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The adoption of Information and Communication Technologies in early childhood education is crucial for adapting traditional classrooms to the digital era. Over time, young children are increasingly using touch screen technologies such as tablets at home and in early childhood settings. However, the literature shows that there is a significant gap in knowledge of using this technology in early childhood education. Most researchers have focused on the pedagogical theory behind using touch screen devices, but there have not been many empirical studies about how these technologies affect students' learning processes. This paper presents three learning experiences where early childhood students perform educational activities using tablet computers, interactive whiteboards, and paper cards. The results show that students who used the technology were more motivated and achieved better results that those who used paper cards. Lay Description: What is already known about this topic: The use of ICT in childhood education offers new possibilities for teachers to provide new and more visual digital learning content to their students.Touch technologies seem suitable for young students. Because their motor skills are not fully developed yet, interacting with computers through a mouse and a keyboard is more difficult than doing it through natural gestures.There are many studies in higher education levels that demonstrate that proper use of ICT in education can lead to an increase of the students' motivation and learning. What this paper adds: Three empirical studies in three different childhood education classrooms to shed some light about how ICT can impact positively students learning.A comparison of interactive whiteboards and tablet computers benefits regarding more traditional methodologies in childhood education.Insights about how hardware and software can be combined to provide students a suitable learning environment in childhood education classrooms. Implications for practice and/or policy: Teachers should consider how they will create the workgroups. It is highly advisable to create heterogeneous groups taking into account the students' skills. This way, members of the same group can help each other, creating a richer learning scenario.Several teachers who participated in our studies said that they were not able to use ICT in their classrooms because they did not have enough digital competences. Our studies and the results obtained led them consider integrating technology in their classrooms. The good results obtained by the students who worked with technology changed the teachers' perspective about the use of technology in the classroom.Students showed a great interest in the use of tablet computers and interactive whiteboards, which translated into higher motivation compared with the students who solved the activities on paper. [ABSTRACT FROM AUTHOR]

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

Background: Although existing studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and music therapy have advantages in the treatment of non‐fluent aphasia, the efficacy of the combination of these two methods remains to be investigated. Aims: To investigate the clinical efficacy of low‐frequency rTMS combined with music therapy on language function and depression in patients with non‐fluent aphasia after stroke. Methods & Procedures: A single‐blind parallel randomised controlled trial was conducted. Sixty patients (mean duration = 93.78 days) with non‐fluent aphasia after stroke were randomly divided into a traditional therapy group (n = 20), a music therapy group (n = 20) and a combined therapy group (n = 20, 1 Hz). The language function and depression were evaluated before and 3 weeks after treatment with the Chinese version of the Western Aphasia Battery scale, Boston Diagnostic Aphasia Examination scale and Stroke Aphasic Depression Questionnaire Hospital Version scale. Outcomes & Results: The combined therapy group was significantly better in all outcomes than the traditional therapy group and was significantly better in depression than the music therapy group. The music therapy group was significantly better in repetition and depression than the traditional therapy group. Language improvement was positively correlated with depression improvement. For adverse events, only two patients in the combined therapy group showed slight dizziness during rTMS treatment and their symptoms improved after rest. Conclusions & Implications: Our preliminary randomised controlled study indicates that low‐frequency rTMS combined with music therapy is feasible and safe in improving language function and depression in non‐fluent aphasia patients after stroke. WHAT THIS PAPER ADDS: What is already known on this subject: Repetitive transcranial magnetic stimulation (rTMS) and music therapy respectively have advantages in the treatment of non‐fluent aphasia after stroke, but whether the combination of the two methods is more effective is still unknown. What this paper adds to the existing knowledge: This is one of the first randomised control trials to investigate whether the clinical efficacy of low‐frequency rTMS combined music therapy for non‐fluent aphasia is better. The findings show that low‐frequency rTMS combined music therapy is superior to traditional therapy in spontaneous speech, auditory comprehension, repetition, naming, aphasia quotient, functional language level and depression, and superior to music therapy in depression, while music therapy is superior to traditional therapy in repetition and depression. What are the potential or actual clinical implications of this work?: Low‐frequency rTMS combined music therapy may be a better method for treatment of non‐fluent aphasia. [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: Simulated learning activities are an effective tool for reducing speech–language therapy (SLT) students' anxiety and improving their confidence for clinical placements. Such activities include interacting with patients who are actors, clinical educators or peers and are known to decrease anxiety and increase confidence in SLT students. Screen‐simulated patients using video are another alternative, which has not yet been fully evaluated in the education of SLT students. Aims: To compare the effectiveness of (1) modified simulated patient and (2) video simulated learning for increasing self‐reported (a) confidence and (b) preparedness and (c) decreasing self‐reported anxiety. Methods & Procedures: This study used a randomized crossover design with 127 first‐year graduate‐entry master's SLT student participants. Students participated in two activities related to a clinical interaction with a paediatric client's carer: (1) a 1‐hr modified simulated patient experience with clinical staff as the simulated patient; and (2) a video‐learning task, with two videos of a clinician–carer interaction and an accompanying worksheet. Students were randomly allocated to a group of four students and the groups randomly allocated to receive modified simulated patient or video‐learning first. Students were not blinded to the activities. The students completed a 19‐item questionnaire at three time points: before either activity, after the first activity and after the second activity, to evaluate their self‐reported confidence, clinical preparedness and anxiety. Outcomes & Results: A total of 62 students completed modified simulated patient first and 63 completed video‐learning first. After either single activity the students had significantly increased confidence and preparedness scores, while only the modified simulated patient significantly reduced student anxiety scores. As a second activity, modified simulated patient resulted in further significant improvements in confidence, preparedness and anxiety; however, adding video learning as a second activity resulted in no significant benefit. Conclusions & Implications: This study demonstrates the effectiveness of two low‐resource clinical‐learning activities for novice SLT students that can be applied in a range of settings. Of the two activities, modified simulated patient had greater effectiveness, as it was the only activity to decrease anxiety. An investigation of the pedagogical principles within the activities revealed that modified simulated patient activity had more opportunities for peer learning, supervisor feedback and verbal reflection in comparison with video learning that may explain the increased benefits. What This Paper Adds: What is already known on the subject: Simulated learning activities are an effective teaching tool for SLT students, increasing confidence and decreasing anxiety in preparation for placement. Simulated patients require more resources than video simulation. Both simulated patients and video simulation provide a safe learning environment, where students can learn without risk to clients. What this paper adds to existing knowledge: This study is among the first to investigate a modified version of simulated patients; our modification involves a clinical educator performing the role of both the simulated patient and simulation facilitator. It is the first to evaluate simulation via video learning for SLT students. The paper demonstrates the effectiveness of these two activities, and the slight advantage of modified simulated patient, for increasing novice students' confidence and preparedness and decreasing their anxiety about clinic. It also unpacks the pedagogical principles used in each activity to explain the reasons that modified simulated patient had greater effectiveness. What are the potential or actual clinical implications of this work?: The two educational activities required no specialist equipment and can be applied in a range of pre‐clinical and clinical settings by university staff and/or community clinical educators. Increasing confidence and preparedness, and decreasing anxiety will help ensure that student learning on scarce clinical placements is maximized. [ABSTRACT FROM AUTHOR]

