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Background: Learner profiles detected from digital trace data are typically triangulated with survey data to explain those profiles based on learners' internal conditions (e.g., motivation). However, survey data are often analysed with limited consideration of the interconnected nature of learners' internal conditions. Objectives: Aiming to enable a thorough understanding of trace‐based learner profiles, this paper presents and evaluates a comprehensive approach to analysis of learners' self‐reports, which extends conventional statistical methods with psychological networks analysis. Methods: The study context is a massive open online course (MOOC) aimed at promoting physical activity (PA) for health. Learners' (N = 497) perceptions related to PA, as well as their self‐efficacy and intentions to increase the level of PA were collected before and after the MOOC, while their interactions with the course were logged as digital traces. Learner profiles derived from trace data were further examined and interpreted through a combined use of conventional statistical methods and psychological networks analysis. Results and Conclusions: The inclusion of psychological networks in the analysis of learners' self‐reports collected before the start of the MOOC offers better understanding of trace‐based learner profiles, compared to the conventional statistical analysis only. Likewise, the combined use of conventional statistical methods and psychological networks in the analysis of learners' self‐reports before and after the MOOC provided more comprehensive insights about changes in the constructs measured in each learner profile. Major Takeaways: The combined use of conventional statistical methods and psychological networks presented in this paper sets a path for a comprehensive analysis of survey data. The insights it offers complement the information about learner profiles derived from trace data, thus allowing for a more thorough understanding of learners' course engagement than any individual method or data source would allow. Lay Description: What is already known about this topic: Researchers have made extensive use of data from online learning platforms—often referred to as learning trace data—to understand how learners engage in online learning activities.Surveys are often used to gather information about learners' motivation, perceptions, and other internal factors, to complement the insight gleaned from learning traces and thus create a more complete picture of the learning behaviour.When analysing survey data, the focus is usually on individual factors without considering how different factors are connected and affect one another.Psychological networks analysis is a novel analytic approach to studying complex phenomena both in psychology and education. What this paper adds: The paper uses psychological networks as a method for examining mutual relations among learners' internal factors (e.g., motivation, perceptions) measured through self‐reports before and after a course.By combining conventional statistical analysis of self‐reports with psychological networks analysis, the paper develops a comprehensive picture of learners' internal factors measured through self‐reports, one that accounts for both individual and interconnected nature of those factors.This comprehensive approach to information extraction from surveys allows for better understanding of trace‐based learner profiles, that is, profiles mined from data about learners' interaction with online learning activities. Implications for practice and/or policy: The presented method paves a way for a comprehensive analysis of the data collected from learners through surveys.It helps us gain a better understanding of learners' engagement with online learning activities.It can advance the evaluation of digital educational programs that aim to encourage changes in health‐related behaviour. [ABSTRACT FROM AUTHOR]

Aim: Evidence shows that 20%–30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration. Materials and methods: We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 – neurological diseases (n = 93), G2 – head and neck surgery (n = 200), G3 – gastroenterological diseases (n = 94) and G4 – other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered. Results: There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX–X). Conclusions: Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery. WHAT THIS PAPER ADDS: What is already known on the subject: Clinical signs of penetration or aspiration include coughing, throat clearing and voice changes, while silent penetration or aspiration patients aspirate without demonstrating any clinical symptoms. The most common consequences of silent aspiration include aspiration pneumonia, recurrent lower respiratory tract infections and respiratory failure. Additionally, malnutrition and dehydration can be indicators of silent aspiration. Patients may unknowingly reduce their oral intake and lose weight. Retrospective studies have shown that 20%–30% of patients aspirate silently (e.g. patients after stroke, acquired brain injury, head and neck cancer treatment, prolonged intubation). Clinical examination of swallowing can miss up to 50% of cases of silent aspiration. What this paper adds to existing knowledge: Currently, silent aspiration is often discussed in neurological literature, but its applications to head and neck surgery are limited. In this study, we identify head and neck surgery patients who should be prioritised or considered to be in higher need of instrumental swallowing evaluation due to a higher risk of silent aspiration. What are the potential or actual clinical implications of this work?: Post‐treatment structural changes can result in lower cranial nerve paresis (IX, X, XII) and face injury, in which vagus and glossopharyngeal nerves are injured. After tracheostomy and radiotherapy, patients with problems swallowing saliva need careful clinical examination, particularly cranial nerve examination. [ABSTRACT FROM AUTHOR]

