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Previously, Rahardja (2020) paper (in the first reference list) developed a (pairwise) multiple comparison procedure (MCP) to determine which (proportions) pairs of Multiple Binomial Proportions (with under-reported data), the significant differences came from. Generally, such an MCP test (developed by Rahardja, 2020) is the second part of a two-stage sequential test. In this paper, we derived two omnibus tests (i.e., the overall equality of multiple proportions test) as the first part of the above two-stage sequential test (with under-reported data), in general. Using two likelihood-based approaches, we acquire two Wald-type (Omnibus) tests to compare Multiple Binomial Proportions (in the presence of under-reported data). Our closed-form algorithm is easy to implement and not computationally burdensome. We applied our algorithm to a vehicle-accident data example. [ABSTRACT FROM AUTHOR]

Background: The most common conservative treatment for Adolescent Idiopathic Scoliosis (AIS) is bracing. However, several papers questioned the effectiveness of bracing for curves between 40° and 50° Cobb: the effectiveness in preventing curve progression could be as low as 35%. Seriate casting is considered a standard approach in early onset scoliosis; however, in the setting of AIS, cast treatment is seldom utilized, with only few studies reporting on its effectiveness. Aim of the study: The main aim of the study is to determine whether a seriate casting with Risser casts associated with bracing is more effective in preventing curve progression than bracing alone in curves larger than 40°. Furthermore, the secondary endpoints were: (1) is there a difference in effectiveness of casting between Thoracic (T) and Thoracolumbar/Lumbar (TL/L) curves? (2) Does the 'in cast' correction predicts the treatment outcome? (3) What is the effect on thoracic kyphosis of casting? Methods: This is a retrospective monocentric case–control study; through an Institutional Database search we identified all the patients treated at our institution between 1 January 2017 and 31 December 2020, with a diagnosis of AIS, Risser grade between 0 and 4 at the beginning of the treatment, at least one curve above 40° Cobb and treatment with either seriate Risser casting and bracing (Study Group, SG) or bracing alone (Control Group, CG). Standing full spine X-rays in AP and LL are obtained before and after the cast treatment; only AP standing full spine X-rays 'in-cast' are obtained for each cast made. Patients were stratified according to the curve behavior at the end of treatment (Risser 5): progression was defined as ≥6° increase in the curve magnitude or fusion needed; stabilization is defined as a change in curve by ±5°; and improvement was defined as ≥6° reduction in the curve. Results: For the final analysis, 55 compliant patients (12 M, 43 F, mean age 13.5 ± 1.6) were included in the SG and 27 (4 M, 23 F, mean age 13.6 ± 1.6) in the CG. Eight (14.5%) patients in the SG failed the conservative treatment while 14 (51.3%) failed in the CG. Consequently, the Relative Risk for progression in the Efficacy Analysis was 1.8 (95% CI 1, 3–2.6, p = 0.001), and the Number Needed to Treat was 2,4. No significant difference was found between the T and TL/L curves concerning the 'progressive' endpoint (z-score 0.263, p = 0.79). The mean percentage of 'in cast' curve reduction was 40.1 ± 15.2%; no significant correlation was found between the percentage of correction and the outcome (Spearman Correlation Coefficient 0.18). Finally, no significant differences between baseline and end of FU TK were found (32° ± 16.2 vs. 29.6 ± 15.8, p = ns). Discussion: Seriate Risser casting for AIS with larger curves (>40° Cobb) is effective in reducing curve progression when compared with full time bracing alone in treatment compliant patients. The treatment is equally effective in controlling T and TL/L curves; furthermore, a slight but non-significant decrease in TK was observed in patients treated with casting. This type of treatment should be considered for AIS patients who present with large curves to potentially reduce the percentage of surgical cases. Short Abstract: The aim of the study is to determine whether seriate Risser casting associated with bracing is more effective in preventing curve progression than bracing alone in curves larger than 40°. This is a retrospective monocentric case–control study; we identified all the patients treated at our institution with a diagnosis of AIS, Risser grade 0–4 at the beginning of the treatment, at least one curve above 40° Cobb (35° if treated with bracing alone) and treatment with either seriate Risser casting and bracing (Study Group, SG) or bracing alone (Control Group, CG). Fifty-five patients (12 M, 43 F, mean age 13.5 ± 1.6) were included in the SG and 30 (5 M, 25 F, mean age 13.9 ± 1.7) in the CG. Eight (14,5%) patients in the SG failed the conservative treatment while fifteen (50%) failed in the CG. Consequently, the Relative Risk for progression in the Efficacy Analysis was 1.8 (95% CI 1.3–2.6, p = 0.001), and the Number Needed to Treat was 2,4. Seriate Risser casting for AIS with larger curves (>40°) is effective in reducing curve progression when compared with full time bracing alone. This type of treatment should be considered for AIS patients who present with large curves. [ABSTRACT FROM AUTHOR]