Background: Treatment fidelity (TF), that is, the degree to which the treatment delivery has adhered to protocol, is an important aspect of establishing treatment validity and reliability. Research has shown that establishing TF is only done in a small percentage of aphasia treatment studies. Aims: This project supports the work of the CommuniCATE study, which explored the benefits of technology‐enhanced aphasia therapy on participants' reading, writing, speech and conversation skills. It examines the TF of the Reading strand of the CommuniCATE project by assessing whether the therapy adhered to the protocol. The following research questions were asked: Does treatment delivery adhere to treatment protocol? Does the degree of TF vary according to the person delivering the therapy (i.e. student therapist or qualified therapist)? Does the degree of TF vary over time (early treatment sessions compared with later treatment sessions)? Was the checklist tool reliable? Methods & Procedures: This study assessed the fidelity of 38 retrospective video recordings of therapy. It used a checklist measure of criteria to which the delivery of the sessions should adhere, and against which the sessions were rated. Participants were the people with aphasia receiving therapy, the students and qualified speech and language therapists delivering therapy, and the independent raters assessing the sessions. A sample of sessions was randomly chosen, including sessions delivered by qualified therapists and by students, and sessions from different time points in the treatment process. The fidelity was rated by the first author, and the fidelity rating calculated as a percentage. Comparisons in fidelity scores for the different variables were drawn using Mann–Whitney tests. The reliability of the checklist was assessed through inter and intra‐rater reliability testing, and the results were analysed using Kappa statistics. Outcomes & Results: High fidelity was found across all therapy conditions with a mean score of 98.2%. Fidelity scores were not affected by the administrator of therapy; sessions delivered by qualified and student therapists were rated equally highly. There was a small but significant effect of time, with later treatment sessions scoring more highly than earlier sessions. However, scores across both periods > 90%. Inter‐rater reliability found a high percentage agreement of 93.3% and a Poor Kappa agreement level. Intra‐rater agreement found a high percentage agreement of 97.3% and a Fair Kappa agreement level. Conclusions & Implications: The CommuniCATE reading therapy was implemented as per the protocol across time points, and withstood delegation to students. The high fidelity and good reliability scores have positive implications for the study's validity and reliability, and for the study's replication. What this paper adds: What is already known on the subject: TF refers to the degree to which the delivery of core components of a treatment matches the implementation guidelines, that is, the adherence to protocol. Despite the acknowledged importance of TF reporting, this is often neglected in the literature. What this paper adds to existing knowledge: This paper shows that the TF assessment of the CommuniCATE study (reading strand) found a 98.2% fidelity score, and that high fidelity was not compromised across treatment conditions. This paper outlines the principles of TF and highlights the need for measures to be in place to establish TF, for example, manuals, training and supervision; and to monitor TF, for example, via the use of checklists. This paper also underlines the scarcity of TF measures and checks in aphasia research. This paper therefore serves as a model of TF practice in aphasia therapy research. What are the potential or actual clinical implications of this work?: This study contributes to the findings of the CommuniCATE project (reading strand), and the high fidelity findings enhance the validity of the project and indicate that the therapy manual and training enable accurate implementation of delivery. This paper also contributes to the literature on TF evaluation in aphasia studies, which is presently lacking, and highlights the need for increased focus on the optimum strategies of TF reporting. [ABSTRACT FROM AUTHOR]

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

Background: Some studies have researched the correlation between flipped learning and cognitive learning outcomes; however, there is a paucity of research elaborating on the effects of flipped language learning on cognitive load (CL). Objectives: This study investigates the effects of using flipped learning designs (student‐led, teacher‐led and collaboration‐led) on learning outcomes and CL management during out‐of‐class activities versus during‐class activities. Methods: A mixed methods research was used to concurrently triangulate different strands of data on the effects of flipped learning designs on English as foreign language (EFL) learners' learning outcomes and CL. A total of 122 EFL learners were randomly assigned to either the control or experimental group and participated in the study. The interpretations were made based on running one‐way analysis of variance between four groups. Results and Conclusion: This study evidenced the efficacy of the interactive use of collaboration‐led flipped learning design over student‐led and teacher‐led designs for improving learning outcomes and lowering CL during computer‐assisted language learning (CALL) course. Pedagogically, CALL practitioners need to develop and integrate a well‐organized combination of student‐led and teacher‐led flipped learning activities for during‐class and out‐of‐class phases with respect to the CL and learning material complexity, while also considering the specific contexts and goals of their instructional settings. Theoretically, the results indicate the necessity of merging active learning and sociocultural theories into an instructional design to take advantage of the identified affordances of flipped language learning approach in terms of psychological effects (CL management) and learning effects (CALL outcomes). Lay Description: What is already known about this topic: The flipped language learning approach involves receiving online instruction outside the classroom and is a learner‐centered pedagogy. What this paper adds: This study contributes by triangulating different strands of data on the effects of flipped learning designs on learning outcomes and cognitive load.The findings highlight the effectiveness of collaboration‐led design for flipped language learning, facilitating engagement in both out‐of‐class and during‐class activities. Implications for practice: The findings emphasize the importance of designing and implementing instructional designs that align with emerging educational technologies.Teachers should consider the flexibility, fluency and novelty of the learning material when designing flipped learning activities. [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]