Objective: The LittlEARS® Early Speech Production Questionnaire (LEESPQ) was developed to provide professionals with valuable information about children's earliest language development and has been successfully validated in several languages. This study aimed to validate the Serbian version of the LEESPQ in typically developing children and compare the results with validation studies in other languages. Methods: The English version of the LEESPQ was back‐translated into Serbian. Parents completed the questionnaire in paper or electronic form either during the visit to the paediatric clinic or through personal contact. A total of 206 completed questionnaires were collected. Standardized expected values were calculated using a second‐order polynomial model for children up to 18 months of age to create a norm curve for the Serbian language. The results were then used to determine confidence intervals, with the lower limit being the critical limit for typical speech‐language development. Finally, the results were compared with German and Canadian English developmental norms. Results: The Serbian LEESPQ version showed high homogeneity (r =.622) and internal consistency (α =.882), indicating that it almost exclusively measures speech production ability. No significant difference in total score was found between male and female infants (U = 4429.500, p =.090), so it can be considered a gender‐independent questionnaire. The results of the comparison between Serbian and German (U = 645.500, p =.673) and Serbian and English norm curves (U = 652.000, p =.725) show that the LEESPQ can be applied to different population groups, regardless of linguistic, cultural or sociological differences. Conclusion: The LEESPQ is a valid, age‐dependent and gender‐independent questionnaire suitable for assessing early speech development in children aged from birth to 18 months. [ABSTRACT FROM AUTHOR]

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

Background: When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non‐attendance or non‐adherence that are multifactorial and variable dependent on, for example, population and intervention. Aims: To identify rates of non‐attendance and non‐adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. Methods: Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self‐efficacy), personal circumstances (socio‐demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non‐attendance rates were identified via local health records and non‐adherence ascertained using a specific parent‐reported measure within the treatment experience domain. Results: Participants (N = 199) were predominantly mothers, and were ethnically and socio‐economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non‐attendance was 25% and the main predictors of non‐attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non‐adherence in this cohort was 26% with parental rating of the importance of a recommendation and self‐efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. Conclusions & Implications: Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS: What is already known on the subject: It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge: This study identified rates of parental non‐attendance and non‐adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non‐attendance. What are the potential or actual clinical implications of this work?: This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN. [ABSTRACT FROM AUTHOR]

