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Background: Instructional videos constitute a pivotal component in flipped learning. Despite their significance, there is a dearth of research specifically dedicated to instructional videos within the context of flipped classrooms. This paucity has led to an empirical void in verifying the efficacy of instructional videos in flipped learning environments. Objectives: The present study endeavours to contribute to the extant literature on flipped pedagogical practices by providing empirical evidence regarding the effectiveness of instructional videos in flipped learning environments. Methods: This study employs a convergent mixed‐methods design. Forty‐five instructional videos in three subtypes were administered in two classes over a 15‐week semester. Data, both quantitative (log data from the learning management system) and qualitative (from focus group discussions at two time points), were concurrently collected from a flipped class (n = 25) and a blended class (n = 28) with the aim of gauging student engagement and learning outcomes in the flipped class and understanding video‐viewing features typical of the flipped class. Results: Both datasets corroborated that participants in the flipped class outperformed their counterparts in the blended class in terms of video‐watching, peer interaction, knowledge retention, and transfer skills. Conclusions: The instructional videos within the flipped classroom setting serve to enhance student engagement in the learning process and improve learning outcomes. The efficacy of these instructional videos in flipped learning can be further augmented through strategic approaches in both their design and implementation. Lay Description: What is currently known about this topic: The flipping pedagogy is conducive to learning.Videos play a crucial role in flipped learning.Videos prepared students for classroom activities.However, engaging students with pre‐class videos presents a challenge. What this paper adds: This paper furnishes direct empirical evidence supporting the effectiveness of instructional videos in flipped learning.It uncovers factors affecting student engagement with videos in flipped learning.It offers insights into the design and implementation of videos in flipped learning. Implications for practice: Considering facilitating conditions and affective factors when creating videos.Acknowledging learner characteristics when designing videos.Utilizing instructional strategies when implementing videos. [ABSTRACT FROM AUTHOR]

Background: Given students' lack of self‐directed learning skills and the growing concern about implementing massive online open courses (MOOCs) in K12 education, learning strategies are needed to facilitate MOOC learning. Many studies have provided different strategies for effective learning in MOOCs. However, there is still limited research to confirm whether these strategies effectively support MOOC learning when deployed by secondary schools, which are not MOOC developers. Objectives: This mixed‐method study examines the provision of different learning strategies, including a learning guide, an academic mentoring programme, a training workshop, and a reimbursement scheme, and investigates the impact of these strategies on student learning in MOOCs. Methods: The study uses two data sources: (1) surveys with 40 participants and (2) semi‐structured interviews with 12 participants. The quantitative data were analysed with descriptive statistics and Fisher's exact test, and the qualitative data were analysed with thematic analysis. Results and Conclusion: The findings indicate that MOOC learners had positive attitudes towards the overall school support, with mentoring enjoying great popularity amongst the students. In terms of the effectiveness of the school support, the mentoring programme and reimbursement scheme were more effective than the university training and learning guide. The paper discusses the implications for researchers and educators. Lay Description: What is already known about this topic: There are a large number of K12 MOOC implementations, which are (i) STEM‐related and computer science courses, and (ii) from Europe and the USA.Limited studies provided different learning strategies for MOOC learning from the perspective of K12 schools, which are not MOOC developers.There is a need to explore MOOC initiatives encompassing a wide variety of subjects, including computer science MOOCs and non‐computer science MOOCs, in regions beyond Europe and the USA.There is also a need for further scrutiny of the effectiveness of learning strategies provided by the K12 school. What this paper adds: Our study launched the first MOOC implementation in K12, encompassing several subject areas beyond computer science in the region of Asia.Our study provided different learning strategies adopted by the K12 school, and the analysis revealed that MOOC learners took positive attitudes towards overall school support with mentoring enjoying great popularity with these students.Our study examined the effectiveness of school support and identified that mentoring and reimbursement are more effective than university training and the learning guide. Implications for practitioners: The insights gained from the study enable other K12 schools and educators to implement MOOC into existing school infrastructures successfully.These strategies provided in the MOOC implementation program can be helpful in many different online learning contexts. [ABSTRACT FROM AUTHOR]

Background: People who have communication difficulties may benefit from using augmentative and alternative communication (AAC). Understanding and measuring outcomes from the use of AAC is an important part of evaluating the impact of devices and services. Outcome measurement needs to reflect the changing nature of the impact of using AAC on an individual's ability to participate in activities of daily life. There is a limited understanding of the concepts that should inform the evaluation of outcomes from AAC device provision, nor how people's expectations from AAC may change over time. Aims: To inform the development of a patient‐reported outcome measure for AAC by understanding more about people's expectations from AAC and how these change over time. Methods & Procedures: A longitudinal qualitative research study was designed and carried out with seven participants over a period of 2 years. Participants were recruited from a regional specialist assessment service for AAC in the south‐west of the UK. Four semi‐structured interviews were carried out: (1) before assessment for AAC, (2) after assessment, (3) directly after provision of an AAC device and (4) between 6 and 12 months after provision. An original analytic method was used in this study that built on the principles of longitudinal interpretative phenomenology analysis, applied with a dialogic theoretical lens. This approach enabled the inclusion of a range of multimodal and embodied data collected to this study and allowed the research team to draw out salient themes across the cohort group while attending to the influence of time and context on experience. Outcomes & Results: The results confirm and extend the three core concepts that were used to guide analysis: changes; contexts; future possibilities. The contextual and temporal influences on outcomes attainable from AAC for this cohort were also identified and illustrated through cross‐case comparison. Deeper, analytic, and conceptual engagement with theory, which was then applied to analysis of the data, provided methodological rigour in the study. The results enhance our understanding of people's hopes and expectations from AAC and how these change over time. Conclusions & Implications: This qualitative longitudinal research study provides new insights into the journeys of people who experience communication disability, and the shifting nature of their sense of identity as they engage with, and learn from using, AAC. The study is significant as it attends to the dynamic nature of experience and how contextual and experiential factors influence people's hopes and expectations from AAC. The paper presents an original application of longitudinal qualitative research methodology with people who use AAC which can be further applied and tested in the field of communication disability research. WHAT THIS PAPER ADDS: What is already known on this subject: We did not know the impact that time has on the concepts that have been identified to represent important outcomes from AAC. The existing concepts used to define outcomes from AAC were not adequately conceptualized to develop a patient‐reported outcome measure. This study sought to extend our knowledge about outcomes from AAC. What this paper adds to the existing knowledge: This study adds to the methodological toolkit available for qualitative inquiry in the field of communication disability research by presenting a longitudinal qualitative research methodology. It adds depth to our understanding of the concepts that underpin outcomes from AAC and highlights the dynamic nature of contexts and how this influences desired outcomes. What are the potential or actual clinical implications of this work?: This longitudinal qualitative research study provides a broader perspective on the experience of getting AAC. It will enable clinicians to better navigate the contextual and transitionary factors that influence people's experience of acquiring AAC devices. The enhanced concepts described will also support clinical conversations that consider the wider facets of communication and what AAC can add to existing communicative tool kits beyond getting a message across. [ABSTRACT FROM AUTHOR]

Background: The incidence of coagulation of continuous renal replacement therapy circuits remains high. To the best of our knowledge, no scholar has published a protocol to avoid management errors when different types of citrates coexist in the same Intensive Care Unit. Aim: To assess the safety and efficacy of the unification of two protocols with different concentrations of citrate solution. Study Desing: A prospective, quasi‐experimental study was carried out in the intensive care unit of a tertiary referral hospital (in Barcelona, Spain), over 3 years. Consecutive adult patients requiring continuous renal replacement therapy with citrate were included. The sample was divided into two groups, a control group (concentrated citrate) and an intervention group (diluted citrate). The decision to initiate anticoagulation with diluted (18 mmol/L) or concentrated (136 mmol/L) citrate was made based on the machine available and the decision of the doctor responsible for the patient. It was not possible to randomize the sample. Both protocols were matched with a starting citrate dose of 3.5 mmol/L, and a dialysis solution was used. Post‐filter replacement was not used, and the citrate solution was the only fluid administered pre‐filter. Results: The analysis included 59 circuits in the concentrated citrate group and 40 circuits in the diluted citrate group. An increased need for electrolyte replacement was observed in the diluted group (p <.001). The concentrated citrate group had a longer filter life (p <.05), and there was a slight trend toward alkalosis. Conclusion: The diluted citrate group had a higher incidence of electrolyte replacement. The concentrated citrate group had longer circuit lifespan and a trend toward metabolic alkalosis, although this was not statistically significant. If these conclusions are considered, the protocol can be unified. Relevance to Clinical Practice: The present work aims to provide information on the differences in the use of regional anticoagulation with diluted or concentrated citrate. The objective is to pay special attention to aspects that can lead to complications. The unified protocol proposed in this paper could be extrapolated to any machine on the market that uses either of these two types of citrate concentration. [ABSTRACT FROM AUTHOR]

This paper explores how the COVID‐19 pandemic affected care leavers in Quebec, a social group already facing obstacles to social integration. Semi‐structured qualitative interviews were conducted with 48 participants and analysed through Castel's zones of vulnerability model. Results suggest that youth who entered the pandemic with more vulnerabilities were more affected by it in all dimensions of their lives. However, results also suggest that the presence of a strong social support network protects even the most vulnerable ones from being overly afflicted, highlighting the importance of interventions that reinforce care leaver's social support network during times of crisis. [ABSTRACT FROM AUTHOR]

Background: Data literacy (DL) is vital for teachers, as it enables them to build on data and improve teaching and learning. Therefore, developing DL among pre‐service teachers is critical. Objectives: The purpose of this study is threefold: to evaluate whether a feedback visualisation of peer assessment‐based teaching approach (FVPA‐based teaching approach) can (1) promote pre‐service teachers' DL; (2) enhance their learning motivation; and (3) improve their cognitive load. Methods: The research was conducted based on a pre‐test‐post‐test control group quasi‐experimental design. With 20 participants in the experimental group and 21 in the control group, a total of 41 pre‐service teachers were included in the study. The pre‐service teachers in the experimental group adopted the FVPA‐based teaching approach, and those in the control group adopted the traditional peer assessment‐based learning approach. Results and Conclusions: The experimental group participants outperformed the control group participants in DL, learning motivation, and cognitive load. FVPA was conducive to helping pre‐service teachers critically interpret data, understand their teaching and learning issues, and improve self‐reflection. The findings indicate a reciprocal relationship between learning motivation and DL; improving the learning motivation of pre‐service teachers could promote their DL. Implications: This study contributes to current knowledge by providing empirical evidence on the benefits of an FVPA‐based teaching approach in improving pre‐service teachers' DL, motivation, and cognitive load. The study findings, limitations, and prospects for future research are discussed. Lay Description: What is already known about this topic?: Teacher data literacy has emerged as a crucial competency for the forthcoming generation of educators, gaining attention from education institutions globally.Peer assessment, a well‐established practice in pre‐service teacher education, has proven effective in enhancing the learning experience for disadvantaged students by fostering motivation and improving academic performance.Despite the acknowledged benefits of feedback visualisation in facilitating self‐reflection, motivation, and academic performance, creating meaningful visualisations remains a challenge for educators and learners. What this paper adds?: This study introduces feedback visualisation in peer assessment to enhance comprehension of feedback information among pre‐service teachers.Feedback visualisation augments the benefits derived from peer assessment, refining data literacy, improving learning motivation, and alleviating cognitive load among pre‐service educators.The analysis of data directly relevant to pre‐service teachers and the provision of timely feedback can motivate critical analysis and utilisation of data, facilitating the identification of pedagogical and learning challenges.The study explores intricate interactions among learning motivation, data literacy, and cognitive load within the context of peer assessment visual feedback. The implications of study findings for practitioners: We encourage teacher educators to implement peer assessment instruction grounded in visual feedback for a comprehensive understanding of learning outcomes, identification of pedagogical challenges, determination of causes, and evidence‐informed instructional decision‐making.Teacher educator should diversify strategies to augment the motivation of pre‐service teachers, cultivating their proactive engagement in data analysis, interpretation, and application to enhance overall data literacy.We recommend that teacher educators provide rich visual feedback or present complex data in a visually accessible format for pre‐service teachers who need additional assistance to mitigate cognitive load and facilitate successful learning outcomes. [ABSTRACT FROM AUTHOR]