Rationale, aims and objectives Open-label extension (OLE) studies following blinded randomized controlled trials (RCTs) of pharmaceuticals are increasingly being carried out but do not conform to regulatory standards and questions surround the validity of their evidence. OLE studies are usually discussed as a homogenous group, yet substantial differences in study design still meet the definition of an OLE. We describe published papers reporting OLE studies focussing on stated objectives, design, conduct and reporting. Method A search of Embase and Medline databases for 1996 to July 2008 revealed 268 papers reporting OLE studies that met our eligibility criteria. A random sample of 50 was selected for detailed review. Results Over 80% of the studies had efficacy stated as an objective. The most common methods of allocation at the start of the OLE were for all RCT participants to switch to one active treatment or for only participants on the new drug to continue, but in three studies all participants were re-randomized at the start of the OLE. Eligibility criteria and other selection factors resulted in on average of 74% of participants in the preceding RCT(s) enrolling in the OLE and only 57% completed it. Conclusions Published OLE studies do not form a homogenous group with respect to design or retention of participants, and thus the validity of evidence from an OLE should be judged on an individual basis. The term 'open label' suggests bias through lack of blinding, but slippage in relation to the sample randomized in the preceding RCT may be the more important threat to validity. [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]

OBJECTIVES This study aimed to investigate the relationship between the authenticity of instructional formats and outcome measures within a pre-clerkship clinical reasoning course. METHODS We conducted a randomised, prospective, crossover study with Year 2 medical students taking a pre-clerkship clinical reasoning course. Students were randomised to small groups and exposed to three formats of differing instructional authenticity (paper case, DVD presentation, standardised patient [SP] presentation) across three subject areas (abdominal pain, anaemia, polyuria). Three student cohorts were taught using one instructional format per subject area so that each cohort received a different instructional format for each of the three subject areas. Outcome measures (objective structured clinical examination, video quiz, written examination) were selected to determine the effect of each instructional format on the clinical reasoning of students. RESULTS Increasingly authentic instructional formats did not significantly improve clinical reasoning performance across all outcome measures and subject areas. However, the results of the video quiz showed significant differences in the anaemia subject area between students who had been instructed using the paper case and live SP-based formats (scores of 47.4 and 57.6, respectively; p = 0.01) and in the abdominal pain subject area, in which students instructed using the DVD format scored higher than students instructed using either the paper case or SP-based formats (scores of 41.6, 34.9 and 31.2, respectively; p = 0.002). CONCLUSIONS Increasing the authenticity of instructional formats does not appear to significantly improve clinical reasoning performance in a pre-clerkship course. Medical educators should balance increases in authenticity with factors such as cognitive load, subject area and learner experience when designing new instructional formats. [ABSTRACT FROM AUTHOR]

This paper aimed to examine the acute effect of low-load (LL) exercise with blood-flow restriction (LL-BFR) on microvascular oxygenation and muscle excitability of the vastus medialis (VM) and vastus lateralis (VL) muscles during a single bout of unilateral knee extension exercise performed to task failure. Seventeen healthy recreationally resistance-trained males were enrolled in a within-group randomized cross-over study design. Participants performed one set of unilateral knee extensions at 20% of one-repetition maximum (1RM) to task failure, using a LL-BFR or LL free-flow (LL-FF) protocol in a randomized order on separate days. Changes in microvascular oxygenation and muscle excitability in VL and VM were assessed using near-infrared spectroscopy (NIRS) and surface electromyography (sEMG), respectively. Pain measures were collected using the visual analog scale (VAS) before and following set completion. Within- and between- protocol comparisons were performed at multiple time points of set completion for each muscle. During LL-BFR, participants performed 43% fewer repetitions and reported feeling more pain compared to LL-FF (p<0.05). Normalized to time to task failure, LL-BFR and LL-FF generally demonstrated similar progression in microvascular oxygenation and muscle excitability during exercise to task failure. The present results demonstrate that LL-BFR accelerates time to task failure, compared with LL-FF, resulting in a lower dose of mechanical work to elicit similar levels of oxygenation, blood-pooling, and muscle excitability. LL-BFR may be preferable to LL-FF in clinical settings where high workloads are contraindicated, although increased pain experienced during BFR may limit its application. Highlights Compared to free flow (FF), neuromuscular fatigue mechanisms are accelerated during blood flow restricted (BFR) training. This can be observed as changes in microvascular oxygenation and muscle excitability occurring at a ∼43% faster mean rate during BFR compared to FF. BFR exercise seems to elicit the same level of neuromuscular fatigue as FF training within a shorter timeframe. This reduces total joint load and may be especially helpful in cases where high training volumes may be contraindicated (e.g. recovering from a sports injury or orthopedic surgery). [ABSTRACT FROM AUTHOR]

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

Background: 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]

Children are vulnerable in earthquakes, but they are also essential to foster earthquake‐resilient communities. It is critical to enhance the preparedness of children against earthquakes through effective education and training. Immersive virtual reality (IVR) and serious games (SGs) are innovative digital technologies that enable realistic and engaging training environments. However, little research has been made on the applications of IVR SGs for earthquake training targeting children. In order to fill this gap, this paper presents an IVR SG training system based on a problem‐based gaming framework. Three instructional mechanisms within the training system, namely prior instruction, immediate feedback, and post‐game assessment, were investigated to promote learning through effective reflection. A controlled experiment involving 125 secondary school students aged from 11 to 15 years old was undertaken, using leaflets as a traditional training approach for the control group and the IVR SG training system as the main intervention. Results revealed that the IVR SG training system with post‐game assessment was the most effective way to train children, with greater knowledge acquisition and self‐efficacy improvement observed. Possible improvements, such as increasing the time for reflection and differentiating the stimulation between positive and negative feedback, are suggested for further research. Lay Description: What is already known about this topic?: IVR SGs have potentials to train people in emergency behavioural responses, corresponding to problem‐based learning principles.Instructional mechanisms including immediate feedback, post‐game assessment, and prior instruction have been applied in IVR SGs in the literature. What this paper adds?: The present paper examines the pedagogical impacts of the three instructional mechanisms within IVR SGs.The present paper investigates the effectiveness of IVR SG‐based earthquake emergency training, targeting children. Implications for practice and/or policy: IVR SGs with the three instructional mechanisms effectively improve the self‐efficacy of children in the case of dealing with earthquake emergencies.IVR SGs with prior instruction and post‐game assessment facilitate learning, manifesting in significant knowledge gain after training.IVR SGs have the potential to train children in earthquake emergency responses. [ABSTRACT FROM AUTHOR]