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

Background: Despite increasing knowledge of social communication skills of autistic peole, the interrelatedness of different skills such as non‐linguistic comprehension, social inference and empathizing skills is not much known about. A better understanding of the complex interplay between different domains of social communication helps us to develop assessment protocols for individuals with social communication difficulties. Aims: To compare the performances of autistic young adults, young adults with autistic traits identified in childhood and control young adults in social communication tasks measuring non‐linguistic comprehension, social inference and empathizing skills. In addition, to examine associations between the different social communication measures. Methods & Procedures: Autistic young adults (n = 34), young adults with autistic traits (n = 19) and control young adults (n = 36) completed the extra‐ and paralinguistic scales of the Assessment Battery for Communication (ABaCo), the Faux Pas Recognition Test, Social–Pragmatic Questions (SoPra) and the Empathy Quotient (EQ). Outcomes & Results: Group differences were found in the performance in the ABaCo, SoPra and EQ scores. Compared with the control young adults, autistic young adults scored lower. The performance of the young adults in the autistic traits group fell in between the other two groups. There were no group differences in the Faux Pas Recognition Test. The variability within the groups was large in all measurements. In the control group, there was a significant correlation between EQ and SoPra scores and between the Faux Pas and SoPra scores. In the autistic group, a significant correlation was found between Faux Pas and SoPra scores. Also, other patterns were observed but these were not statistically significant. Conclusions & Implications: The young adults with autistic traits fell in between the control and autistic young adults, highlighting the presence of the continuum in the terms of features of social communication. The results support other current research that suggests that theory of mind and other social communication skills may not be universally or widely impaired in all autistic individuals without cognitive deficits. Although all tasks examined social communication skills, only a small number of significant correlations were found between test scores. This highlights that clinical conclusions about a person's social communication should be based on the outcomes of different types of methods measuring different aspects of social communication. It is clear that the interrelatedness of different social communication skills needs further research. What This Paper Adds: What is already known on this subject: For successful communication, the ability to infer others' emotions, intentions and mental states is crucial. Autistic people have difficulty with many aspects of social communication. However, the associations between different aspects of social communication need to be better understood. What this paper adds to existing knowledge: The unique contribution of this study is to compare the performance of autistic people not only with that of a control group but also with people with childhood autistic traits. This provides an understanding of the interrelatedness of different social communication skills in people with varying degrees of autistic traits. This study used four assessment methods focusing on three different social communication elements (non‐linguistic comprehension, social inference and empathizing skills). These elements have complex relationships to one another, some being closely overlapping, some more distally related and some reflect more complex multifactorial elements. This study shows that although groups differ from each other in most of the assessments, the performance of different groups overlapped showing that many autistic young adults can perform well in non‐linguistic and social inference tasks in structured assessment contexts. What are the potential or actual clinical implications of this work?: Our findings suggest that in the assessment of social communication, self‐reports and clinical assessments can be used effectively together. They can complement each other, pointing out the strengths and weaknesses of a person, leading to more personalized therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare performance in the modified shuttle walk test (MSWT) with cardiorespiratory parameters and respiratory muscle strength in children with cystic fibrosis (CF) and healthy controls. Methods: A cross‐sectional study with children divided into the CF group (CFG) and healthy control group (HCG). Two MSWTs were performed and the data from the test with the longest distance walked and its cardiorespiratory parameters (blood pressure, respiratory rate, heart rate (HR), oxygen saturation, and dyspnea sensation) were considered, the last three every 4 levels. Respiratory muscle strength was evaluated using a manometer. The Wilcoxon test was used to compare the parameters before and after the MSWT, and the Mann‐Whitney and independent t‐tests were applied to compare the data between the groups. The distance walked and its association with the variation in cardiorespiratory parameters and respiratory muscle strength were analyzed by Spearman's correlation. Results: Sixty‐two children (31 in each group) participated, with an average age of 10.2 (2.1) years. Children with CF had poorer performance in the average distance walked (CFG 716.7 (274.3)) when compared to the HCG (948.0 (202.8)). Both groups exhibited an increase in all the cardiorespiratory parameters at the end of the test, but the CFG displayed less variation in some parameters. Children with CF presented a positive correlation between distance walked and respiratory muscle strength, HR variation, and systolic blood pressure. Conclusions: There was no difference in respiratory muscle strength between the groups. In the CFG, the greater the respiratory muscle strength, the better the performance in the MSWT. The CFG exhibited less variation in cardiorespiratory parameters than the HCG. Implications for physiotherapy practice: Current knowledge Maximum Effort Tests provide detailed information on physiological health and enable exercise prescription.Exercise performance could be limited in children with cystic fibrosis (CF).Exercise performance is usually associated with obstruction to expiratory airflow in CF. What this paper contributes to our knowledgeChildren with CF show preserved respiratory muscles strengthPulmonary function and respiratory muscles strength were related to exercise performance by modified shuttle walk test (MSWT).Child collaboration influences test performance. [ABSTRACT FROM AUTHOR]