Understanding the drivers of improvements in child undernutrition at only the national level can mask subnational differences. This paper aimed to understand the contributions of factors in the enabling environment to observed differences in stunting reduction between districts in Rwanda. In 2017, we conducted 58 semi‐structured interviews with mid‐level actors (n = 38) and frontline workers (n = 20) implementing Rwanda's multi‐sectoral nutrition policy in five districts in which stunting decreased (reduced districts) and five where it increased or stagnated (non‐reduced districts) based on Rwanda's 2010 and 2014/15 Demographic and Health Surveys. Mid‐level actors are government officials and service providers at the subnational level who represent the frontline of government policy. Interviews focused on political commitment to and policy coherence in nutrition, and contributors to nutrition changes. Responses were coded to capture themes on the changes and challenges of these topics and compared between reduced and non‐reduced districts. Descriptive statistics described district characteristics. Political commitment to nutrition was high in both reduced and non‐reduced districts. Respondents from reduced districts were more likely to define commitment to nutrition as an optimal implementation of policy, whereas those from non‐reduced districts focused more on financial commitment. Regarding coherence, respondents from reduced compared to non‐reduced districts were more likely to report the optimal implementation of multi‐sectoral nutrition planning meetings, using data to assess plans and progress in nutrition outcomes and integration of nutrition into the agriculture sector. In contrast, respondents from non‐reduced districts more often reported challenges in their relationships with national‐level stakeholders and nutrition and/or monitoring and evaluation capacities. Enhancing the integration of nutrition in different sectors and improving mid‐level actors' capacity to plan and advocate for nutrition programming may contribute to reductions in stunting. Key messages: Understanding the lens through which policy implementers at subnational levels view multi‐sectoral nutrition strategies and their role in these strategies provides useful information on the facilitators and constraints of implementation for nutrition actions.Differences in leadership and responsiveness to prioritise nutrition at the subnational levels are important in decentralised governance systems where responsibilities in nutrition planning, coordination and implementation shift to mid‐level actors.Mainstreaming nutrition responsibilities across sectors and administrative levels requires investments in capacities to plan, monitor and advocate for multi‐sectoral nutrition programming, including for mid‐level actors. [ABSTRACT FROM AUTHOR]

Background: The role of patient participation and representation during crises, such as the COVID‐19 pandemic, has been under‐researched. Existing studies paint a pessimistic picture of patient representation during the pandemic. However, there are indications that patient representatives have adapted to the new situation and can contribute to the resilience of healthcare systems. This paper aims to further explore the potential contribution of patient representatives for healthcare system resilience during the COVID‐19 pandemic. Methods: The study used a qualitative approach. We conducted a thematic analysis on the following data: interviews with client council members (n = 32) and representatives from patient organizations (n = 6) and focus groups (n = 2) to investigate patient representation on both the national policy level and organizational level in the Netherlands. Results: We identified the crisis discourse, the dependent position, the diversity of patient perspectives and the layered decision‐making structure as themes that help to understand what made patient representation in pandemic times a struggle for national and local patient representatives. The analysis of the subjects these representatives put forward during decision‐making shows that their input can play an important role in broadening discussions, challenging decisions, and suggesting alternatives during a crisis. We identified several strategies (e.g., collaborating with other actors, proactively putting subjects on the policy agenda, finding new ways of contacting their 'constituency') used by the patient representatives studied to exert influence despite the difficulties encountered. Conclusions: The struggle for patient representation during pandemic decision‐making is a missed opportunity for resilient healthcare systems as these representatives can play a role in opening up discussions and putting different perspectives to the fore. Moreover, the adaptive strategies used by representatives to influence decision‐making offer lessons for future representation activities. However, adaptations to the crisis decision‐making structure are also needed to enable patient representatives to play their role. Patient Contribution: We conducted interviews with patient representatives and discussed our preliminary findings with patient representatives during the focus groups. Zorgbelang, a patient organization supporting client councils and enabling and organizing patient participation for organizations and municipalities, was partner in this research and contributed to the interview guide, conducting interviews and focus groups. Additionally, the analysis made by the first author was discussed and refined multiple times with the partners of Zorgbelang and one of them co‐authored this paper. [ABSTRACT FROM AUTHOR]

Background: Early identification and intervention for hearing loss is important for supporting language development. Despite this, parents are required to overcome barriers to access hearing assessments for their children. Aims: To identify the enablers and barriers to accessing hearing assessments for Australian children identified by their parents, and to compare between metropolitan, regional and rural areas. Methods & Procedures: This sequential, explanatory mixed‐methods study was undertaken online and included participants in metropolitan, regional and rural area of Queensland, New South Wales, Victoria, South Australia, Western Australia and the Northern Territory. A total of 56 participants participated in the surveys, and 10 participated in semi‐structured interviews. Outcomes & Results: Participants in metropolitan areas were more likely to have services in their area; however, access to hearing assessment was related more to individual circumstances (including health literacy skills) rather than geographical location. Many participants experienced long wait times, reduced flexibility, and a lack of audiologists experienced in working with children. Conclusions & Implications: Barriers to hearing assessments (which assist with early identification and intervention for hearing loss) should be addressed so that children have access to clear auditory information to assist with their speech and language development. WHAT THIS PAPER ADDS: What is already known on the subject: Poor audiological input can lead to poor speech, language and literacy outcomes for children. What this paper adds to the existing knowledge: Although previous research indicates that people in regional and remote locations experience difficulty accessing health services within a reasonable timeframe, in this study barriers were experienced regardless of geographical location, and were dependent on individual circumstances. Many parents are unaware of the impact of hearing on speech and language. What are the potential or actual clinical implications of this work?: Further research might examine how health literacy affects access to hearing assessment. Parents shared several potential solutions to these access barriers which should be considered by service providers. [ABSTRACT FROM AUTHOR]

Objectives: DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers.Method: DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care: WS1: Recruitment and follow-up of the DETERMIND cohort-900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years. WS2: Investigation of the extent of inequalities in access to dementia care. WS3: Relationship between use and costs of services and outcomes. WS4: Experiences of self-funders of care. WS5: Decision-making processes for people with dementia and carers. WS6: Effect of diagnostic stage and services on outcomes. WS7: Theory of Change informed strategy and actions for applying the research findings.Outcomes: During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia. [ABSTRACT FROM AUTHOR]

Background: Game‐based learning can frame problem‐solving as a sense‐making experience with domain‐specific tasks for school students. However, multiple challenges arise when trying to support learners in such a complex, problem‐oriented learning environment. Objectives and Methods: With an architecture‐themed mathematics learning game, we conducted two mixed‐method studies to explore the impact and design of game‐based mathematical experience on the math problem‐solving performance of middle school students. Results and Conclusions: The study findings suggested a positive impact of game‐based math experience on math problem‐solving for middle school students. Problematization‐oriented game‐based math tasks with structuring features enhanced students' reasoning with problems and channelled it to doing mathematics. Takeaways: The current research findings support the initiative to frame learning as a sense‐making experience with domain‐specific tasks and inform the design of game‐based mathematical experience and learning support. Lay Description: What is already known about this topic: Realistic mathematical practices frame learning as a sense‐making experience.Challenges arise when involving learners in realistic mathematical experiences driven by domain‐specific tasks. What this paper adds: Game‐based simulation of math tasks framed learning as sense‐making experience.Game‐based math experiencing promoted math contextual problem‐solving performance.Structuring features enhanced problematized experiencing with math tasks. Implications for practice and/or policy: Teachers can integrate and facilitate game‐based math experiencing in class.Efforts should be made to make game‐based math tasks meaningful for students. [ABSTRACT FROM AUTHOR]

Background: Online collaboration tools have been identified as potentially effective means for enhancing student learning, motivation, and engagement in science education. However, their effectiveness in improving science education outcomes among middle school students remains uncertain. Objectives: The study aimed to investigate the impact of online collaboration tools on science education outcomes among middle school students, focusing on learning achievement, engagement, and motivation. Methods: A quasi‐experimental design with a pretest‐posttest control group was used in this study. A total of 60 eighth‐grade middle school students were involved in the study, with both the experimental and control groups comprising 30 students each. The experimental group incorporated the use of digital collaboration platforms, including Asana, Slack, and Team Viewer, as instrumental components of group project execution and discussion in their science lessons. Conversely, the control group adhered to the current educational approach in Turkey, characterized by the employment of an inquiry‐based learning strategy in their science instruction. Data was collected over eight weeks using a science achievement test, engagement scale, and science motivation scale. Results: The experimental group demonstrated significantly higher post‐test scores compared to the control group, suggesting that online collaboration tools positively impacted science education outcomes. Additionally, survey data indicated high levels of engagement and motivation among the experimental group students when using the online collaboration tools. Conclusions: The findings support the notion that online collaboration tools can effectively enhance learning, motivation, and engagement in science education among middle school students. These results have significant implications for educators, educational institutions, policymakers, and curriculum developers. Further research is needed to examine the potential of these tools in various educational contexts and with different student populations. This will help broaden the understanding of how online collaboration tools can be integrated into diverse learning environments, potentially benefiting a larger number of students and further improving science education outcomes. Lay Description: What is already known about this topic: Technology's role, particularly online collaboration tools, in enriching science education is undebatable (Donkin & Rasmussen, 2021; Rahmawati et al., 2022). Such tools have been theorized to bolster student learning outcomes, motivation, and engagement (Donnelly et al., 2013; Ekici, 2017; Khazanchi & Khazanchi, 2019). Yet, the empirical evidence validating their efficacy in science educational settings remains sparse. What this paper adds: This research delves into the influence of online collaboration tools on science learning outcomes among middle school learners. Data indicates that employing these digital tools substantially elevates student performance, as gauged by a science achievement test. Furthermore, students navigating through these online collaborative platforms recorded elevated levels of both engagement and motivation. The primary effectiveness of online collaboration tools stems from their ability to foster specific behaviours, such as increased communication frequency and structured task management, which can amplify learning and group collaboration through their facilitated structured interactions. Implications for practice and/or policy: This study's conclusions offer pivotal insights for educators, academic institutions, policy framers, and curriculum architects. Online collaborative platforms exhibit promise in amplifying student outcomes and engagement within the realm of science education. It is imperative to broaden this research scope to discern the tools' potential across varied educational environments and diverse student demographics. There is a compelling case for stakeholders, especially educators and policymakers, to contemplate incorporating these online tools into science pedagogy, aiming to magnify student learning experiences and engagement levels. [ABSTRACT FROM AUTHOR]

