learning deductive reasoning. Lay Description: What is currently known about the subject matter?: Eye movement modelling examples (EMME) are demonstrations in which learners not only see a teacher's task execution on a computer screen (as in video examples) but also the teacher's eye movements.The eye movements in EMME were visualized as moving coloured dots overlaid on the screen recording.EMME help direct attention to relevant information and enhance learning; it is not yet known if this also applies to reasoning problems.It is unknown if and how presence/absence of a teacher's verbal explanation affects learning from EMME. What our paper adds to this?: Secondary education students watched EMME or regular video examples with/without a teacher's verbal explanation.The examples demonstrated how to solve deductive reasoning problems (adapted version of the Mastermind game).Performance and learning gains were examined and revealed no differences between conditions. The implications of study findings for practitioners: Seeing the teacher's eye movements does not appear to enhance learning of deductive reasoning.The presence/absence of the teacher's verbal explanation does not seem to affect learning deductive reasoning. [ABSTRACT FROM AUTHOR]

Background: Medicines are often suboptimally managed for heart failure patients across the transition from hospital to home, potentially leading to poor patient outcomes. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme included: understanding the problems faced by patients and healthcare professionals; developing and co‐designing the Medicines at Transitions of care Intervention (MaTI); a cluster randomized controlled trial testing the effectiveness of a complex behavioural MaTI aimed at improving medicines management at the interface between hospitals discharge and community care for patients with heart failure; and a process evaluation. The MaTI included a patient‐held My Medicines Toolkit; enhanced communication between the hospital and the patient's community pharmacist and increased engagement of the community pharmacist postdischarge. This paper reports on the patients' experiences of the MaTI and its implementation from the process evaluation. Design: Twenty one‐to‐one semi‐structured patient interviews from six intervention sites were conducted between November 2018 and January 2020. Data were analysed using the Framework method, involving patients as co‐analysts. Interview data were triangulated with routine trial data, the Consolidated Framework for Implementation Research and a logic model. Results: Within the hospital setting patients engaged with the toolkit according to whether staff raised awareness of the My Medicines Toolkit's importance and the time and place of its introduction. Patients' engagement with community pharmacy depended on their awareness of the community pharmacist's role, support sources and perceptions of involvement in medicines management. The toolkit's impact on patients' medicines management at home included reassurance during gaps in care, increased knowledge of medicines, enhanced ability to monitor health and seek support and supporting sharing medicines management between formal and informal care networks. Conclusion: Many patients perceived that the MaTI offered them support in their medicines management when transitioning from hospital into the community. Importantly, it can be incorporated into and built upon patients' lived experiences of heart failure. Key to its successful implementation is the quality of engagement of healthcare professionals in introducing the intervention. Patient or Public Contribution: Patients were involved in the study design, as qualitative data co‐analysts and as co‐authors. [ABSTRACT FROM AUTHOR]