Background: Training conversation partners of people with aphasia who use facilitative communication strategies is one method that can improve access to healthcare for people with aphasia. However, the efficacy of communication partner training (CPT) has been investigated almost exclusively in the context of face‐to‐face (F2F) delivery. Online training may offer more cost‐effective and accessible options to a wider range of conversation partners, including student healthcare professionals. Aims: To conduct a pilot randomized controlled trial with student healthcare professionals comparing (1) an online aphasia CPT program, (2) a F2F CPT program and (3) no program (control group) on outcomes relating to attitudes and knowledge of aphasia. Methods & Procedures: A 45‐min introductory aphasia CPT program was developed using the theories and techniques of Supported Conversations for Adults with Aphasia (SCA)™. A total of 30 first‐year undergraduates studying occupational therapy at The University of Sydney were randomly allocated to one of three conditions: online CPT delivery, F2F delivery or delayed training control (no program). Outcomes measures included pre‐post‐testing with the Aphasia Attitudes, Strategies and Knowledge (AASK) survey. Outcomes & Results: A significant difference existed for the AASK survey pre‐post‐change scores between the online, F2F and control groups (χ2(2) = 20.038, p = 0.000). Post‐hoc analysis revealed that, compared with the control (Ctrl) group, participants in both the online and F2F groups had significantly higher knowledge of aphasia (Online versus Ctrl: p = 0.000; F2F versus control: p = 0.002), knowledge of facilitative strategies (Online versus Ctrl: p = 0.000; F2F versus Ctrl: p = 0.002), and positive attitudes towards aphasia (Online versus Ctrl: p = 0.031; F2F versus Ctrl: p = 0.032). No significant difference was observed between the online and F2F groups for the Total or any subtotals (p = 1.000). Conclusions and Implications: The results from this pilot randomized controlled trial indicate that online delivery of the 45‐min introductory CPT is equally as efficacious as F2F delivery, and thus may be a viable mode of delivery for future aphasia CPT programs. These pilot results pave the way for a larger study that will comprehensively evaluate the efficacy of an online aphasia CPT program for improving attitudes, knowledge and skills in a broad range of student healthcare professionals. What this paper addsWhat is already known on this subjectThe efficacy of F2F CPT for aphasia is well established. Online delivery of CPT programs may offer more cost‐effective and accessible services when compared with F2F approaches; however, there is a need to explore the efficacy of online programs.What this paper adds to existing knowledgeThe 45‐min online aphasia CPT program was found to be efficacious for improving student healthcare professionals' knowledge and attitudes towards aphasia and communication, and produced equally successful outcomes when compared with F2F delivery. This is the first study to report the efficacy of an online CPT program that is aligned with SCA for use with student healthcare professionals that also uses a self‐report outcome measure with validated psychometric properties.What are the potential or actual clinical implications of this work?Online CPT programs may be useful in both clinical and education contexts to support improved efficiency of services and to enhance communication environments for people with aphasia in healthcare contexts. [ABSTRACT FROM AUTHOR]