Objective: Although Ireland has one of the highest levels of well‐being in Europe, having a health condition has been found to have a direct negative impact. The aim of this study is to evaluate the current situation and the experiences of patients with epidermolysis bullosa (EB), a rare genetic skin disease, and their relatives living in Ireland, with a focus on burdens and helpful practices. Methods and Measures: In a mixed‐methods design, a series of standardised questionnaires were combined with open‐ended questions. Via an online survey, data from n = 59 EB patients and relatives of EB patients living in Ireland were collected. Results: EB affects both the patients and their relatives. Burdens were found in relation to the visibility of EB, the degree of severity, the current health status, reduced mobility, the financial impact of EB, the psychosocial impact and personal and social resources. The paper also analyses existing resources and highlights opportunities for support and needs of improvement. Conclusion: Quality of life with EB is influenced by somatic symptoms and the psychosocial burden. Individual helpful practices in dealing with this rare disease can be considered as mediators, but they need to be supported by structural and healthcare improvements. Patient or Public Contribution: The perspective of EB patients, their relatives and EB experts were taken into account in the development of the study design via two feedback loops with the EB patient organisations DEBRA Ireland and DEBRA Austria. The design was adapted accordingly. Additionally, by including open‐ended questions, patients and relatives could contribute their individual perspectives and add insights into their lives with EB that might not have been captured with the structured online survey alone. [ABSTRACT FROM AUTHOR]

With the growing use of artificial intelligence, search engine providers are increasingly pushing advertisers to use automated bidding strategies based on machine learning. Such automated decision‐making systems leave advertisers in the dark about the data being used and how they can influence the outcome of the decision‐making process. Previous literature on artificial intelligence lacks an understanding of the dangers related to artificially intelligent systems and their lack of transparency. In response, our paper addresses the inherent risks of the automated optimization of advertisers' bidding strategies in search engine advertising. The selected empirical case of a service company therefore demonstrates how data availability can trigger a long‐term decline in advertising performance and how search engine advertising performance metrics develop before and after an event of data scarcity. Based on data collected for 525 days, difference‐in‐differences analysis shows that the algorithmic approach has a considerable and lasting negative impact on advertising performance. Furthermore, the empirical case indicates that self‐regulated learning can initialize a downward spiral that gradually impairs advertising performance. Thus, the aim of this study is to increase awareness regarding automated decision‐making dangers in search engine advertising and help advertisers take preventive measures to reduce the risks of algorithm missteps. [ABSTRACT FROM AUTHOR]

Background: Person‐centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. Aim: This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. Methods & Procedures: Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. Results: Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. Conclusion: These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers. WHAT THIS PAPER ADDS: What is already known on this subject: Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge: This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work?: This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers. [ABSTRACT FROM AUTHOR]

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

Background: Education is, after gaming, the second largest sector embracing augmented reality (AR) at an accelerated pace, yet studies on AR's potential as an efficient learning environment had mixed results. Objectives: This study's primary objective is to test students' interaction with graphical 3D elements in AR and its impact on information retention. The second objective is to compare information retention from AR engagement with information retention from exposure to identical 3D content delivered via instructional video. Finally, the third objective explores students' perceptions of AR as a learning environment. Methods: Sixty‐five college students participated in a two‐arm experiment followed by semi‐structured interviews. Results and Conclusion: AR can efficiently deliver a meaningful learning experience and promotes information retention. Nevertheless, AR's interactive features and novelty may distract learners while they engage with the virtual environment. Objective data obtained through eye tracking and video monitoring showed similar levels of engagement with a 3D model for both environments. While both AR and video groups showed significant knowledge gain from pre to post‐intervention, the video format was overall significantly more effective than AR in increasing topic‐related information retention. However, participants preferred the AR learning environment significantly more than the video. Takeaways: Although effective, AR is still a distracting instructional environment. Designing learning experiences tailored explicitly for AR environments requires additional research to ensure its successful deployment as a learning tool. Lay Description: What is already known about this topic: Education is the second‐fastest growing sector to adopt and experiment with augmented reality (AR).Hardware and software tools to create AR environments have reached the consumer level.The advantage of immersing learners in dedicated virtual environments seems obvious.Research has had mixed results in validating AR as a proper learning environment. What this paper adds: AR is a viable environment which supports information retention.For many students, the medium's novelty promotes engagement with the content.Students prefer AR to video lectures, but it may distract them from learning.Regarding information retention, video lectures do better than AR. The implications of study findings for practitioners: Learning experiences in AR should be reserved for some specific topics and designed purposedly.Progressive exposure of learners to AR environments may produce habituation and decrease distraction. [ABSTRACT FROM AUTHOR]

Background: Tele‐collaborative projects serve as invaluable platforms for students from diverse countries to engage in cross‐cultural communication and exchange cultural knowledge. These projects offer immense benefits in terms of fostering intercultural competence among participants. However, one challenge arises when participants engage in spoken communication rather than written. Those who may not share a common first language often rely on a lingua franca such as English for intercultural communication. In such spoken exchanges, varying levels of language proficiency can lead to communication errors that hinder the intercultural learning process and impede the development of intercultural competence in their fellow participants. Objectives: In the present trial study, our primary objective was to tackle the language‐related challenge associated with spoken communication head‐on. Our focus centred on addressing the discrepancies arising in spoken communication, and we aimed to mitigate these discrepancies by utilizing speech‐enabled corrective feedback technology. Methods: In a tele‐collaborative project involving 28 graduate students from the People's Republic of China and Republic of Kazakhstan, the participants engaged in spoken communication and cultural exchange in English via the internet. Given the emphasis on spoken communication and the recognition that English was not their first language, we implemented a speech‐enabled corrective feedback (SECF) technology to ensure effective communication in terms of pronunciation, grammar, and word choice. The SECF technology detected and provided instant feedback on any speech mistakes, enabling participants to make corrections accordingly. The main aim of our study was to explore the potential benefits of integrating SECF technology into a tele‐collaborative project for the development of participants' intercultural competence. Additionally, we sought to gather insights into the students' perceptions of the SECF support. Results and Conclusions: The results of our study revealed significant improvements in the participants' intercultural competence across dimensions such as knowledge, skills, attitude, and awareness. Furthermore, the participants expressed positive perceptions of the SECF technology. Drawing from our findings, we offer valuable implications and recommendations for educators and researchers in the field, enhancing their understanding of the role of SECF technology in supporting intercultural competence development in tele‐collaborative settings. Lay Description: What is currently known about the subject matter: Tele‐collaborative projects are widely utilized to enhance intercultural competence.Low language proficiency of participants often poses a significant challenge in tele‐collaborative projects. What this paper adds: The present study addressed the language barrier by incorporating speech‐enabled corrective feedback (SECF) technology to support our tele‐collaborative project.The study explored how our tele‐collaborative project, supported by SECF, facilitated the development of intercultural competence. The implications of study findings for practitioners: Scholars and practitioners should consider implementing SECF technology to address language‐related barriers in tele‐collaborative projects.Guidelines based on our study can be utilized to design tele‐collaborative projects with SECF support.Training on technology and constant support needs to be provided to participants. [ABSTRACT FROM AUTHOR]

Background: Students who are blind are integrated into public schools in many countries, yet are often excluded from full participation in science since most learning materials are visual. To create a compensatory route, an existing model‐based inquiry‐learning environment was adapted by means of sonification (addition of non‐speech sounds that represent dynamic information). The learning environment uses agent‐based models and a complex systems approach to teach the Kinetic Molecular Theory (KMT) and Gas Laws. The models are accompanied by a workbook consisting of text (printed or auditory) and images (printed or tactile). Objectives: The current research examined whether such perceptual compensation creates a comparable learning environment for learners who are blind compared with learners who are sighted using the original learning environment. The aim of the study is to expand knowledge about how the auditory channel may compensate the visual channel among individuals who are blind. Methods: Conceptual learning in science and reasoning about complex systems were assessed using pre‐ and post‐questionnaires. To explore learners' learning progression throughout the unit, four progression analysis 'windows' were selected. These were groups of adjacent or nearly adjacent items in the workbook that permitted a glimpse of learners' progression. Results: The sonified environment not only supported the learning of learners who are blind compared with the learning of learners who are sighted using visual material, but even furthered their learning with respect to diffusion, one of the more challenging concepts in KMT. It seems the types of sonified representations used in this study increased listeners' sensitivity to the micro‐level interactions in a way less accessible in visual representations. Takeaways: Sonified environments can be provide learners who are blind with equitable participation by compensating and complementing the visual channel. Sonification can have implications for students who are blind as well as students who are sighted. Lay Description: What is already known: Sonification is the use of non‐speech sounds to represent dynamic information. Sonification can potentialy be used to allow equitable participation for students who are blind. What this paper adds: To test this, the study compared the outcomes of learners who are blind who used a sonified learning environment (L2C) to that of learners who are sighted who used a visual environment. Implications for practice: Learners who are blind showed equal or better learning outcomes using the sonified models compared with the learners who are sighted using the visual models. There are major implications for integrating students who are blind in public school classrooms. [ABSTRACT FROM AUTHOR]