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

Background: Children who experience adversity are more vulnerable to language difficulties. Early interventions beginning antenatally, such as home visiting, are provided to help prevent these problems. To improve the precision of early interventions, the impact of combinations of risk and protective factors over time must be explored and understood. There is, however, limited research investigating how such factors interact with intervention to change language outcomes over time. Aim: To explore the different paths that lead to Good and Poor language in a cohort of children experiencing adversity whose mothers received an optimal dose of the Maternal Early Childhood Sustained Home visiting (MECSH) intervention over 2.5 years. Methods & Procedures: A total of 24 low socioeconomic status (SES) mothers experiencing adversity and their children who received more than half the scheduled dose of the MECSH intervention were followed over time: from before birth to school entry. Data were extracted from surveys and direct measurement over the study course. Child language outcome at school entry and the influence of seven key child, maternal and environmental factors, which have been shown in previous research to result in Good and Poor language outcomes, were explored through qualitative comparative analysis (QCA). QCA is a qualitative analytical technique that provides a deeper understanding of factor combinations influencing language development. Outcomes & Results: Multiple paths to Good (six paths) and Poor language (seven paths) were found. Paths with mostly protective factors resulted in Good language, except when maternal antenatal distress was present. Paths with two or more influential risks usually resulted in Poor language outcomes. When children experiencing adversity received the MECSH home visiting intervention, there was no one risk or protective factor necessary for Good or Poor language outcomes; however, there were clear patterns of factor combinations. Conclusions & Implications: Mothers' antenatal psychological resources were a flag for future language concerns which can be used to improve the precision of the MECSH intervention. They were highly influential to their children's Good and Poor language outcomes by 5 years, when over time they were combined with characteristics such as early childhood education, poor maternal responsivity and/or the number of children in the home. Knowledge of early conditions associated with later Poor language can help clinicians identify and respond in preventative and promoting ways to improve language skills. What this paper addsWhat is already known on the subjectChildren experiencing adversity are more vulnerable to language difficulties. Both risk for language difficulties and protection against them in this group are via a complex combination of factors. It is unknown how intervention works with these complex factors to result in Good and Poor language outcomes.What this paper adds to existing knowledgeThere are multiple paths to both Good and Poor language outcomes for children experiencing adversity. Mothers' psychological resources antenatally in combination with other key factors were particularly influential to Good and Poor language outcomes.What are the clinical implications of this work?In this study, maternal antenatal distress together with poor maternal responsivity were present in children's paths to Poor language outcomes at school entry. An extra focus on responsivity is required in antenatally distressed mothers of children experiencing adversity in early interventions. Children of mothers with good psychological resources antenatally who received home visiting intervention had Good language outcomes at 5 years when combined with 3 years or more of early childhood education and if there were one to two children in the home. Knowledge of these influences on language development can improve the precision of home visiting interventions and help clinicians tailor their visits to individual families' needs. [ABSTRACT FROM AUTHOR]

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

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

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

Background: Health sciences education prepares students for social‐ and healthcare by developing evidence‐based nursing, leadership and working life skills, including collaboration. Due to the changes caused by the global pandemic, health sciences education has shifted more to online and hybrid contexts, which can challenge students' competence development. Students' competence development and interaction in collaborative hybrid learning is a little researched area. Objectives: To observe and evaluate health sciences students' competence development in a collaborative hybrid learning context. Methods: This quasi‐experimental mixed‐method study was implemented by providing educational intervention. First‐year Bachelor's degree health sciences students (n = 18) of a Finnish university completed an educational intervention with synchronous online and face‐to‐face learning. Students' collaborative hybrid learning and interaction were video observed, while self‐evaluation of competence development was made with a questionnaire. Results: In the collaborative interactions, the students showed analytical thinking, problem‐ solving and communication and technology skills. Extensive knowledge of health sciences and ethics skills was not strongly visible in interaction. The students effectively used collaborative work time to perform tasks. Cognitive interaction (monitoring and evaluating learning) was observed in 85% and socio‐emotional interaction (expressions of emotions and motivation) in 53% of the data. Related to the students' learning results, the students' ability to communicate and interact with culturally different people improved after the educational intervention. Conclusion: Collaborative learning methods in hybrid learning can create opportunities for students to construct their competence in interaction. Attention should be paid to different areas of competence and the role of socio‐emotional interaction. Lay Description: What is already known about this topic: Health sciences education prepares students for social and healthcare by developing working life skills, including collaboration.Hybrid learning brings benefits but challenges the equity of students with different attention modes.Collaborative learning is widely used but has not been studied much in hybrid context.Students' competence development and interaction in collaborative hybrid learning is a little researched area. What this paper adds: The purpose was to observe and evaluate health sciences students' competence development in a collaborative hybrid learning context.Hybrid collaborative interaction encourages students to construct knowledge in health sciences.The students utilised the collaborative time appropriately.Socioemotional interactions were very visible in collaborative learning. Implications for practice: This study helps educational organisations to design hybrid model education.The design requires pedagogical and technical competence and should include collaborative methods.Attention should be paid to different areas of competence in collaborative learning.The role of socio‐emotional interaction needs more focus in hybrid learning. [ABSTRACT FROM AUTHOR]