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

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

Background: A total of 68% of pre‐school children with cleft palate have speech problems requiring speech therapy. There is a lack of access to regular targeted therapy. Parent training leads to positive outcomes in early communication skills in cleft palate and non‐cleft speech disorders. Connected health has been used to address inadequate access to therapy, providing intervention to those who would not otherwise receive therapy. Aims: To evaluate the speech, activity and participation outcomes of Parent Led, Therapist Supervised, Articulation Therapy (PLAT) compared with routine speech therapy intervention in parent–child dyads. Methods & Procedures: A total of 44 children, aged 2.9–7.5 years, were included in a two‐centre, two‐phase randomized controlled trial. Informed consent and assent were obtained. Participants and speech and language therapists (SLTs) were unblinded to the groups. Parents, in the parent‐trained group (n = 23), attended 2 days' training, received a detailed speech therapy programme, and undertook intervention over 12 weeks supported by the cleft specialist SLT using FaceTime and one face‐to‐face session. In the control arm (n = 21), parent–child dyads received six therapy sessions over 12 weeks with a research SLT, comparable with usual care. Speech recordings were undertaken pre‐ and post‐intervention. Percent consonant correct (PCC) was analysed by external SLTs blinded to the time and group. Activity and participation were measured using the Intelligibility in Context Scale (ICS) and Focus on Outcomes for Children Under Six (FOCUS) questionnaire. Outcomes & Results: There was no evidence of an interaction between Time and Group or an overall statistical difference between groups for PCC scores. There was a statistically significant difference over time for both groups (words: p < 0.002; confidence interval (CI) = 9.38–16.27; d = 0.57; sentences: p < 0.002; CI = 16.04–25.97; d = 0.23). Effect sizes were medium for words and small for sentences. For intelligibility and participation, there was no evidence of an interaction between Time and Group or an overall statistical difference between groups. A statistically significant difference over time was found for intelligibility (F = 29.97, d.f. = 1, 42, p < 0.001, 95 % CI = 1.45–3.15 d = 0.46) and for participation (F = 14.19, d.f. = 1, 41, p < 0.001 95% CI = 7.63–25.03; d = 0.36) with FOCUS results indicating clinically meaningful (parent‐led group) and significant (control group) change in participation. Conclusions & Implications: PLAT can be as effective as routine care in changing speech, activity and participation outcomes for children with cleft palate, when supported by a specialist cleft SLT using connected health. What this paper addsWhat is already known on this subjectOver 50% of children with cleft palate require speech therapy. However, there is a lack of timely, accessible speech therapy services in the UK and Ireland. Previous studies have shown that parents can deliver therapy effectively, and that connected health can support the delivery of speech therapy. This study aims to provide evidence that parent‐led therapy with the supervision of a specialist cleft therapist using FaceTime is effective.What this paper adds to existing knowledgeThis randomized controlled trial indicates that parents can be trained to deliver therapy for children with cleft palate speech disorders, under the supervision of an SLT. This approach results in improved speech, activity and participation outcomes similar to routine care.What are the potential or actual clinical implications of this work?This study indicates that both parent‐led articulation therapy and routine care showed meaningful gains in speech, activity and participation, and that parent‐led articulation therapy when supported by a cleft SLT using connected health could be an additional service delivery model for children with cleft palate speech disorders. [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: 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: Though pedagogical artificial agents are expected to play a crucial role in the years to come, earlier studies provide inconsistent results regarding their effect on learning. This might be because their potential for exhibiting subtle nonverbal behaviours we know from human teachers has been untapped. What is more, there is little evidence of the processes underlying the effect of nonverbal behaviours of teachers (either human or artificial) on learning, so as to better guide their practical application. Objectives: The aims of the current research were threefold: firstly, to examine the effect of an artificial agent's vocal expressiveness on non‐verbal immediacy (teachers' ability to increase psychological closeness through nonverbal communication). Secondly, to test whether an artificial agent showing strong vocal expressiveness will enhance affective and cognitive learning (perceived and actual), as compared to an artificial agent that shows weak vocal expressiveness. Thirdly, to examine whether the underlying mechanisms of motivation and attention explain the effect of immediacy (and thereby also of vocal expressiveness) on the two learning outcomes. Methods: The study used a between‐participants design, with the participants being randomly assigned to one of the two experimental conditions: artificial modelling with strong expressiveness and artificial modelling with weak vocal expressiveness. Results and conclusions: Results showed that an artificial agent with strong vocal expressiveness increased affective and perceived cognitive learning. Partial support was found for actual cognitive learning. What is more, our findings revealed that vocal expressiveness is related to affective and perceived cognitive learning because it promotes nonverbal immediacy. Finally, results provided evidence of motivation as a mediator of the path from immediacy to affective learning. Major takeaways: The current findings verify the important role of nonverbal immediacy found in traditional educational settings. However, showing that these results also apply to artificial teachers is essential, given that the educational landscape is changing and reshaping by artificial intelligence. Thus, taking into consideration the role of vocal expressiveness in the development of artificial teachers or voice assistants like Alexa, Siri, and Google assistant, as a way to enhance immediacy and affective experience of learners is of imperative value, since they will be found more and more in our societies. Lay Description: What is currently known about the subject matter: There is a positive effect of nonverbal cues of human teachers on students' learningThe artificial agent's voice is important for learning. What their paper adds to this: Provides strong evidence of the positive effect of vocal expressiveness of artificial agents on learning outcomes.Reveals that vocal expressiveness is related to learning outcomes because it enhances immediacy.Examines the proposed mechanisms of motivation and attention as mediators of the path from immediacy to affective and cognitive learning. Implications of study findings for practitioners: Taking into consideration vocal expressiveness of artificial agents during the design process is essential for increased learning.The combination of the vocal parameters of pitch and speech rate is effective for constructing vocal expressiveness.By showing the underlying mechanisms of artificial agents' nonverbal cues (i.e., vocal cues) on learning, it helps designers to make a better decisions during construction.The study's findings are also pertinent for human teachers in improving students' learning in traditional educational settings. [ABSTRACT FROM AUTHOR]

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

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]

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

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

Purpose. To examine whether cognitive behaviour therapy (CBT) reduces psychopathology in patients with schizophrenia more effectively than the use of non-cognitive psychotherapies. Method. Systematic review and meta-analysis of the literature was performed. All Randomized Controlled Trials meeting the inclusion criteria were analysed using RevMan software. This design was used to maximize power and study efficacy. Medline, PsycINFO, and Embase were searched using free-text keywords to identify potential papers. Nine were included in the final meta-analysis. Change in psychopathology at the end of therapy was the end point investigated. A random effects model was used to assess the standard mean difference between the CBT and supportive control groups. Results. Meta-analysis of CBT versus supportive therapy did not find significant differences between the therapy groups at the end of treatment in respect of psychopathology. There was no evidence of publication bias. Post hoc power analysis using the Z test ruled out type one error. Conclusions. Theoretically based CBT therapies, although proving effective, may not out perform more accessible and simpler forms of therapy for patients with schizophrenia in reducing psychopathology. Consideration of supportive therapy should be made for patients with psychotic mental disorder. Practitioner Points CBT may not be the psychotherapeutic treatment of choice to alleviate the phenomenology of Schizophrenia., It may be valuable trialling simple supportive therapies prior to implementing more costly and complex cognitive therapies., This review, like the Cochrane review and others, does not suggest CBT in psychosis is not effective, simply that it dose not outperform supportive therapy in effecting change in phenomenology. [ABSTRACT FROM AUTHOR]

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

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]

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]