Background: As the concept of flipped classrooms continues to gain interest across disciplines, more research is needed to strengthen the instructional design by integrating active learning strategies and emerging technologies. Among various possibilities, little is known about how game‐based learning combined with Augmented Reality (AR) can be effectively infused into language education to establish supportive flipped learning contexts. Objectives: This study thus proposed an AR‐enhanced game‐based learning (ARGBL) approach, featuring the use of an augmented board game to engage students actively in classroom activities. It further compared the effects of the proposed approach with traditional game‐based learning on the students' vocabulary acquisition and creative thinking as they were instructed to learn English as a foreign language (EFL) in flipped classrooms. Methods: A quasi‐experimental design was adopted to examine the effectiveness of the proposed approach to promote the students' participation in flipped in‐class activities, thereby improving their learning outcomes. Participants were recruited from two classes of the same undergraduate course, one of which was designated as the experimental group to take part in game‐based learning activities in class by playing an AR‐enhanced board game, and the other as the comparison group to learn by playing a paper‐and‐pencil game with identical puzzle content. The desired student learning outcomes were measured by pre‐ and post‐intervention vocabulary tests and creative thinking tests, supplemented by individual interviews. Results: Results indicated that the students in the experimental group significantly outperformed their counterparts in vocabulary acquisition and creative thinking. They also expressed positive perceptions of the augmented game‐based learning experience in the flipped EFL classroom. Take Away: ARGBL can be a promising approach to improving student learning, and it is particularly beneficial to the design of classroom activities in flipped learning contexts due to its affordances for enriched content visualization and active learner engagement through gameplay. Lay Description: What is already known about this topic: Flipping the classroom is becoming prevalent in education, and researchers have stressed the need to move beyond comparing the outcomes of flipped and non‐flipped settings in order to advance innovation and examine the effectiveness of instructional design.Recent research has shown positive effects of using AR technology for content delivery, with location‐based context‐aware applications being more commonly applied in language education, while the potential of image‐based AR also warrants research attention.Learning by playing games has been considered an engaging strategy that provides benefits for learner engagement, but not all game genres have been fully studied. What this paper adds: This study proposed an ARGBL approach, applying image‐based AR to augment board gaming activities in class when the classroom was flipped.The ARGBL approach was found to significantly improve the students' English vocabulary acquisition.The ARGBL approach was found to significantly enhance the students' creative thinking development. Implications for practice: The innovative merger of image‐based AR and physical board gaming pieces into a hybrid form of mediation, namely the AR‐enhanced board game, likely encouraged face‐to‐face interaction of meaningful language use in flipped in‐class activities, thereby leading to the vocabulary growth and creative thinking development of EFL learners.The effectiveness of the ARGBL approach should be considered as an integrated whole with a holistic understanding of the interplay between the AR technology and the active learning strategy through gameplay in the broader pedagogical context of flipped classrooms. [ABSTRACT FROM AUTHOR]

Background: The substantial growth in gamification research has connected gamified learning to enhanced engagement, improved performance, and greater motivation. Similar to gamification, personalized learning analytics dashboards can enhance student engagement. Objectives: This study explores the student experiences and academic achievements using a gamified dashboard in a large, introductory STEM course. Methods: We examined two groups of students enrolled in different sections of a one‐semester‐long physical geology course with a total enrollment of 223 students. The only difference between the groups was that one had access to the dashboard. The data collection included students' assignments, overall performances, and exam scores. Students in both sections completed a Science Literacy Concept Inventory survey at the beginning and end of the term. Additionally, students completed an end‐of‐term survey containing open‐ended questions on their experience and interactions with specific elements. Results: Students shared mostly positive comments about their experience with the dashboard, and the final grade of students with access to the dashboard was 13% higher, on average, compared to their peers in the non‐dashboard section. Conclusion: With low costs and little time invested, gamified dashboards could have a significant impact on student performance in large STEM lecture courses. Lay Description: What is already known about this topic: Leaner dashboards that provide personalized feedback are linked to improved student performance in undergraduate STEM courses. However, students may be reticent to adopt dashboards, especially students in the middle range of the performance distribution, for whom the impact of the dashboard may be most significant.Prior research on gamification in STEM courses suggests that adding gameful elements like progress trackers, badges, and rewards can increase students' engagement in undergraduate coursework.The combination of personalized learning in dashboards and the motivational experience of gamification should boost student engagement, dashboard adoption, and ultimately foster academic achievement. What this paper adds: In this paper, we examine the differences in academic performance between students with and without access to a gamified learning dashboard in an undergraduate Geology course.We observe that students with access to the dashboard (the treatment group), outperform students without access (the control group). The greatest benefit is observed for students who use the dashboard more frequently.Students reported that the progress tracker, the badges, and the rewards all incentivized their use and provided useful feedback about their performance. Students who did not adopt the dashboard expressed a need for more detail about the tool and its purpose. Implications for practice and/or policy: Instructors and instructional designers for large enrollment undergraduate STEM courses should consider the affordances of gamified learner dashboards for increasing engagement and for providing synchronous feedback about learners' strategies in the course.Aligning the dashboard to the content of the curriculum—by ensuring that badges reflect key concepts‐ encouraged participation and helped students identify the utility of the tool. Dashboards should be personalized to individuals and to the course.Adding gameful elements in a low‐cost intervention for increasing adoption and engagement of dashboards in large enrollment introductory courses. [ABSTRACT FROM AUTHOR]

Background: Autistic children without intellectual disability will likely experience higher level language and communication difficulties. These may appear subtle, in that they are not immediately evident to those who do not know the child well and may not manifest in all environments. Because of this, the impact of such difficulties may be underestimated. This phenomenon has similarly attracted little research attention, meaning the extent to which subtle language and communication difficulties contribute to the needs of autistic individuals without intellectual disability may be underspecified in clinical services. Aims: To offer a detailed exploration of how relatively subtle language and communication difficulties impact on autistic children without intellectual disability and what strategies parents recognize can mediate those negative effects. Methods & Procedures: Twelve parents of autistic children from the target group (aged 8–14 years, attending mainstream school) were interviewed about how subtle language and communication difficulties impact their autistic child. Rich accounts were derived then analysed using thematic analysis. Eight of the children discussed had previously been interviewed independently in a parallel study. Comparisons are discussed in this paper. Outcomes & Results: Parents reported heterogeneous but pervasive higher level language and communication difficulties which universally impacted key areas of the children's function: peer relationships, developing independence and performance in education. Communication difficulties were also universally associated with negative emotional responses, social withdrawal and/or negative self‐perceptions. While parents identified a range of ad hoc strategies and naturally occurring opportunities that improved outcomes, there was little mention of the means to address primary language and communication difficulties. The current study showed a number of parallels with child accounts, demonstrating the benefits of collecting data from both sources in clinical and research investigations. However, parents were more concerned about longer term implications of language and communication difficulties and highlighted their impact on the child developing functional independence. Conclusions & Implications: Subtle language and communication difficulties, typically identified in this higher ability autistic group, can impact significantly on key areas of childhood function. Support strategies seem to be parent generated and inconsistently applied across individuals, without the benefit of coherent specialist services. Dedicated provision and resources targeting areas of functional need may be beneficial to the group. In addition, the commonly reported association between subtle language and communication difficulties and emotional well‐being indicates the need for greater exploration using empirical methods, and joined‐up clinical working between speech and language therapy and mental health services. What this paper adds: What is already known on the subject: There is now a wide understanding of how language and communication difficulties can impact the individual. However, where those difficulties are relatively subtle, for example, in children without intellectual disability and where difficulties are not immediately evident, less is known. Research has often speculated on how identified differences in higher level structural language and pragmatic difficulties might impact on the function of autistic children. However, to date dedicated exploration of this phenomenon is limited. The current author group explored first‐hand accounts of children. Corroborative evidence from parents of the same children would add further weight to understanding this phenomenon. What this paper adds to the existing knowledge: This study provides a detailed exploration of parents' perspective relating to the impact of language and communication difficulties on autistic children without intellectual disability. It provides corroborative detail that support child accounts of the same phenomenon, indicating the impact on peer relationships, school outcomes and emotional well‐being. Parents also report functional concerns around the child's ability to develop independence and this paper demonstrates how parents and children might deviate in their accounts, with parents reporting increased concerns around the longer term implications of early language and communication difficulties. What are the potential or actual clinical implications of this work?: Relatively subtle language and communication difficulties can have a significant impact on the lives of autistic children without intellectual disability. Greater service provision for this group is therefore indicated. Interventions could focus on areas of functional concern where language is implicated, for example, peer relationships, developing independence and school success. Additionally, the relationship between language and emotional well‐being points to further integration between speech and language therapy and mental health services. Differences found between parental and child reports highlight the need to collect data from both parties during clinical investigations. Parental strategies may offer benefits for the wider population. [ABSTRACT FROM AUTHOR]

Background: Many amateur singers enjoy singing in choirs. They are likely to lack the training and expertise of professional singers and this may have an impact on their vocal health. Aims: To assess the experiences of amateur singers, their use of warm‐up and cool‐down sessions, their vocal health, their sources of help and advice and their reactions to receiving a diagnosis and treatment. Methods and Procedures: A questionnaire was sent to amateur choir singers. Quantitative data on their use of warm‐up and cool‐down activities were collected and the singers rated how frequently they experienced adverse voice symptoms after singing. Qualitative data were collected from singers who had sought advice about their voice and from those who had received a diagnosis and treatment. Outcome and Results: Most choirs used warm‐up sessions but few used cool‐down. Singers who participated in choir warm‐ups experienced significantly less vocal symptoms. Individual warm‐ups were ineffective. Singers who had previously had a diagnosis continued to have significantly higher symptom scores. A quarter of the singers who had neither sought help nor had a diagnosis had high scores. Singers appeared uncertain about who to consult for help. Those who saw a speech and language therapist were much more likely to receive a diagnosis and treatment either by the therapist or by referral to an ear, nose and throat specialist. Those receiving treatment were mainly positive about it and likely to complete a course of therapy. Conclusions and Implications: Warm‐up sessions performed by choirs are helpful in avoiding voice symptoms and are recommended. The presence of singers who are unaware of potential damage to their voices is a concern. A simple rating system, as used in this research, may act to alert them to the dangers. Choir leaders could be more active in advising singers and refer them to professionals where necessary. Speech and language therapists appear more sensitive to their problems and could be a first point of contact. WHAT THIS PAPER ADDS: What is already known on this subject: Poor vocal health may occur in amateur singers and lead to voice disorders which will reduce the demonstrated benefits of regular singing. They may be less aware than professional singers of potential hazards and may not know how to sing in a way that ensures good vocal health. There has been less research on the extent of voice problems in amateurs or of the actions they may take to resolve the vocal difficulties they encounter. What this paper adds to the existing knowledge: This survey demonstrates that choir warm‐ups were effective in helping to avoid common symptoms associated with voice problems. A large minority of singers who had not sought help for voice problems had high symptom scores on our assessment. Singers frequently turned to a singing teacher for help. Those who consulted a speech and language therapist were much more likely to be referred for further investigation and treatment. What are the potential or actual clinical implications of this work?: We present a simple subjective measure of symptom severity which succeeds in distinguishing between singers who warm up their voices and those who do not and between singers who have received a past diagnosis and those who have not. There are a number of indications in this research that amateur singers are unsure if they need help and are uncertain who can offer it. In these circumstances the use of a simple measure of the severity of vocal abuse may be useful. [ABSTRACT FROM AUTHOR]