Background: Narrative discourse is central to effective participation in conversations. When discourse is assessed in people with communication disability, structured tasks (e.g., picture descriptions) provide experimental control, while unstructured tasks (e.g., personal narratives) represent more natural communication. Immersive virtual reality (VR) technology may provide a solution by creating standardized experiences for narrative retell, therefore balancing ecological validity and experimental control in discourse assessment. Research is needed to understand how VR immersion affects narrative retell, first for adults with no communication disability, before application with adults with aphasia or related communication disability. Aims: To assess (1) the effects of VR immersion on the linguistic content and structure of narrative retells in a healthy adult population; and (2) whether VR immersion can influence the way a narrative is retold so that the speaker conveys their own experience, rather than the experience of the characters they are watching. Methods & Procedures: In this pilot cohort study, 13 healthy adult participants with no reported communication disability watched an animated short film and a comparable immersive VR short film in a randomized order. Participants were asked to retell the events of the story after each condition in as much detail as possible. Outcomes & Results: Mean length of utterance (in morphemes) was significantly higher in the video condition compared with the VR condition. Significantly more first‐person pronouns were used in the VR condition compared with the video condition. No other measures of linguistic content or structure were significantly different between the VR and video conditions. Conclusions & Implications: Increased morpho‐syntactic length and complexity in the video condition may suggest effects of elicitation stimulus on the narrative produced. The larger number of first‐person pronouns in the VR condition may reflect that participants experienced a sense of presence in the virtual environment, and therefore were able to retell their communication experience rather than narrating the experiences of characters from an external perspective. Given the increasing need for more functional assessment of discourse in people with communication disability, further research is needed to validate these findings. WHAT THIS PAPER ADDS: What is already known on this subject: As an ecologically valid tool, discourse analysis is often used to assess daily communicative exchanges in adults with acquired communication disability. Clinicians and researchers using narrative discourse assessment must balance the experimental control and diagnostic reference sample capabilities of structured tasks with the ecological validity and real‐life transferability of unstructured personal narratives. What this study adds to existing knowledge: This study explores the use of immersive VR technologies to create standardized, replicable, immersive experiences as a foundation for narrative discourse assessment. It highlights how the 'sense of presence' in a virtual world can prompt healthy adult speakers to retell a narrative of a personal experience that can be replicated for many different participants. The results suggest that immersive VR narrative assessment for adults with communication disability may balance ecological validity with measurement reliability in discourse assessment. What are the potential or actual clinical observations of this work?: Immersion in VR resulted in the production of narratives with morpho‐syntactic features that aligned with typical narrative generation, rather than retell. Participants used more first‐person pronouns, suggesting retelling of personal experience. Though further study is needed, these preliminary findings suggest clinicians can use immersive VR stimuli to generate structured story generations that balance experimental and diagnostic control with ecological validity in narrative discourse assessment for adults with communication disability. [ABSTRACT FROM AUTHOR]

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

Background: 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]

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

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

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

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

Zinc deficiency is a global public health problem, affecting ~17% of the world's population, with the greatest burden in low‐ and middle‐income countries. An increasing body of evidence suggests that biofortification may be a cost‐effective and sustainable approach to reducing zinc and other micronutrient deficiencies. Biofortification enhances the nutritional quality of food crops through conventional plant breeding techniques and agronomic practices. This paper presents ongoing research on biofortification in Pakistan, where over 40% of women are zinc deficient. The Biofortified Zinc Flour to Eliminate Deficiency (BiZiFED) project aims to investigate the impact of biofortification as a strategy to alleviate zinc deficiency in Pakistan. The project is supported by the Biotechnology and Biological Sciences Research Council (BBSRC) Global Challenges Research Fund from May 2017 to April 2019. This paper outlines the four objectives and work packages within the BiZiFED project: (1) a double‐blind, randomised controlled trial to examine the effect of consuming flour made from a high zinc variety of biofortified wheat (Zincol‐2016/NR‐421) on dietary zinc intake and status; (2) a cost‐effectiveness study to assess the health and economic impact of agronomic biofortification of wheat; (3) a mixed methods study to explore the cultural acceptability and sustainability of biofortification in Pakistan; (4) capacity building and development of long‐term research partnerships in Pakistan. The findings will contribute to the evidence base for the potential impact of biofortification to alleviate zinc deficiency among the poorest communities. [ABSTRACT FROM AUTHOR]