There is a lack of studies that examine the role of a pedagogical agent on student development in a specific learning situation that involves psychological and cognitive preparatory activities in high school settings. We examined the effectiveness of pedagogical agent (APT) cognitive and affective feedback on learner motivation and well‐being. We applied an experimental research design, involving 45 fourth‐year high school students, divided in experimental and control groups (APT vs. human tutor). We performed a quantitative analysis to collect and analyse data of students using our APT. APT cognitive feedback had a positive effect on students' motivation for learning by encouraging students' proposals and initiatives and arousing students' interest in the topic. In addition, APT affective feedback fostered an appropriate emotional climate and creative environment for learning by enhancing students' curiosity, creativity and confidence for carrying out the activity, while reducing students' negative emotions such as boredom and anger. This study provided us useful insights about the affective (and cognitive) competencies that a virtual affective pedagogical agent needs to have in order to support students' mental and emotional health throughout a learning situation. Yet, further research is needed to consolidate these findings and make APT more adaptive to different learning situations. Lay Description: What is currently known about this topic: Animated pedagogical agents were extensively used to provide customized feedback.Their aim was to improve both students' emotional state and learning performance.Both the conditions and agent design issues still need to be further investigated.Learning situations may involve psychological and cognitive preparatory activities.Effects of an APT in these learning situations have not been investigated yet. What this paper adds: It analyses the role of an APT in psychological and cognitive preparatory activities.APT provides a variety of cognitive and affective feedback types.APT had a positive effect on students' motivation for learning through encouraging students' proposals and initiatives and arousing students' interest in the topic.APT fostered an appropriate emotional climate through encouraging creativity and strengthening students' confidence for carrying out the activity. Implications for practice and/or policy: APT can be a valuable support to teachers and students in complex learning tasks.Pedagogical agent designers are given useful insights for enhancing agents design.A pedagogical agent needs to be endowed with specific pedagogical competencies.Psychological and cognitive preparatory activities require APT emotional involvement. [ABSTRACT FROM AUTHOR]

This study compares the effects of object‐oriented and robot programming activities on programming achievement, abstraction, problem solving, and motivation. In the study, two consecutive experimental cases were conducted to examine the consistency of findings. The research sample comprises 81 tenth‐grade students undergoing vocational secondary education. A total of 41 students participated in the first case that spanned 12 weeks, and 40 students participated in the second that spanned 8 weeks. After computational activities, the programming achievement scores significantly increased in all test groups. However, the achievement scores did not differ significantly between the groups. For the comparison groups, there was no statistically significant difference in the pre‐ and posttest scores of the formal and descriptive abstraction in both cases. However, a statistically significant increase was found in the formal (only Case 2) and descriptive abstraction scores of the students in the experimental groups. The abstraction results revealed a significant difference in the descriptive abstraction scores of Case 2 in favour of the experimental group. No statistically significant difference was found in the problem‐solving scores within or between groups. In both cases, the motivation scores of the experimental groups were found to be statistically higher than those of the comparison groups. Lay Description: What is already known about this topic?: Programming activities that encourage how to think rather than what to think, have the potential to be effective instructional tools for cognitive processes.Despite the increasing research trend in computer science education, especially Computational Thinking (CT), there is a lack of studies investigating abstraction.Most of the studies on CT are based on a single cross‐sectional study shaped by relatively short‐term instructional activities and narrow‐scoped computational concepts. What this paper adds?: This study examined the effects of two programming modalities on tenth‐grade students' learning, intellectual skills, and motivation.Two consecutive interventions were conducted in order to examine the consistency of the findings.Robot programming is as effective as object‐oriented programming in the acquisition of programming concepts.Robot programming enhanced students' descriptive abstraction and motivation more effectively.Programming did not lead to any significant changes in students' problem‐solving approaches to daily‐life problems. Implications for practice and/or policy: The use of manipulative robotics can enrich learning outcomes in programming education.Robotic activities support the development of descriptive abstraction skills better than object‐oriented programming.Robotic technologies have great potential to increase student motivation regardless of the novelty effect.Problems used in programming activities should be chosen more relevant to the authentic world scenarios to connect computational approaches with daily life problems.Educational robots can be used as alternative tools to embody computational concepts in programming education. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to see if a more sophisticated ventilator hyperinflation protocol might result in more sputum clearance compared to manual hyperinflation. Background: Hyperinflation has been used to mobilize lung secretions in mechanically ventilated patients in the intensive care unit setting for almost 50 years. In the past decade, rather than using a bag external to the ventilator circuit to deliver hyperinflation (known as "bagging" or "manual hyperinflation"), a new technique has evolved using existing ventilator circuitry (known as "ventilator hyperinflation"). One conservative ventilator hyperinflation protocol has demonstrated equivalence with manual hyperinflation in sputum clearance. Design A randomized crossover study. Method: Patients received manual hyperinflation and ventilator hyperinflation in two randomly ordered treatments on the same day by the same physiotherapist, using a ventilator hyperinflation protocol involving titration of hyperinflation according to airway pressure. Results: Between 2013 and 2018, 48 patients were enrolled in the study. Physiotherapy treatment using ventilator hyperinflation yielded significantly more wet weight sputum (median 2.84 g, IQR 1.81, 4.22) than treatment using manual hyperinflation (median 1.5 g, IQR 0.73, 2.31, P <.001), without significant differences in secondary measures. Conclusions: A more sophisticated approach to the titration of the volume delivered using ventilator hyperinflation relative to the airway pressure resulted in greater wet weight sputum cleared during physiotherapy treatment. Relevance to Clinical Practice: The results presented in this paper demonstrate that the application of ventilator hyperinflation using peak airway pressure rather than tidal volume may be superior in facilitating sputum clearance and improved oxygenation without patient harm. [ABSTRACT FROM AUTHOR]

The article discusses different methods adopted by journal's editors for recognizing and detecting fraudulent data submitted by researchers. Topics include statistical methods suggested by J. B. S. Haldane for detecting fraud data; raising awareness among author's and journal's editors about the problem of plagiarism; and use of statistical method by researcher John Carlisle using data from the randomized controlled trials.