Background: The Montreal Children's Hospital Feeding Scale (MCH‐FS) allows paediatricians and other health care professionals to identify feeding difficulties among children. Aim: To translate and adapt the MCH‐FS into Italian, and to evaluate the validity and reliability of this Italian version of the Montreal Children's Hospital Feeding Scale (I‐MCH‐FS). Methods & Procedures: A total of 150 children with special healthcare needs were admitted to the Rare Disease Unit of the Paediatrics Department at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, between March 2021 and March 2022 (74 males; mean age = 3.85 ± 1.96 years; median age = 4 years; age range = 6 months–6 years and 11 months) and 150 healthy participants (83 males; mean age = 3.5 ± 1.98 years; median age = 3 years; age range = 6 months–6 years and 11 months) were included in the study, which was approved by the local ethics committee. The original version of the MCH‐FS was translated and cross‐cultural adapted through five stages: (1) initial translation, (2) synthesis of the translations, (3) back translation, (4) expert committee and (5) test of the prefinal version. Test–retest reliability and internal consistency were assessed using Pearson r, Spearman r and Cronbach's alpha, respectively. Construct validity was established by comparing data obtained from patients with those of healthy participants using the Mann–Whitney U‐test. Outcomes & Results: A Pearson r of 0.98, a Spearman r of 0.95 and Cronbach's alpha value of 0.86 were obtained. In the clinical group, 40.6% children were classified as having feeding disorders (n = 61), while in the normative group 4.7% were diagnosed with feeding problems (n = 7). Mean total score of the clinical group was significatively different from the normative's. Conclusions & Implications: The I‐MCH‐FS is a valid and reliable one‐page, quick screening tool used to identify feeding disorders among children with special needs in outpatient paediatric setting. WHAT THIS PAPER ADDS: What is already known on the subject: The MCH‐FS is a valid and reliable parent‐report measure aimed at discriminating between children presenting or not feeding disorders. What this paper adds to existing knowledge: This paper presents the translation and cross‐cultural adaptation of the scale into the Italian language. What are the potential or actual clinical implications of this work?: The Italian version of the MCH‐FS can be used in the special healthcare needs population. [ABSTRACT FROM AUTHOR]

Background: The risks of developmental language disorder (DLD) for both educational progress and socio‐emotional development are well documented, but little is known about how children and young people with DLD experience and describe their language and communication. The need to complement experimental and quantitative studies with qualitative perspectives of the lived experience of individuals with DLD for speech and language therapists (SLT) practice has recently been foregrounded. Aims: To understand further the experiences of young people with DLD focusing on language and communication in a school context, and thereby contribute to the improvement of the communicative situation in school for this group. The study is guided by the following research question: How do young people diagnosed with DLD describe their experiences of language and communication in school? Methods & Procedures: The study is based on data generated from qualitative semi‐structured interviews with 23 participants diagnosed with DLD (age 13–19 years old) living in Sweden. All participants attended mainstream schools. To enable data to be collected during COVID‐19 restrictions, all interviews were conducted using Zoom. Reflexive thematic analysis was used to analyse the data. Outcomes & Results: Four main themes related to experiences of language and communication in school were constructed from the interviews: (1) feelings of inadequacy and comparisons with others; (2) feelings of being misjudged and misunderstood; (3) the importance of feeling safe and comfortable; and (4) the significance of the social and communicative context. The results bear witness of difficult and challenging aspects related to language and communication in school, including educational, social and emotional dimensions. An important outcome of this study is how young people diagnosed with DLD describe their language and communication functioning to be dependent on both individual characteristics and abilities, as well as situational, contextual and social factors. Conclusions & Implications: The results from this study show that young people with DLD can have persisting problems related to language and communication in school, including educational, social and emotional dimensions. SLT services may therefore be needed throughout the school years to ensure that students with DLD receive adequate support. In addition, support that goes beyond language abilities and targets social, contextual and emotional aspects should be considered. WHAT THIS PAPER ADDS: What is already known on this subject: Children and young people have unique knowledge about their language and communication which is instrumental for designing interventions and support strategies. Qualitative analyses of interview data have been able to identify both risk factors and protective strategies in relation to the well‐being of individuals with DLD. Despite this, children and young people with DLD are rarely heard in research or clinical discussions. What this paper adds to existing knowledge: In this study we listen to the voices of young people with DLD as they describe their experiences of language and communication in school. The participants describe a condition that makes them struggle to keep up with peers and puts them at risk of being misjudged by teachers, but also give examples of situations where negative consequences are hardly felt. What are the potential or actual clinical implications of this work?: DLD is a complex and dynamic disorder where contextual and social factors interact with individual abilities in creating the end result. The results of the study indicate that DLD can cause persisting problems related to language and communication in school, with impact on educational, social and emotional dimensions. To counteract these effects, SLT services may be needed throughout the school years, and support that goes beyond language abilities must be considered. [ABSTRACT FROM AUTHOR]

Background: The Communicative Participation Item Bank (CPIB) is a patient‐reported outcome measure (PROM) designed to measure the extent of interference, or difficulty, experienced by adults with communication disorders participating in their day‐to‐day communication activities. To date, there is limited evidence regarding sensitivity of the CPIB for capturing change with intervention in people with Parkinson's disease (PwPD). Aims: The purpose of this study was to examine the following measurement properties of the CPIB in PwPD who received community‐based, standard care, speech‐language therapy focusing on motor speech concerns: Change over time between treatment and observation groups, comparison to patient‐defined ideal and satisfactory targets, comparison of static short form to computerised adaptive testing (CAT), comparison of self to proxy‐rated scores, and comparison to other common PROMs. Methods and Procedures: Forty‐six PwPD (20 treatment/26 observation) completed data collection upon enrolment (pre‐treatment) and 6 months later. In addition to the CPIB, PROMs included the Voice Handicap Index 10‐item short form (VHI‐10), PROMIS Global Health‐Related Quality of Life, Levels of Speech Usage, self‐rated speech severity, and Patient Health Questionnaire‐9 (PHQ‐9). Participants also engaged in qualitative interviews. Forty‐four family members completed proxy CPIB ratings. Outcomes and Results: There were no significant differences between treatment and observation groups on the CPIB pre‐treatment, but there were significant differences post‐treatment. The differences appeared to be largely due to significant gains in the treatment group. No participants reached their ideal CPIB target, and few reached their satisfactory target. Static CPIB short form and CAT scores were not significantly different, with an average of five CAT items administered per participant. Overall group similarities between patient and proxy scores may have obscured wide variability across individual patient‐proxy pairs. Associations between CPIB and VHI‐10, health‐related quality of life, self‐reported speech severity, and depression ranged from weak to moderate. Conclusions and Implications: The CPIB appears to be sensitive to capturing change with intervention, and similar results are obtained with the static short form and CAT formats. One clinical caution is that even with gains observed in the treatment group, no participants obtained their ideal communicative participation goals, and few obtained a satisfactory level of communicative participation. Thus, while current interventions are beneficial, they may not meet the full range of clients' communication needs. While responding to the CPIB through a proxy rater may be feasible, caution is warranted due to concerns about maintaining the autonomy of PwPD. What this paper adds: What is already known on this subject: The communication disorders associated with Parkinson's disease (PD) can have a negative impact on quality of life and life participation as measured by patient (or person)‐reported outcome measures (PROMs). The Communicative Participation Item Bank (CPIB) is one PROM available to use with adults with communication disorders. However, little is known about whether the CPIB captures changes in communicative participation as a result of standard care treatment for people with Parkinson's disease (PwPD). Use of computerised adaptive testing (CAT), proxy report and comparison to targeted participation outcomes have not been explored. What this study adds to existing knowledge: As a result of this study, we know that the CPIB captured differences between treatment and observation groups after community‐based, standard care speech therapy intervention focusing on motor speech production in PwPD. Static short form and CAT scores did not differ significantly, so the CAT option provides better efficiency requiring, on average, five items to administer compared to the 10‐item short form. Proxy and PwPD scores did not differ as a group, but wide variability was noted. What are the potential or actual clinical implications of this work?: The CPIB may be a clinically sensitive instrument for capturing changes in communicative participation after treatment. No participants met their ideal CPIB target, and few reached their satisfactory target, suggesting that while current interventions contribute to gains in communicative participation, there are still unmet needs that may call for support and interventions addressing the more complex array of factors affecting communicative participation outcomes for PwPD. [ABSTRACT FROM AUTHOR]

Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self‐reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: 'Understaffing', 'Professional Code Expectations and Moral Distress' and 'Management'. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality. [ABSTRACT FROM AUTHOR]

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

Background: Online collaborative learning has been widely adopted in the field of education. However, learners often find it difficult to engage in collaboratively building knowledge and jointly regulating online collaborative learning. Objectives: The study compared the impacts of the three learning approaches on collaborative knowledge building, group performance, socially shared regulation, behavioural engagement, and cognitive load in an online collaborative learning context. The first is the automatic construction of knowledge graphs (CKG) approach, the second is the automatic analysis of topic distribution (ATD) approach, and the third one is the traditional online collaborative learning (OCL) approach without any analytic feedback. Methods: A total of 144 college students participated in a quasi‐experimental study, where 48 students learned with the CKG approach, 48 students used the ATD approach, and the remaining 48 students adopted the OCL approach. Results and Conclusions: The findings revealed that the CKG approach could encourage collaborative knowledge building, socially shared regulation, and behavioural engagement in building knowledge better than the ATD and OCL approaches. Both the CKG and ATD approaches could better improve group performance than the OCL approach. Furthermore, the CKG approach did not increase learners' cognitive load, but the ATD approach did. Implications: This study has theoretical and practical implications for utilising learning analytics in online collaborative learning. Furthermore, deep neural network models are powerful for constructing knowledge graphs and analysing topic distribution. Lay Description: What is currently known about the subject matter: Online collaborative learning has been widely adopted in the field of education.Learners often find it difficult to engage in collaboratively building knowledge and jointly regulating collaborative learning. What the paper adds to this: This study compared the impacts of three learning approaches, namely, the automatic construction of knowledge graphs (CKG), the automatic analysis of topic distribution (ATD), and the traditional online collaborative learning (OCL) approach.The findings revealed that the CKG approach could encourage collaborative knowledge building, socially shared regulation, and behavioral engagement in building knowledge better than the ATD and OCL approaches. Both the CKG and ATD approaches could better improve group performance than the OCL approach. Furthermore, the CKG approach did not increase learners' cognitive load, but the ATD approach did. Implications of study findings for practitioners: It is strongly recommended that the CKG approach can be employed to enhance collaborative knowledge building, socially shared regulation, and behavioral engagement in building knowledge in an online collaborative learning context. Both the CKG and ATD approaches contribute to improving group performance.Deep neural network models are powerful for constructing knowledge graphs and analysing topic distribution. [ABSTRACT FROM AUTHOR]