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

While the educational disruption caused by the Covid‐19 pandemic underscores the importance of blended learning in higher education, research on the effectiveness of blended learning is still inconclusive. Drawing from the motivational design model of the ARCS (i.e., attention, relevance, confidence, and satisfaction), this study attempts to fill the gap to evaluate effectiveness of blended learning from a multi‐dimensional perspective. Participants were randomly assigned into three experimental groups (i.e., face‐to‐face, pure online, and blended). A questionnaire survey was administered in each group after the trial courses. The data was analysed by using the one‐way ANOVA with post hoc tests. The results showed that blended learning outperformed pure online learning in enhancing students' attention, confidence, and satisfaction perceptions. Additionally, blended learning had a higher level of satisfaction perception than face‐to‐face learning. Follow‐up interviews were also conducted to provide an in‐depth understanding of how blended learning motivated students during the learning process. Considering that blended learning may become a new normal in higher education after the Covid‐19 pandemic, the findings of the present study provide evidences to support the effectiveness of the blended learning approach in addressing students' motivational needs. Lay Description: What is already known about this topic?: Blended learning, also called as hybrid learning, is a learning approach that combines face‐to‐face learning with online learning;It is able to integrate benefits afforded by both traditional face‐to‐face learning and pure online learning to deliver course content;However, the findings concerned with the effectiveness of blended learning are mixed;The measurements of learning effectiveness in previous studies are often based on single variables (e.g., test score or students' satisfaction), but neglect the multi‐dimensional nature of learning effectiveness. What this paper adds?: Based on motivational design model of the ARCS (i.e., attention, relevance, confidence, and satisfaction), the present study compared the effectiveness of blended learning with other learning approaches (e.g., pure online learning and face‐to‐face learning) through a randomized experiment;It was identified that blended learning outperformed pure online learning in enhancing students' perceptions of attention, confidence, and satisfaction;Blended learning also had a higher level of satisfaction perception compared to face‐to‐face learning;Last but not least, evaluating learning effectiveness from an integrated lens of objective assessment based on test scores and subjective assessment based on the multi‐motivational perspectives is an important first step to understanding the effectiveness of blended learning to support learning in higher education in the future. Implications for practice and/or policy: As blended learning outperforms pure online in several motivational appeals, it is recommended that universities should consider conducting blended learning as far as possible rather than pure online learning;Learning strategies can be applied to trigger students' curiosity and keep them engaged continuously in the learning process, such as utilizing a variety of online quality resources, and interacting with students from other universities through online communities;As the confidence of taking blended learning courses varies among different levels of students, instructors should try to provide sufficient support during the learning process especially for the online sections;Since satisfaction is identified as a critical motivator, instructors should pay more attention on how to improve students' satisfaction through the design of blended learning, such as try controlling the length of course videos and interacting with students synchronously in the online course platforms;Last but not least, since some of the tasks in blended learning need to be initiated and completed by students themselves, it is necessary for educational institutions to consider incorporating the training for self‐regulation as part of their competence based training. [ABSTRACT FROM AUTHOR]

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

Background: Past research has shown that seductive details (i.e., interesting, but irrelevant adjuncts in learning materials) hamper learning in short, instructor‐paced learning sessions through impaired cognitive processing. Objectives: We integrate theory and research on multimedia learning and self‐control to test whether detrimental effects of seductive details also apply to longer and strenuous learning sessions (e.g., online lectures), in which there is greater need for self‐control. Methods: A total of N = 194 students studied five chapters in a digital learning unit about chemistry either (1) without seductive details, or (2) with seductive details but without being informed about their irrelevance for the learning goal, or (3) with seductive details while being informed about their irrelevance. To assess learning outcomes, all students completed the same posttests for recall and transfer of knowledge. Results and conclusions: For students who were uninformed about the details' irrelevance, the seductive details impeded learning outcomes not just overall, but also in the final phase of prolonged studying (i.e., when the willingness to self‐control is reduced). The latter effect was mediated through a reduced positive affect. Implications: The seductive details effect seems to generalize to prolonged learning sessions, where students may start to dislike the seductive details. Lay Description: What is already known about this topic?: Seductive details (i.e., interesting, but irrelevant adjuncts) hamper learning in short instructor‐paced learning sessions through impaired cognitive processing.However, they also have beneficial effects on affective factors.These benefits did not translate to better learning outcomes in past research.It is unknown whether the affective benefits could translate to better learning outcomes in longer, more self‐paced learning sessions (e.g., digital learning sessions), with higher self‐control demands. What this paper adds?: The harmful effect of seductive details on learning also appears in extended and self‐paced digital learning sessions.However, seductive details hampered learning only when students perceived them as relevant. The implications of study findings for practitioners: Seductive details should be used very cautiously or even be excluded from instructional material.If it is impossible to dismiss the seductive details in actual learning materials, students should be informed about the details' irrelevance for learning to avoid their potential negative effects. [ABSTRACT FROM AUTHOR]