Objective: We explore factors that may have contributed to differences in treatment‐emergent adverse events in the phase 2 and phase 3 lasmiditan clinical trials. Background: Phase 2 and phase 3 trials showed that the centrally penetrant 5‐HT1F agonist, lasmiditan, was effective; higher frequency and severity of adverse events (AEs) were seen in phase 2. Methods: This work represents a hybrid of a review of primary documents and study reports with additional post hoc analyses. Protocols, informed consents, data collection forms, and methodologies were reviewed. This information was supplemented by results from the clinical study reports and post hoc analyses of individual patient data from each trial. Results: For lasmiditan 100 and 200 mg, in phase 2, the incidence of ≥1 AE was 72‐86% (26% severe), while in phase 3 was 36‐43% (2% severe). The most common AEs in all studies were CNS‐related. The phase 2 consent form was more descriptive of AEs than phase 3. In phase 2, patients recorded AEs and severity in a paper diary that warned about drowsiness and dizziness. In phase 3, patients recorded in electronic diaries whether they experienced unusual feelings after dosing with lasmiditan that they had not felt with a migraine before, and were contacted to determine if an AE had occurred. In phase 2, the AE Schwindel was variably translated from German as "vertigo" or "dizziness," while phase 3 vertigo cases were queried to ensure there was a sensation of rotation or movement. History of recurrent dizziness and/or vertigo was exclusionary in phase 3. Conclusions: This work illustrates how informed consent wording, AE collection methods, translation, exclusion criteria, and other factors may be important determinants for reporting of the frequency and severity of AEs in clinical trials. [ABSTRACT FROM AUTHOR]

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

Learning letters is an important area of language learning, conducive to the beginning of reading and writing. Indeed, today's generation prefers to learn through digital games rather than through formal teaching processes. Inspired by this need, the researcher designed this study (a) to test the effectiveness of an instructional digital game, "Kes Sesi," designed to teach letter recognition skills and (b) to briefly present its instructional development process, which was based on the ADDIE model. This was a quasi‐experimental study with two treatment groups and a control group involving 87 kindergarteners. Treatment groups played the game for 12–6 weeks for learning, 6 weeks for practice. The control group continued with its regular class activities. One treatment group played the game based on predefined sound categorization, the other without any categorization. A test on children's sound recognition abilities was administered three times as a pretest, a midtest, and a posttest. The treatment groups performed significantly better than the control group. The game enhanced the kindergarteners' ability to practice uncategorized content while it enhanced their ability to learn categorized content. The results are promising in that Kes Sesi can be useful in self‐supported learning contexts with little adult input and with minimum outside interference. Lay Description: What is already known about this topic: Learning letters is an important area of language learning, conducive to the beginning of reading and writing.There is a variety of research studies on digital games for learning in the literature.It is a challenge to teach preschool children letters. What this paper adds: There seems to be a gap when it comes to experiments on kindergarteners' early reading skills.Although there are many relevant games in the market, there are no studies investigating kindergarteners' sound recognition skills through game playing on mobile technology.This study has its unique feature in terms of providing a sample article on "Design, development and application of learning tools and systems," which is a topic within the Journal's scope. Implications for practice and/or policy: Digital educational games such as "Kes Sesi" can be useful in self‐supported learning circumstances with little adult input or intervention.Similar educational games can be designed by taking the current research study as an example, and it is believed that it will encourage production of many similar games.Students' performances reach an optimal level when educational games are used after the teacher helps them construct their learning and guide them in this endeavor. [ABSTRACT FROM AUTHOR]

This study investigated the effect of a touch‐typing course on the spelling and narrative‐writing skills on the computer of elementary school students. Data of 207 students in Grades 4, 5, and 6 were analysed using a pretest–posttest design. Students in the experimental group (n = 154) followed a touch‐typing course, and those in the control group (n = 53) did not. The experimental group showed more progress in typing, spelling, and narrative‐writing skills on the computer than the control group. It can be concluded that the touch‐typing course had a positive effect, not only on typing skills but also on spelling and narrative‐writing skills on the computer. Lay Description: What is known Typing skills are important for the quality of the typewritten text output.In touch‐typing with automaticity of transcription, workting‐memory load is decreased.Studies on the effect of a touch‐typing course are rare. What this paper adds This study investigated the effect of a touch‐typing course on spelling and narrative writing.We used a design with an experimental (with typing‐course) and a control group (no course)The experimental group showed more improvement in typing, spelling and narrative writing. Implications for practitioners It is important for the quality of student's text output to learn how to touch‐typeTouch‐typing can be learned in a teacher-directed course, containing 15 training sessions of 1.5 hours eachPractice of 20 minutes a day is necessary [ABSTRACT FROM AUTHOR]

Aim The aim of this systematic review was to evaluate the efficacy of anti-plaque chemical formulations for managing gingivitis, in 6-month, home-use, randomised clinical trials ( RCTs). Material and Methods A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand-searches identified relevant papers, which were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences ( WMD) and 95% confidence intervals. Results After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD −0.217), modified gingival index ( n = 23, −0.415), gingivitis severity index ( n = 26, −14.939%) or bleeding index ( n = 23, −7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD −0.475), Silness & Löe ( n = 26, −0.109), and plaque severity ( n = 12, −23.4%) indices, with significant heterogeneity. Conclusion Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices. [ABSTRACT FROM AUTHOR]

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

In health care, particularism asserts the primacy of the individual case. Moral particularists, such as Jonsen and Toulmin, reject deduction from universal moral principles and instead seek warrants for action from the multiple sources unique to a given patient. Another kind of health care particularism, here referred to as the knowledge of particulars, is offered as a corrective to evidence-based medicine ( EBM), its influence on health care practice and policy, and specifically to EBM's reliance on the aggregate. This paper describes the knowledge of particulars and identifies strategies for its legitimation in health care policy and practice. First, the paper documents the ascendancy of the aggregate through EBM's definition of 'what works' in health care. Second, it delineates the limits of health care knowledge based on the analysis of aggregates, not only for the care of individual patients but for the formulation of policies about patient care. Third, the paper analyses prominent rejections of the particular in contemporary health policy discourse and relates them to larger political purposes. Finally, it depicts the knowledge of particulars as the basis for clinical prudence and offers three potential strategies for promoting particularism as essential to high-quality care. [ABSTRACT FROM AUTHOR]