Mobile devices are increasingly used to administer self-report measures of mental health symptoms. There are significant differences, however, in the way that information is presented on mobile devices compared to the traditional paper forms that were used to administer such measures. Such differences may systematically alter responses. The present study evaluated if and how responses differed for a self-report measure, the PTSD Checklist (PCL), administered via mobile device relative to paper and pencil. Participants were 153 trauma-exposed individuals who completed counterbalanced administrations of the PCL on a mobile device and on paper. PCL total scores (d = 0.07) and item responses did not meaningfully or significantly differ across administrations. Power was sufficient to detect a difference in total score between administrations determined by prior work of 3.46 with a d = 0.23. The magnitude of differences between administration formats was unrelated to prior use of mobile devices or participant age. These findings suggest that responses to self-report measures administered via mobile device are equivalent to those obtained via paper and they can be used with experienced as well as naïve users of mobile devices. [ABSTRACT FROM AUTHOR]

Background: Mobilization is a key component in the recovery of those admitted to critical care. However, previous research has demonstrated challenges in the implementation of mobilization within critical care, including staff knowledge, attitudes, and behaviours. Aim: The aim of the current study was to explore the perceived barriers and limitations to mobilization from the perspective of nursing staff, and to compare these with physiotherapists. Study Design: Single‐site service evaluation utilizing the patient mobilizations attitudes and beliefs survey for ICU and locally developed barriers to rehabilitation questionnaire. Results: About 135 participants (126 nurses and 9 physiotherapists) were invited to anonymously complete the questionnaires (either paper or electronic), with a response rate of 73.0% (n = 92) for nursing staff and 100% for physiotherapists. Nursing staff reported significantly higher perceived barriers to rehabilitation on both questionnaires when compared with physiotherapy staff, which was not associated with years of experience within critical care. Behavioural barriers were most frequent in both professions which included items such as time availability and presence of perceived contra‐indications to mobilization. Conclusion: Nursing staff reported greater perceived barriers to rehabilitation when compared with physiotherapists. Further quality improvement projects are now required to reduce these barriers and assist the implementation of mobilization as part of the rehabilitation process. Relevance to Clinical Practice: Rehabilitation is an essential element of practice within critical care. Understanding the system, local and personal barriers will allow for improvement projects to enhance the delivery of care and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Zoomorphism, an obverse of conventional anthropomorphism, has been shown in many cases to be a powerful tool with respect to the metaphorical use of animals. Objectives: This study introduced zoomorphism into the instructional video design of pedagogical agents (PAs). Method: We first developed three image sets, each of which corresponded to a type of zoomorphic PA image construct (full panda, a human face with a panda body, and a human body with panda head imagery). Then, we conducted an image‐screening experiment in which 177 second‐grade students from a primary school were asked to select their favourite PA image for each image construct set. We used a realistic human PA as the baseline. Next, 114 second‐grade students from another school were randomly assigned to learn instructional videos on the topic of pandas using a PA with one of four imageries. Results and Conclusions: ANOVA and Kruskal–Wallis tests indicated that students presented with PAs with full‐panda imagery achieved significantly higher learning performance, learning experience, social presence, and learning interest than those presented with other imageries of PAs. The regression results showed that the effect of zoomorphic PAs with full‐panda imagery on learning performance was exerted in a direct way and that its effect on learning experience was mediated by social presence and learning interest. Implications: Our findings suggest that zoomorphic appearance is an essential quality for video learning that merits further investigation for the efficient imagery construction of PAs. Lay Description: What is already known about this topic: The inclusion of pedagogical agents with images that are attributed human qualities to animals known as anthropomorphism is very popular in multimedia education; however, the existing studies on the effects of such images on learning have shown inconsistent results. What this paper adds: We introduced the alternative philosophy of animal use‐zoomorphism, which is the obverse of anthropomorphism, into agent image building. Implications for practice and/or policy: Our study demonstrated that the zoomorphism of agent images increases learning performance and experience; thus, our findings suggest the prospect of zoomorphism in the development of agent image patterns. [ABSTRACT FROM AUTHOR]

Most Human African Trypanosomiasis (HAT) control programmes in areas endemic for Trypanosoma brucei gambiense rely on a strategy of active mass screening with the Card Agglutination Test for Trypanosomiasis (CATT)/T. b. gambiense. We evaluated the performance, stability and reproducibility of the CATT/T. b. gambiense on blood-impregnated filter papers (CATT-FP) in Kajo-Keji County, South-Sudan, where some areas are inaccessible to mobile teams. The CATT-FP was performed with a group of 100 people with a positive CATT on whole blood including 17 confirmed HAT patients and the results were compared with the CATT on plasma (CATT-P). The CATT-FP was repeated on impregnated filter papers stored at ambient and refrigerated temperature for 1, 3, 7 and 14 days. Another 82 patients with HAT, including 78 with a positive parasitology, were tested with the CATT-FP and duplicate filter paper samples were sent to a reference laboratory to assess reproducibility. The CATT-FP was positive in 90 of 99 patients with HAT (sensitivity: 91%). It was less sensitive than the CATT-P (mean dilution difference: -2.5). There was no significant loss of sensitivity after storage for up to 14 days both at ambient and cool temperature. Reproducibility of the CATT-FP was found to be excellent (kappa: 0.84). The CATT-FP can therefore be recommended as a screening test for HAT in areas where the use of CATT-P is not possible. Further studies on larger population samples in different endemic foci are still needed before the CATT-FP can be recommended for universal use. [ABSTRACT FROM AUTHOR]

Cysticercosis is an infestation of Cysticercus cellulosae. When it occurs in the brain, chronic neurological complications can ensue, most commonly seizures. Neurocysticercosis is usually diagnosed by neuroimaging, a technique not available in most endemic countries. Hence immunological tests are valuable for diagnosis and epidemiological surveys. We evaluated the suitability of paper for storing blood and cerebrospinal fluid (CSF) until subsequent testing by enzyme-linked immunosorbent assay (ELISA), by testing whole blood samples on filter paper from 305 patients and CSF samples from 117 patients stored on ordinary white typing paper and on filter paper. Optimal preservation of biological samples is achieved when whole blood is stored on filter paper, CSF on white paper, and when samples are frozen within 1 week after collection. Our results could improve diagnostic capabilities and facilitate epidemiological surveys in endemic countries where immunodiagnostic tests cannot be rapidly performed because of inadequate laboratory infrastructure. [ABSTRACT FROM AUTHOR]

Previous research has found that music brings back more vivid and emotional autobiographical memories than various other retrieval cues. However, such studies have often been low in ecological validity and constrained by relatively limited cue selection and predominantly young adult samples. Here, we compared music to food as cues for autobiographical memories in everyday life in young and older adults. In two separate four‐day periods, 39 younger (ages 18–34) and 39 older (ages 60–77) adults recorded their music‐ and food‐evoked autobiographical memories in paper diaries. Across both age groups, music triggered more frequent autobiographical memories, a greater proportion of involuntary memories, and memories rated as more personally important in comparison to food cues. Age differences impacted music‐ and food‐evoked memories similarly, with older adults consistently recalling older and less specific memories, which they rated as more positive, vivid, and rehearsed. However, young and older adults did not differ in the number or involuntary nature of their recorded memories. This work represents an important step in understanding the phenomenology of naturally occurring music‐evoked autobiographical memories across adulthood and provides new insights into how and why music may be a more effective trigger for personally valued memories than certain other everyday cues. [ABSTRACT FROM AUTHOR]

Background Study: English education has been promoted in Taiwan for many years. Recently, content and language integrated learning (CLIL) has received attention as an effective way to integrate English into real‐life contexts. With advances in technology, digital storytelling is suitable for students to develop multiple skills such as narrating real‐life stories and recording them in English. Objectives: The present study developed a cooperative learning model in a CLIL context to enhance elementary school students' digital storytelling, English speaking proficiency performance, and financial knowledge. Methods: The participants were 43 sixth‐grade students from two classes: the experimental group (n = 26) and the control group (n = 17). To investigate whether the digital storytelling results produced by the experimental group under the cooperative learning approach differed from the digital storytelling results produced individually by the control group, an experimental design was implemented throughout the 9‐week course. All the participants took financial knowledge and English‐speaking proficiency pre‐tests and then received financial knowledge classes and digital storytelling instruction to help them effectively design digital storytelling videos, which incorporated the concepts of financial knowledge and English‐speaking skills. Results and Conclusions: The results showed that the experimental group outperformed the control group in the overall digital storytelling performance, English speaking proficiency, and financial knowledge. Lay Description: What is already known about this topic: CLIL is a teaching method in which language is a tool for learning both the content of a subject and the language itself.Digital storytelling enables users to develop multiple skills, such as organization and interpersonal skills.Cooperative Learning assists the integration of technology. What this paper adds: An instructional design that uses digital storytelling to teach finance and English with CLIL.An experimental study among EFL elementary school students for acquiring financial knowledge and English speaking skills. Implications for practice and/or policy: The course in this study may help EFL teachers by providing them with a basic financial knowledge curriculum in English for elementary school students.Cooperative learning through digital storytelling design for elementary school students may accelerate their organization and communication skills. [ABSTRACT FROM AUTHOR]

Background and Aims: Long‐acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that is generating positive outcomes. Negative effects are typically mild and transient, but can occasionally be serious, resulting in treatment discontinuation/non‐adherence. This paper aims to analyse patients' accounts of how they felt during the first 72 h after initiating LAIB. Methods: Semi‐structured interviews were conducted (June 2021–March 2022) with 26 people (18 males and 8 females) who had started LAIB within the previous 72 h. Participants were recruited from treatment services in England and Wales and were interviewed by telephone using a topic guide. Interviews were audio‐recorded, transcribed and coded. The concepts of embodiment and embodied cognition framed the analyses. Data on participants' substance use, initiation onto LAIB and feelings were tabulated. Next, participants' accounts of how they felt were analysed following the stages of Iterative Categorization. Results: Participants reported complex combinations of changing negative and positive feelings. Bodily experiences included withdrawal symptoms, poor sleep, injection‐site pain/soreness, lethargy and heightened senses inducing nausea ('distressed bodies'), but also enhanced somatic wellbeing, improved sleep, better skin, increased appetite, reduced constipation and heightened senses inducing pleasure ('returning body functions'). Cognitive responses included anxiety, uncertainties and low mood/depression ('the mind in crisis') and improved mood, greater positivity and reduced craving ('feeling psychologically better'). Whereas most negative effects reported are widely recognized, the early benefits of treatment described are less well‐documented and may be an overlooked distinctive feature of LAIB. Conclusions: During the first 72 h after initiating long‐acting injectable buprenorphine, new patients report experiencing a range of interconnected positive and negative short‐term effects. Providing new patients with information about the range and nature of these effects can prepare them for what to expect and help them manage feelings and reduce anxiety. In turn, this may increase medication adherence. [ABSTRACT FROM AUTHOR]