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

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

Background: Texture‐modified foods (TMF) is a common intervention for improving swallowing safety and efficiency for people with dysphagia. Non‐standardized texture classification (NSTC) of foods is used worldwide. However, as this study documents, it can introduce a lack of clarity and confusion over definitions that can potentially harm patients' safety. The International Dysphagia Diet Standardisation Initiative (IDDSI) framework offers international terminology and standardized methods for texture testing that can address this issue Aims: To document differences between NSTC and standardized texture classification (STC) of the IDDSI, to document changes in the STC in the 30 min following meal delivery, and to explore the relationship between food intake and texture level. Methods & Procedures: In this observational study, data were collected from 24 long‐term care departments during five meals served to 624 residents, including at least one breakfast, lunch and dinner. To document differences between NSTC and STC, all NSTC food textures used in the LTC facilities were reclassified to match the IDDSI texture level at the time food left the kitchen (n = 1276). To document time‐related changes in texture, the STC texture as food left the kitchen was compared with texture 30 min later (n = 1276). Finally, to explore the relationship between texture and consumption, estimates were made of single‐item food consumption (n = 3820) using a subjective evaluation of consumption percentage Outcomes & Results: A total of 1276 food items were classified over the course of five meal services (with at least one each from breakfast, lunch and dinner). Statistically significant differences in NSTC and STC texture levels were found that revealed that residents were consuming food that was more difficult to eat than intended by the TMF prescription. In addition, significant changes in food texture were found over time, with texture levels significantly increasing 30 min after food left the kitchen. Finally, greater consumption was found for softer textures in comparison with regular foods; moreover, food consumption was greatest during breakfast and lowest during lunch. Conclusions & Implications: Residents requiring TMF received harder textures than intended which required complex swallowing ability, thus introducing a choking risk. Using the STC as proposed by the IDDSI could improve patient safety, oral intake and nutritional status. Time‐related changes should also be considered in circumstances where patients do not consume food soon after service. Lastly, reduced food consumption during lunch might negatively impact overall nutrient intake, particularly in cultures where lunch is the main meal of the day. What this paper adds: What is already known on the subject: Despite widespread agreement on the importance of STC, institutional care providers widely use NSTC. The IDDSI framework offers international terminology and standardized methods for texture testing. The clinical importance of using STC is not well understood. What this paper adds to existing knowledge: This study found that residents who required texture‐modified foods were eating food textures that were more challenging to swallow than intended. Differences were found in food texture between when it left the kitchen compared with texture 30 min later. Pureed texture had greater consumption than regular textured food. Food consumption was found to be the highest during breakfast, and reduced during lunch, which might negatively impact overall nutrient intake. What are the potential or actual clinical implications of this work?: Accurate food texture prescription is the first step towards increasing patients' safety. However, food preparation and handling are also very important steps, not to be disregarded. Time‐related changes in food texture are remarkable and should be considered in circumstances where patients do not consume food soon after service, as these can compromise patients' safety. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was a clinical validation of the NANDA‐I nursing diagnosis "Impaired Resilience (00210)" in people under fertility treatment and determination of the sensitivity, specificity, and predictive value of the defining characteristics. Methods: A cross‐sectional study was conducted between September 2019 and June 2020. A total of 104 patients were recruited through fertility‐related websites, and they answered an online questionnaire after giving informed consent. The Rasch model was used for statistical analysis. The study was approved by the Ethics Committee. Findings: The "Impaired Resilience (00210)" had a prevalence of 15.4% in the sample, and seven defining characteristics confirmed as representative are "decreased interest in vocational activities," "depression," "impaired health status," "ineffective coping strategies," "low self‐esteem," "renewed elevation of distress," and "social isolation." No item showed differential item functioning. "Renewed elevation of distress" and "low self‐esteem" were the most sensitive defining characteristics and had the highest negative predictive value. "Shame" was the most specific one. Conclusions: The nursing diagnosis "Impaired Resilience (00210)" was validated, and results may improve its accuracy in people going through fertility treatment. Implications for nursing practice: This paper contributes by raising knowledge regarding NANDA‐I nursing diagnosis and enhancing the quality of nurses' critical judgment and clinical reasoning. A more effective assessment will allow early recognition of patients struggling with adversity during fertility treatment and enhance a nursing resilience approach in the reproductive field. [ABSTRACT FROM AUTHOR]