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

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

Difficulties in implementing effective instruction for at‐risk students arise from two challenges: the transfer of evidence‐based knowledge and the lack of economic resources. Computer‐assisted programmes offer a suitable solution, providing quality instruction using low‐cost resources. Thirty‐two first‐grade students with early learning difficulties were identified and paired based on at least three of the pre‐intervention reading measures (reading efficiency of monosyllabic and disyllabic items, words, pseudowords and text reading speed). Each pair was assigned to one of two different intervention programmes: a computer‐assisted intervention programme (CAIP) focused on syllables or the programme provided by the Spanish State School Assistance Services (SSAS). Every week, the CAIP participants received in pairs four 15‐min training sessions on syllable decoding plus one 30‐min group comprehension session. The CAIP was delivered by trainee students. The SSAS programme typically consisted of a 1‐hr individual or in small groups sessions per week delivered by trained practitioners. Both programmes were administered for 11 weeks. The CAIP intervention showed better results than the SSAS intervention for both decoding and comprehension, with moderate to large effect sizes. Lay Description: What is already known about this topic: Implementing effective instruction for at‐risk students presents two challenges: evidence‐based knowledge transfer and lack of economic resources.The use of computer‐assisted programmes to provide quality instruction for at‐risk students is not a common practise in the Spanish context. What this paper adds: A comparison between a computer‐assisted instructional programme (CAIP) and a programme provided by the Spanish State School Assistance Services (SSAS).A programme designed to be applied by professionals or non‐professionals with minor guidance.The CAIP intervention showed better results after 11 weeks of application, replicating the positive effects of computer programmes in other languages. Implications for practise and/or policy: Findings showed that computer programmes represent an effective tool for the transfer of scientific knowledge to educational practise with little economic cost, minor teaching training and short time. [ABSTRACT FROM AUTHOR]

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

Copyright of Journal of Computer Assisted Learning is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Aim: This study compared the cost-effectiveness of botulinum neurotoxin A (BoNT-A) injections with two-duct ligation of the submandibular glands as treatment for severe drooling after one treatment cycle.Method: The study was part of a larger, partly single-blinded, randomized clinical trial (trialregister.nl identifier NTR3537). Data were collected between 2012 and 2017. Evaluation was at 32 weeks after one treatment cycle. Fifty-seven patients with cerebral palsy or other neurological, non-progressive disorders and severe drooling classified as having a drooling frequency ≥3 or a drooling severity ≥2, in whom conservative treatment was deemed ineffective, were randomized to treatment by BoNT-A or two-duct ligation. An incremental cost-effectiveness ratio (ICER) was calculated using the success rates as the measure of benefit. Treatment success was defined as a decrease ≥50% from baseline to 32 weeks in the subjective visual analogue scale for the severity of drooling or the objective drooling quotient.Results: Fifty-three patients were analysed (22 females, 31 males; mean age 11y, range 8-22y). Average costs for one treatment cycle, which included one BoNT-A injection, were €1929 (standard error 62) for BoNT-A and €3155 (standard error 99) for two-duct ligation. Treatment success was in favour of two-duct ligation (63% vs 27%; number needed to treat 3). The ICER was €34 per 1% gain in treatment success in favour of two-duct ligation versus BoNT-A.Interpretation: The additional cost of two-duct ligation is to some extent offset by a larger treatment success rate compared with BoNT-A.What This Paper Adds: Botulinum neurotoxin A (BoNT-A) is less expensive per percentage of success than two-duct ligation. The additional cost of two-duct ligation over BoNT-A is offset by greater treatment success. [ABSTRACT FROM AUTHOR]