Rationale Aims and Objectives: Horizontal violence has been defined as aggressive or hostile behaviour directed at an individual or between colleagues from the same working group. Measuring the prevalence of horizontal violence requires valid measures. To date, there has not been a review of the psychometric properties of available measurement tools for horizontal violence. Method: A rapid review of the MEDLINE and BUSINESS EBSCO databases was conducted to identify studies testing the validity of any measure of horizontal violence in any workplace setting. Title and abstract and full‐text screening, data extraction and quality appraisal were completed by two researchers working independently. The COnsensus‐based Standards for the selection of health Measurement Instruments (COSMIN) was used to determine the methodological quality of studies, including details of the psychometric properties of included papers. Results: Fourteen papers reporting 17 studies were included in the review. Seven measures of horizontal violence (Civility Norms Questionnaire Brief; Negative Acts Questionnaire—Revised; Inventory of Violence and Psychological Harassment; Leyman Inventory Psychological Terror Mobbing of Single Cases of Harassment in Employees Relations; Shortened Negative Acts Questionnaire—Revised; Uncivil Workplace Behaviour Questionnaire) were identified. Most included studies were methodologically robust. Six measures had strong psychometric properties except for the Mobbing of Single Cases of Harassment in Employees Relations (MSCH) where key information about psychometric properties was not reported. Conclusions: We identified six measures of horizontal violence that had good psychometric properties. The Negative Acts Questionnaire—Revised has been most extensively tested in different settings but is not necessarily a more precise measure than others. [ABSTRACT FROM AUTHOR]

Background: Total laryngectomy (TL) results in permanent functional changes requiring rapid development of complex new skills. A significant portion of this learning happens in the acute post‐surgical stage. There is increasing interest in enhanced recovery after surgery (ERAS) protocols in TL; however, implementation has been difficult. COVID‐19 has placed significant pressures on acute services, requiring rapid service changes for TL patients. Aims: To understand the acute patient experience of having a TL both before and during COVID‐19. Methods & Procedures: Semi‐structured interviews using a pre‐designed topic guide were conducted with 10 people who had undergone a TL within the last 2 years. Participants were recruited by their speech and language therapists using purposive sampling. Braun and Clarke's iterative approach to data collection and thematic analysis was used to generate key themes from the data. Outcomes & Results: Thematic analysis identified four main themes: (1) pre‐operative information‐giving: 'it was just words'; (2) decision‐making influences: 'I just wanted them to get it all out and get it over with'; (3) coping with adjustment to the new normal: 'this is part of me now'; and (4) the importance of relationship‐building: 'when you've had something like this, you need some care and understanding'. Conclusions & Implications: The need for an individualized approach to TL intervention which incorporates medical and psycho‐social approaches from pre‐treatment to acute discharge is vital. ERAS models should be reviewed to shift beyond the medical model alone. Rapid service changes due to COVID‐19 did not contribute any major changes to the acute patient‐reported experience. What this paper adds: What is already known on the subject: We know that ERAS protocols have the potential to improve patient outcomes following TL. However, the research does not consider anything other than the early oral feeding debate and it has therefore been difficult to implement ERAS protocols in current service models. COVID19 required head and neck cancer services to make quick changes to surgical pathways, with the potential that some ERAS protocols had been adopted inadvertently. In order to understand the impact of this, we need to understand the patient experience following TL both before and during COVID19. What this paper adds to existing knowledge: This paper used qualitative interviews to understand the acute patient experience following TL both during and before COVID19. Findings from these interviews highlighted that people were on the most part, well prepared for the functional changes they would experience after surgery. However, people felt there were gaps in service delivery at the pre‐treatment and early discharge home period. Overall, the gaps identified were from a more psycho‐social need suggesting that future ERAS models of care should consider both medical and psycho‐social principles to enhance patient experience and outcome. What are the potential or actual clinical implications of this work?: Pre‐treatment services provided to people who have a TL could be reviewed to help maximize long‐term adjustment to life. Areas which could be reviewed include the method and mode of information delivery. Further work needs to be done in partnership with community services to improve the immediate discharge home experience. [ABSTRACT FROM AUTHOR]

Background: As adequate support, virtual reality (VR) has been increasingly introduced into the classroom to help students learn a new language. However, empirical studies exploring the educational potential of using 360° spherical video‐based virtual reality (SVVR) in high‐school Chinese language classrooms are still lacking. Objectives: A mind mapping‐based SVVR learning system is proposed for international high‐school students' Chinese courses and examines its effects on improving Chinese learning achievements and perceptions among Grade 10 students who learn Chinese as a foreign language. Methods: This study adopted a quasi‐experiment design. Participants (N = 66) were assigned to one of three conditions: mind mapping‐based SVVR (MMBSVVR), conventional SVVR (CSVVR), or traditional lecturing (TL). Our mixed‐method approach employed pre‐and post‐tests to measure Chinese learning achievements, questionnaires to measure Chinese learning motivation, problem‐solving ability, and self‐efficacy, and semi‐structured interviews to further explore students' feelings and attitudes about Chinese courses in corresponding learning environments. Results and Conclusions: The results showed that the MMBSVVR classroom significantly improved high students' Chinese learning achievements in Chinese vocabulary and making sentence, problem‐solving ability, and self‐efficacy. Moreover, SVVR stimulates students' learning interest and class participation, and mind mapping provides students with a clear guide to arrange the knowledge. These findings help interpret the relationships between MMBSVVR and learning achievements, Chinese learning motivation, problem‐solving ability, and self‐efficacy in an international high school Chinese courses, thus providing insight on integrating MMBSVVR into existing classrooms. Lay Description: What is Already Known about this Topic: By creating fully immersive 3D environments, 360° spherical video‐based virtual reality (SVVR) in promoting language learning has been confirmed by many scholars with a focus on English language learning.Mind mapping effectively enables second language learners to review and retain new words in the target language meaningfully. Also, it can create a more vivid learning atmosphere through images and graphics and promote learners' memory and learning motivation. What This Paper Adds: A mind mapping‐based SVVR learning system has been developed with the support of the constructivism theory.A mind mapping‐based SVVR learning system is proposed to facilitate international students' Chinese learning performance in Chinese vocabulary acquisition and sentence construction.In addition to promoting international students' learning outcomes, the proposed approach indicated promising results in learning motivation, problem‐solving ability, and self‐efficacy. Implications for Practice and/or Policy: This study provides an evidence base for further research through the utilization of VR learning environments in Chinese language classrooms.This study advocates introducing SVVR technology in the Chinese learning classrooms to increase the learning context for international students. It is also worth encouraging scholars to design VR learning systems with different learning strategies.Due to the cognitive requirements of the Chinese language learning process, it is necessary to introduce mind maps in the SVVR learning system to assist students in constructing knowledge and combining prior and new knowledge to generate long‐term memory. [ABSTRACT FROM AUTHOR]

Background: Mobile‐assisted language learning (MALL) has long been advocated to promote students' language study outcomes. However, little is known about how using instant messaging applications (an example of MALL) affect student motivation, language anxiety, and actual achievement. Objectives: To help close this gap, we have conducted a quasi‐experimental study, in which we have used self‐determination theory to test a mediational process model, in an effort to understand the psychological mechanisms that underlie the effect of instant messaging applications on student outcomes. Methods: Two groups of Saudi undergraduate students (N = 447) were recruited to participate in the study. Participants under the experimental condition were invited to engage in language‐related tasks with their teacher outside of class through the WhatsApp application, whereas participants under the control condition received standard teaching. We applied partial least square structural equation modelling (PLS‐SEM) to test our model. Results and Conclusions: The results of the PLS‐SEM showed that the total effects of using instant messaging applications on autonomous motivation and L2 achievement were significant but that language anxiety was influenced only indirectly and negatively through language achievement. Also, the PLS‐SEM showed that our results have strong predcitive power indicating support for external validity. Implications: Our results show that instant messaging applications can be used to facilitate interest and achievement and to decrease anxiety. Furthermore, we are contributing to L2 methodological literature by using applications of PLS‐SEM in experimental designs that can help researchers and practitioners of motivational processes. Lay Description: What is already known about this topic: Using WhatsApp and more broadly instant messaging applications are conceived to be motivating in language teaching contextStudies indicate students are inclined toward using these applications in language learningResearch shows that using WhatsApp is easy to apply for language teaching purposes What this paper adds: The study examined the effect of using WhatsApp on language learners' motivation, achievement, and language anxietyA pre‐ and post‐test approach with experimental and control condition has been used to evaluate the effect more accuratelyThe study employs Self‐determination Theory as a theoretical framework for testing a motivational process modelResults show that using WhatsApp predicted the outcomes directly and indirectly Implications for practice and/or policy: WhatsApp can significantly encourage university students to better learning of the language skills especially in times where face‐to‐face communication is limitedWhatsApp is conditioned by the guidance of instructors, their ongoing formative and summative assessmentWhatsApp appears to allow students enjoy their learning process due to the opportunities for collaborative work and constant exchange of content [ABSTRACT FROM AUTHOR]

Background: Efforts to empower adolescent girls remain constrained by confusion around how to conceptually define empowerment and how to design interventions. More research, particularly among young adolescents, is needed that considers contextual and age-specific circumstances. This paper examines the latent classes of empowerment among early adolescent girls in Bangladesh and factors associated with membership in these classes. Using data from the Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents project, a four-arm randomized controlled trial designed to evaluate different community-based approaches for adolescents' skills development, we identify the latent classes before and after intervention and explore whether girls' membership in the study arms was associated with latent class membership at endline.Methods: To identify underlying subgroups among the sample, we conducted latent class analysis at baseline and endline using indicators of seven different constructs of empowerment based on the literature. Using multinomial logistic regression analysis, we assessed whether respondents' background characteristics and membership in the study arms were predictive of latent class membership at both timepoints.Results: A three-class model at baseline and a four-class model at endline showed optimal fit. In both models, three distinct latent classes were observed: (1) a least empowered class, (2) a mobile, socially active class, and (3) a socially progressive class. At endline, a fourth class emerged-the most empowered-that was mobile, socially active, and socially progressive. Girls' marital status, religion, and parents' level of education predicted latent class membership; household wealth was predictive at baseline, but not endline. Study arm was also associated with class membership at endline: girls in the Gender-Rights Awareness Arm had the highest probability of belonging to the fourth, most empowered class.Conclusion: This paper identifies and characterizes latent classes of empowerment that exist among the sample before and after the intervention. The apparent differential effects of interventions in predicting latent class membership have implications for community-based programming. Findings suggest that skills-building curriculum focused on promoting gender equitable norms, voice, and agency has potential to influence early adolescent girls across multiple dimensions of empowerment. [ABSTRACT FROM AUTHOR]