Background: Skill integration is vital in students' mastery development and is especially prominent in developing code tracing skills which are foundational to programming, an increasingly important area in the current STEM education. However, instructional design to support skill integration in learning technologies has been limited. Objectives: The current work presents the development and empirical evaluation of instructional design targeting students' difficulties in code tracing particularly in integrating component skills in the Trace Table Tutor (T3), an intelligent tutoring system. Methods: Beyond the instructional features of active learning, step‐level support, and individualized problem selection of intelligent tutoring systems (ITS), the instructional design of T3 (e.g., hints, problem types, problem selection) was optimized to target skill integration based on a domain model where integrative skills were represented as combinations of component skills. We conducted an experimental study in a university‐level introductory Python programming course and obtained three findings. Results and Conclusions: First, the instructional features of the ITS technology support effective learning of code tracing, as evidenced by significant learning gains (medium‐to‐large effect sizes). Second, performance data supports the existence of integrative skills beyond component skills. Third, an instructional design focused on integrative skills yields learning benefits beyond a design without such focus, such as improving performance efficiency (medium‐to‐large effect sizes). Major Takeaways: Our work demonstrates the value of designing for skill integration in learning technologies and the effectiveness of the ITS technology for computing education, as well as provides general implications for designing learning technologies to foster robust learning. Lay Description: What is currently known about the subject matter?: Skill integration is vital in students' mastery development, and is especially prominent in developing coding tracing skills.Coding tracing skills are foundational to programming, an increasingly important area in the current STEM education, yet many novice students struggle with code tracing.Instructional design to support skill integration in learning technologies has been limited.One of the most effective technologies for skill mastery, intelligent tutoring systems (ITS), is underused or only used in a partial form in programming education. What our paper adds to this?: We present the development and empirical evaluation of instructional design targeting students' difficulties in code tracing particularly in integrating component skills in an ITS, the Trace Table Tutor.The instructional features of the ITS technology (e.g., active learning, step‐level support, individualized problem selection) support effective learning of code tracing.Students' performance data supports the existence of integrative skills beyond component skills.An instructional design that provides deliberate practice and focused practice on integrative skills yields learning benefits beyond a design without such features. The implications of study findings for practitioners: Designing for skill integration is valuable and should receive more attention in designing learning technologies to foster robust learning.The instructional features of full‐scale ITSs are effective in supporting learning and merit further application in learning technologies in computing education. [ABSTRACT FROM AUTHOR]

Background: The coronavirus pandemic has affected education worldwide. Estonian schools moved to distance learning on March 16. Objectives: This paper outlines the stages of unexpected and temporary changes affecting different stakeholders based on activity and content of the messages in the Facebook group 'Homeschooling with technology'. Also the applicability of the concerns‐based adoption model was explored to explain these changes. Methods: The investigated timespan includes the week before the emergency situation and the weeks of the school term and school holidays during the emergency situation, with 52 days in total, divided into seven periods. The 872 messages were coded by two researchers and changes were examined. Results and Conclusions: Four stages were identified, from low exposure and involvement with the change to focusing on collaboration and skipping the consequence stage. Furthermore, the new changes in the educational system might focus people again on personal concerns. Implications: The results help capture the changes in teaching and learning situation caused by the coronavirus pandemic in order to learn from these changes and be prepared for such situations in the future. Lay Description: What is already known about this topicIn the emergency situation, even well‐experienced teachers were not sure what and how to teach.There are several models and there are different models on handling the changes in education.Concerns‐based adoption model (CBAM) looks at how change affects people.Emotions have changed from negative to neutral in social media during school closures What this paper addsPrevious studies have been based mostly on surveys, but this paper adds an in‐depth analysis of messages from social media.Four stages describing how changes affect people have identified.New changes brought back personal concerns and no impact concerns raised.CBAM model is applicable in explaining unexpected temporary changes Implications for practice and/or policyIn teacher training, curricula courses about distance learning methodologies and tools should be added.National guidelines about the management of distance learning situations should be prepared. [ABSTRACT FROM AUTHOR]

Background: There is a lack of critical or empirical work interrogating the nature and purpose of evaluating technology use in education. Objectives: In this study, we examine the values underpinning the evaluation of technology use in education through field specialist perceptions. The study also poses critical reflections about the rigour of evaluation instruments development in the educational technology field. Method: A total of 48 domain specialists were surveyed to investigate the face and content validity of 39 items under eight constructs, with both qualitative and quantitative data from the survey analysed. Results: There was an alignment between the constructs that the specialists felt were important and the constructs that have typically been the focus of empirical studies, with field specialists indicating high relevance scores for technology (M = 3.24/4), learning outcomes (M = 3.20/4), affective elements (M = 3.19/4), behaviour (M = 3.15/4), presence/community (M = 3.07/4), teaching/pedagogy (M = 3.01/4), design (M = 2.96/4), and institutional environment (M = 2.86/4). Only a minority of other studies were found to perform face and content validity checks and even then only with small samples of respondents (usually n ≤ 5). Implications: Specialists in educational technology research confirm that all eight dimensions are important to consider when evaluating the use of technology in education. Thorough face and content validity processes should be adopted when developing educational technology evaluation instruments. Further work has validated an eight factor 28 item instrument for evaluating the use of technology in education using a large sample of students from a global open learning online course. Lay Description: What is already known about this topic: Comprehensive evaluation of technology use is essential to make decisions on learning technology strategies.There is a lack of critical work interrogating how technology use is evaluated in education.There is a need for developing evaluation instruments in the educational technology field. What this paper adds: An examination of 48 field specialist perceptions of important constructs when evaluating technology use in education.Field specialists agreed that eight constructs identified in empirical studies were relevant to educational technology evaluation.Evidence of limited face and content validation processes based on previous empirical work.A comprehensive 39‐item instrument for evaluating technology use in education. Implications of study findings for practitioners: Adopt a broad range of constructs when evaluating the use of technology in education.Apply face and content validation processes involving a large sample of experts.Consider using the 39‐item instrument to evaluate educational technology use. [ABSTRACT FROM AUTHOR]