Co‐infection with HIV and hepatitis C virus (HCV) results in a threefold increase in relative risk of progression to end stage liver disease and cirrhosis compared to HCV alone. Although curative treatments exist, less than one quarter of people with HCV are linked to care, and even fewer have received treatment. The Care2Cure study is a single‐blinded, randomized controlled trial to improve the HCV care continuum among people co‐infected with HIV. This ongoing study was designed to test whether a nurse case management intervention can (i) improve linkage to HCV care and (ii) decrease time to HCV treatment initiation among 70 adults co‐infected with HIV who are not engaged in HCV care. The intervention is informed by the Andersen Behavioral Model of Health Services Use and consists of nurse‐initiated referral, strengths‐based education, patient navigation, appointment reminders, and care coordination for drug–drug interactions in the setting of HIV primary care. Validated instruments are used to measure participant characteristics including HCV knowledge, substance use, and depression. The primary outcome is linkage to HCV care (yes/no) within 60 days. In this protocol paper, we describe the first clinical trial to examine the effects of a nurse case management intervention to improve the HCV care continuum among people co‐infected with HIV/HCV in the era of all‐oral HCV treatment. We describe our work in progress, challenges encountered, and strategies to engage this hard‐to‐reach population. [ABSTRACT FROM AUTHOR]

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self‐determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother–infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self‐efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post‐partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post‐partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self‐perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post‐partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post‐partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: −2.09; 95% CI: −2.88 to −1.31; p < 0.001), 6 weeks post‐partum (MD: −4.35; 95% CI: −5.20 to −3.49; p < 0.001) and 3 months (MD: −4.89; 95% CI: −5.70 to −4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post‐partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post‐partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post‐partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post‐partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post‐partum, the intervention group's infants showed slower weight (t = −0.90, p = 0.371) and length (t = −0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post‐partum, there was a significant difference in both weight (t = −3.46, p = 0.001) and length (t = −2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self‐confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow‐up in future research. Key messages: This study validated the application of responsive breastfeeding (RBF) intervention during the exclusive breastfeeding phase of Chinese infants.The RBF intervention may help to increase mothers' level of autonomous motivation for breastfeeding, enhance breastfeeding self‐efficacy and increase exclusive breastfeedingrates. The intervention had no significant effect on the weight and length of 6 week old infants but significantly impacted 3monthold infants, with slower growth observed in the intervention group compared to the control group.Future intervention programmes shouldinclude extended follow‐up periods to investigate the long‐term effects of RBF on infant growth and development. [ABSTRACT FROM AUTHOR]

Background speechBITE (http://www.speechbite.com) is an online database established in order to help speech and language therapists gain faster access to relevant research that can used in clinical decision-making. In addition to containing more than 3000 journal references, the database also provides methodological ratings on the PEDro-P (an adapted version of the PEDro) scale to assist clinicians in identifying the scientific quality of randomized (RCTs) and non-randomized control trials (NRCTs). While reliability of the PEDro scale has been established by similar allied health databases, the reliability of the PEDro-P scale has yet to be reported. Aims To examine the reliability of PEDro-P scale ratings undertaken by raters on the speechBITE database and benchmark these results to the published reliability for the original PEDro scale. Both the total score (out of ten) as well as each of the 11 scale items were included in this analysis. Methods & Procedures speechBITE's volunteer rater network of 17 members rated the first 100 RCTs and NRCTs on the website. The criterion and overall scores for these ratings were compared with previously published reliability studies using the PEDro scale. Intra-class correlations and per cent agreement measures were used to establish and benchmark reliability. Outcomes & Results The speechBITE PEDro-P ratings ranged from fair to excellent for both the total score and for each of the 11 scale items. Furthermore, reliability was equal to that of other databases. Conclusions & Implications speechBITE users can be confident of the reliability of ratings published on the website. Further analysis of differences between this study and previous PEDro scale reliability studies are discussed. [ABSTRACT FROM AUTHOR]

Rate differences are an important effect measure in biostatistics and provide an alternative perspective to rate ratios. When the data are event counts observed during an exposure period, adjusted rate differences may be estimated using an identity-link Poisson generalised linear model, also known as additive Poisson regression. A problem with this approach is that the assumption of equality of mean and variance rarely holds in real data, which often show overdispersion. An additive negative binomial model is the natural alternative to account for this; however, standard model-fitting methods are often unable to cope with the constrained parameter space arising from the non-negativity restrictions of the additive model. In this paper, we propose a novel solution to this problem using a variant of the expectation-conditional maximisation-either algorithm. Our method provides a reliable way to fit an additive negative binomial regression model and also permits flexible generalisations using semi-parametric regression functions. We illustrate the method using a placebo-controlled clinical trial of fenofibrate treatment in patients with type II diabetes, where the outcome is the number of laser therapy courses administered to treat diabetic retinopathy. An R package is available that implements the proposed method. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The use and development of mobile interventions are experiencing rapid growth. In "just-in-time" mobile interventions, treatments are provided via a mobile device, and they are intended to help an individual make healthy decisions 'in the moment,' and thus have a proximal, near future impact. Currently, the development of mobile interventions is proceeding at a much faster pace than that of associated data science methods. A first step toward developing data-based methods is to provide an experimental design for testing the proximal effects of these just-in-time treatments. In this paper, we propose a 'micro-randomized' trial design for this purpose. In a micro-randomized trial, treatments are sequentially randomized throughout the conduct of the study, with the result that each participant may be randomized at the 100s or 1000s of occasions at which a treatment might be provided. Further, we develop a test statistic for assessing the proximal effect of a treatment as well as an associated sample size calculator. We conduct simulation evaluations of the sample size calculator in various settings. Rules of thumb that might be used in designing a micro-randomized trial are discussed. This work is motivated by our collaboration on the HeartSteps mobile application designed to increase physical activity. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In two-armed trials with clustered observations the arms may differ in terms of (i) the intraclass correlation, (ii) the outcome variance, (iii) the average cluster size, and (iv) the number of clusters. For a linear mixed model analysis of the treatment effect, this paper examines the expected efficiency loss due to varying cluster sizes based upon the asymptotic relative efficiency of varying versus constant cluster sizes. Simple, but nearly cost-optimal, correction factors are derived for the numbers of clusters to repair this efficiency loss. In an extensive Monte Carlo simulation, the accuracy of the asymptotic relative efficiency and its Taylor approximation are examined for small sample sizes. Practical guidelines are derived to correct the numbers of clusters calculated under constant cluster sizes (within each treatment) when planning a study. Because of the variety of simulation conditions, these guidelines can be considered conservative but safe in many realistic situations. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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