Introduction: Health literacy (HL) refers to individuals' abilities to process and use health information to promote health. This study aimed to develop the first HL measurement tool for the Chinese Hong Kong population. Methods: A two‐phase methodology was adopted. In Phase I, evidence synthesis with a deductive method was conducted to formulate the item list from the literature. In Phase II, a modified e‐Delphi survey was conducted among stakeholders (i.e., healthcare providers and healthcare consumers) to confirm the content validity of the item list. The stakeholders were invited to rate the relevance of each draft item on a 4‐point scale and provide suggestions for revisions, removal or adding new items. Results: In Phase I, a total of 34 items covering functional, interactive and critical HL were generated. In Phase II, to obtain a balanced view from experts and laypeople, healthcare professionals (n = 12) and consumers (n = 12) were invited to participate in the Delphi panel. The response rates of the three rounds were 100%. After the third round, the consensus was reached for 31 items, and no further comments for adding or revising items were received. All items exhibited excellent content validity (item content validity index: 0.79–1.00; K*: 0.74–1.00). Conclusions: A Health Literacy Scale for Hong Kong was developed. Compared with existing HL scales, the scale fully operationalized the skills involved in functional, interactive and critical HL. The Delphi study shows evidence supporting the high content validity of all items in the scale. In future studies, these items should undergo rigorous testing to examine their psychometric properties in our target population groups. By illuminating the details in the development process, this paper provides a deeper understanding of the scale's scope and limitations for others who are interested in using this tool. Patient or Public Contribution: Public as healthcare consumers, in addition to healthcare providers, were involved in developing a new HL scale for this study. The input from the public contributed to examining the scale's content validity by judging whether all items reflected the skills that they need to find and use health‐related information in their daily life. [ABSTRACT FROM AUTHOR]

Aim: To evaluate safety and motor function after treatment with allogeneic umbilical cord blood (AlloCB) or umbilical cord tissue-derived mesenchymal stromal cells (hCT-MSC) in children with cerebral palsy (CP).Method: Ninety-one children (52 males, 39 females; median age 3 years 7 months [range 2-5 years]) with CP due to hypoxic-ischemic encephalopathy, stroke, or periventricular leukomalacia were randomized to three arms: (1) the AlloCB group received 10 × 107 AlloCB total nucleated cells (TNC) per kilogram at baseline (n = 31); (2) the hCT-MSC group received 2 × 106 hCT-MSC at baseline, 3 months, and 6 months (n = 28); (3) the natural history control group received 10 × 107 AlloCB TNC per kilogram at 12 months (n = 31). Motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66) and Peabody Developmental Motor Scale, Second Edition.Results: Infusions (n = 143) were well tolerated, with eight infusion reactions (three in the AlloCB group, five in hCT-MSC) and no other safety concerns. At 12 months, the mean differences (95% confidence intervals [CI]) between actual and expected changes in GMFM-66 score were AlloCB 5.8 points (3.4-8.2), hCT-MSC 4.3 (2.2-6.4), and natural history 3.1 (1.4-5.0). In exploratory, post hoc analysis, the mean GMFM-66 score (95% CI) of the hCT-MSC group was 1.4 points higher than natural history (-1.1 to 4.0; p = 0.27), and the AlloCB group was 3.3 points higher than natural history (0.59-5.93; p = 0.02) after adjustment for baseline Gross Motor Function Classification System level, GMFM-66 score, and etiology.Interpretation: High-dose AlloCB is a potential cell therapy for CP and should be further tested in a randomized, blinded, placebo-controlled trial.What This Paper Adds: Unrelated donor allogeneic umbilical cord blood (AlloCB) and human umbilical cord tissue-derived mesenchymal stromal cell infusion is safe in young children with cerebral palsy. Significant changes in motor function were not observed 6 months after treatment. One year later, treatment with AlloCB was associated with greater increases in Gross Motor Function Measure-66 scores. [ABSTRACT FROM AUTHOR]

Background: Different types of assessments influence learning and learning behaviour. Multiple‐choice questions (MCQs) reward partial knowledge and encourage surface learning, while open‐ended questions (OEQs) promote deeper learning. Currently, MCQs is part of team‐based learning (TBL) curriculum, and it is challenging to implement OEQs as immediate feedback is necessary. Objectives: We asked if MCQ and OEQs affect student achievement, student learning and student engagement differently in a TBL classroom. Methods: MCQs and OEQs test scores of N = 66 students were automatically captured in Learning Activity Management System (LAMS) and were compared using a switching replications quasi‐experimental design with pre‐ and post‐tests to answer the research questions. Student learning approaches and engagement in the team activities were assessed using the study process questionnaire and the structure of observed learning outcomes taxonomy respectively. Results and Conclusions: Students get significantly higher MCQ scores than OEQs for the same set of questions, but the reverse is true for application exercises (AEs), which focus on higher‐level application. Most students significantly deepened their learning approaches before OEQs, while poorly prepared students were less engaged during OEQ discussions. Interestingly students subjected to OEQs took less time and scored higher in AE discussions, suggesting better focus on higher‐level thinking. Implications: This project is significant as it bridges our understanding of the value of OEQs and TBL. Our approach is transferable to other courses, and thus it can improve the quality of teaching and learning in tertiary education. Lay Description: What is already known about this topic?: Multiple‐choice questions (MCQs) do not promote deep learning as much as open‐ended questions (OEQ) do.Team‐based learning (TBL) requires MCQs because of the need for immediate feedback.Automated marking can make it more efficient to provide immediate feedback on OEQs as required by the TBL approach. What this paper adds?: OEQs changed student‐learning approaches in the TBL context.OEQs changed the quality of team discussions during the team‐readiness assessment.Test (tRAT) and application exercise phases.Students were concerned about the validity of automated grading. Implications for practitioners: Consider using OEQs in TBL context for deepening student learning.Consider how to defuse students' scepticism of new technology.Consider forming teams with a mix of deep and surface learners. [ABSTRACT FROM AUTHOR]

This paper provides guidance for researchers with some mathematical background on the conduct of time-to-event analysis in observational studies based on intensity (hazard) models. Discussions of basic concepts like time axis, event definition and censoring are given. Hazard models are introduced, with special emphasis on the Cox proportional hazards regression model. We provide check lists that may be useful both when fitting the model and assessing its goodness of fit and when interpreting the results. Special attention is paid to how to avoid problems with immortal time bias by introducing time-dependent covariates. We discuss prediction based on hazard models and difficulties when attempting to draw proper causal conclusions from such models. Finally, we present a series of examples where the methods and check lists are exemplified. Computational details and implementation using the freely available R software are documented in Supplementary Material. The paper was prepared as part of the STRATOS initiative. [ABSTRACT FROM AUTHOR]

To undertake a literature search and critical appraisal of best available evidence to answer the clinical question: Does the addition of clonidine (I) to standard treatment with an opioid (C) improve outcomes (O) in infants with Neonatal Abstinence Syndrome? A search of both comprehensive (MedLine and Embase) and pre-filtered databases (Dynamed, UpToDate and TRIP), utilising Boolean Operators to combine search terms appropriately. Three relevant studies were identified. One paper describing the outcomes of a randomised controlled trial by Agthe et al. (2009) most accurately answered the clinical question posed. This paper was critically appraised, and evidence applied to the clinical scenario. The use of clonidine as an adjunct to opioid in the management of infants with NAS reduces the total number of treatment days and dose of opioid required to control symptoms. However, there is a higher risk of rebound in symptoms post-cessation of opioid and clinicians need to account for this in their discharge planning. More large scale, multi-centre high-quality research is needed to clarify the role of clonidine in the treatment of NAS: as monotherapy versus adjunct, the optimal dose and longer-term impact on neurodevelopment. [ABSTRACT FROM AUTHOR]

Psychiatric genomics research with African populations comes with a range of practical challenges around translation of psychiatric genomics research concepts, procedures, and nosology. These challenges raise deep ethical issues particularly around legitimacy of informed consent, a core foundation of research ethics. Through a consideration of the constitutive function of language, the paper problematises like-for-like, designative translations which often involve the 'indigenization' of English terms or use of metaphors which misrepresent the risks and benefits of research. This paper argues that effective translation of psychiatric genomics research terminology in African contexts demands substantive engagement with African conceptual schemas and values. In developing attenuated forms of translational thinking, researchers may recognise the deeper motivational reasons behind participation in research, highlighting the possibility that such reasons may depart from the original meaning implied within informed consent forms. These translational issues might be ameliorated with a critical re-examination of how researchers develop and present protocols to institutional ethics review boards. [ABSTRACT FROM AUTHOR]

Introduction: This paper accomplishes two goals. First, we assesses the measurement invariance of legal cynicism among adolescents in São Paulo, Brazil, Montevideo, Uruguay, and Zurich, Switzerland. Second, we evaluate a series of social and individual antecedents that are expected to influence legal cynicism across contexts.Methods: This paper first evaluates the measurement invariance of legal cynicism using Multigroup Confirmatory Factor Analysis with three randomized clustered samples of adolescents in Zurich (n = 1447), São Paulo (n = 2680) and Montevideo (n = 2204). Second, we assessed the correlates for legal cynicism in each city using structural equation modelling techniques.Results: The results demonstrated metric invariance, but not scalar invariance among adolescents in São Paulo, Zurich, and Montevideo. We were able to establish partial measurement invariance for legal cynicism in São Paulo and Zurich, and therefore proceeded with the comparison of latent means and antecedents. The results show that on average legal cynicism is higher in Zurich, but that the size and strength of antecedents were similar across cities. Low self-control was by far the strongest correlate of legal cynicism.Conclusions: Overall, our results suggest that current operationalizations of legal cynicism may not be rooted in social structural context and experiences with legal authorities, but rather reflect how individuals interpret legal boundaries and dispositions towards rule-breaking. Researchers must reconsider how legal cynicism fits into models of legal socialization, and whether developmental models of self-control may help us understand the origins and nature of legal cynicism, as it is currently measured. [ABSTRACT FROM AUTHOR]

Aim: To determine if pain is associated with 12-month incidence of mood affective disorders (MAD) in adults with cerebral palsy (CP).Method: Data from Optum Clinformatics® Data Mart (2013-2016) were used for this retrospective cohort study. Diagnostic codes were used to identify adults (≥18y) with CP, incident cases of MAD, and covariates (other neurodevelopmental conditions, sleep disorders, arthritis). Pain (any type, location) was identified between 1st October 2014 and 30th September 2015. The pain group was divided into new or consistent pain if they had a history of pain (i.e. consistent) in the 12 months before their first pain claim date. Crude incidence rates of MAD (expressed per 100 person-years) were estimated. Cox regression was used to estimate hazard ratio (95% confidence interval [CI]) of MAD after adjusting for covariates.Results: Adults that had new pain (n=859; incidence rate=15.5) or consistent pain (n=1303; incidence rate=17.9) had greater crude incidence rate of MAD compared to adults without pain (n=3726; incidence rate=5.9). The elevated rate of MAD remained after adjusting for covariates, for new pain (hazard ratio=2.4; 95% CI=1.9-3.0) and consistent pain (hazard ratio=2.1; 95% CI=1.7-2.7).Interpretation: Pain is associated with greater incidence of MAD in adults with CP. This association remained after accounting for potential confounding factors.What This Paper Adds: What this paper adds Pain was associated with higher 12-month incidence of mood affective disorders (MAD). The 12-month MAD incidence was similar between new and consistent pain groups. The MAD incidence remained higher adjusting for neurodevelopmental comorbidities, sleep disorders, and arthritis. [ABSTRACT FROM AUTHOR]