Objective: Two percent of the Japanese population is comprised of foreign residents with further increase expected due to immigration policy revisions. The purpose of this paper is to examine the healthcare needs and difficulties experienced by foreign residents in Japan by level of their Japanese language fluency. Design: A quantitative, descriptive design was used. Sample: We surveyed foreign residents in the greater Tokyo area (N = 209). Measurements: The research team created the survey questions and the contents of the survey include foreign residents' experiences during their visits or stays at medical and public health facilities in Japan. Results: More than 90% of the participants or their families visited medical facilities in Japan regardless of Japanese language fluency; however, those with less Japanese language fluency experienced statistically significant uneasiness or inconvenience concerning communication compared to those with native Japanese language fluency (p =.000). Conclusions: Nurses in Japan may benefit from additional training related to use of interpreters as well as education about diversity and cultural humility. Through better understanding of the specific communication barriers of foreign residents, nurses will be able to better anticipate difficulties and address them. [ABSTRACT FROM AUTHOR]

Background: Laryngeal dystonia (LD), or spasmodic dysphonia (SD), is a neurological disorder characterized by focal dystonia or involuntary spasms of the laryngeal muscles and associated voice symptoms. It is typically treated with injection of botulinum toxin (BoNT) that weakens the affected muscles. Aims: The primary purpose of this qualitative study was to explore participants' experience of living with LD and BoNT treatment. The secondary purpose was to examine those experiences as a function of participants' scores on the Communicative Participation Item Bank (CPIB). Results will enhance our understanding of restrictions in communicative participation, assist in planning intervention targeting these restrictions and aid in clinical interpretation of CPIB scores. Methods & Procedures: Semi‐structured interviews using a phenomenological tradition and focusing on BoNT treatment and communicative participation were conducted with 26 people with LD who are on established BoNT treatment regimens. Interviews were recorded, transcribed, coded and analysed inductively. Participants were categorized by CPIB scores into groups ranging from none to extensive participation restrictions. Both self‐ and expert ratings of voice were obtained. Outcomes & Results: Participants with different levels of CPIB scores had different experiences related to communicative participation in the context of BoNT treatment. These differences were organized into the following topics: BoNT and voice; attitudes toward participation; coping strategies; and advice. For all participants except those in the least restricted and most restricted groups, expert ratings of voice did not relate to CPIB scores. Conclusions & Implications: Although most participants report improved voice with BoNT treatment, many participants experienced lingering restrictions in communicative participation, some to a severe extent. Participants reported coping with these restrictions in many ways; some of these strategies were more successful than others. Those with restricted participation recommended more support for daily life and the emotional toll of LD, as well as support for family members. This support might be offered by speech–language pathologists. What this paper adds: What is already known on the subject: Participants with different levels of CPIB scores had different experiences related to communicative participation in the context of BoNT treatment. What this study adds to the existing knowledge: Although most participants report improved voice with BoNT treatment, many participants experienced lingering restrictions in communicative participation, some to a severe extent. What are the potential or actual clinical implications of this work?: SLP services that take a participation‐focused approach to intervention and use multi‐factorial approaches to help clients maximize their life participation in the context of LD are well within the SLP scope of practice. SLPs can help clients find and use their optimal voices within the constraints of the dystonia and BoNT effects. [ABSTRACT FROM AUTHOR]