Context: Recently, a few papers have suggested that tissue flossing (TF) acutely improves range of motion (ROM) and neuromuscular performance. However, the effects of TF on muscle contractile properties are yet to be defined. Objective: To investigate the acute effects of TF on ankle ROM and associated muscle gastrocnemius medialis displacement and contraction time assessed with tensiomyography. Design: Crossover design in a single session. Setting: University laboratory. Participants: Thirty recreationally trained volunteers (age 23.00 [4.51] y). Intervention: Active ankle plantar flexion and dorsiflexion were performed for the duration of 2 minutes (3 sets, 2-min rest between sets), while a randomly selected ankle was wrapped using TF elastic band (BAND) and the other ankle served as a control condition (CON). Main outcome measures: Participants performed an active ankle plantar flexion and dorsiflexion ROM test and muscle gastrocnemius medialis tensiomyography displacement and contraction time measurement pre, 5, 15, 30, and 45 minutes after the floss band application. Results: There were no statistically significant differences between BAND and CON conditions (active ankle plantar flexion ROM: P = .09; active ankle dorsiflexion ROM: P = .85); however, all ROM measurements were associated with medium or large effect sizes in favor of BAND compared with CON. No significant changes were observed in the tensiomyography parameters. Conclusions: The results of this study suggest that TF applied to the ankle is a valid method to increase ROM and at the same time maintaining muscular stiffness. [ABSTRACT FROM AUTHOR]

This article discusses the methodology and potential pitfalls in interobserver agreement studies, specifically in the context of assessing the suitability for fetal ECG ST analysis (STAN) when commencing cardiotocography (CTG). The authors used proportions of agreement and kappa analysis to assess the data, which are commonly used methods in similar studies. They also compared their new physiology-based FFTree CTG interpretation approach with the FIGO classification and found some differences in the proportions of agreement. The authors provided special graphs to visualize the results and presented the data in a transparent manner. [Extracted from the article]

Introduction: Systemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training. Aim: Assess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses. Methods: National cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians). Results: N = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%). Conclusion: GPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates. [ABSTRACT FROM AUTHOR]

Geomagnetism, similar to other areas of geophysics, is an observation-based science. Data agreement between comparative geomagnetic vector observations is one of the most important evaluation criteria for high-quality geomagnetic data. The main influencing factors affecting the agreement between comparative observational data are the attitude angle, scale factor, long-term time drift, and temperature. In this paper, we propose a method based on a genetic algorithm and linear regression to correct for these effects and use the distribution pattern of points in Bland–Altman plots with a 95% confidence interval length to qualitatively and quantitatively evaluate the agreement between the comparative observational data. In Bland–Altman plots with better agreement, that is, with the corrected data, more than 95% of the points are distributed within the 95% confidence interval and there is no obvious pattern in the distribution of the points. Meanwhile, the length of 95% confidence interval decreased significantly after the correction. The method presented here has positive effects on the vector instrumentation detection and would enhance the robustness of geomagnetic observatory by bringing the data quality of the backup variometer data in line with the primary variometer. [ABSTRACT FROM AUTHOR]

Background: Down syndrome (DS) is a neurodevelopmental disorder of genetic origin with a cognitive‐behavioural profile that distinguishes it from other syndromes. Within this profile, language difficulties are particularly marked, having been more studied in childhood than in adulthood. More generally, there is a paucity of research on the prosodic skills of individuals with DS, despite the relevance of this linguistic component for effective communication. Aims: This study aimed to analyse, for the first time, the prosodic profile of Spanish‐speaking teenagers and young adults with DS. We hypothesized that participants with DS would show significantly lower skills for the perception and production of prosodic functions and forms when compared to peers with intellectual disability (ID) of unknown origin. We also hypothesized that teenagers and young adults with DS would have better prosody perception than prosody production. Methods & Procedures: The final sample included in the study comprised 28 Spanish‐speaking teenagers and young adults with DS and 29 teenagers and young adults with other ID matched on chronological age and nonverbal cognition. Their prosodic skills were tested by means of the Profiling Elements of Prosody for Speech and Communication battery. This battery allows for the separate evaluation of the comprehension and expression of the communicative functions of prosody and the discrimination and production of the forms that carry out such functions. Outcomes & Results: In the prosody function tasks, which are the most adaptive tasks for the communicative process, we found, as expected, significantly lower scores on the turn‐end, chunking, and focus tasks in the group with DS. However, no significant between‐group differences were found for the affect tasks. Participants with DS also had significantly lower scores on the prosodic form tasks than participants with other ID. The results of the comparison between prosodic perception and production skills showed that a generalization about a better profile in comprehension versus production is not possible and that there is a dependence on the demands of the prosodic task undertaken. Conclusions & Implications: The findings contribute to the ongoing development of the language profile of teenagers and young adults with DS and imply the need to design prosodic intervention programs based on their specific profile. WHAT THIS PAPER ADDS: What is already known on the subject: Prosody is a fundamental element of language, and its mastery affects the effectiveness of communication. However, research on prosody in Down syndrome (DS) that offers a holistic view from a psycholinguistic approach is still scarce. To date, studies focused on providing a detailed profile of prosodic skills in individuals with DS have been mainly conducted with a few English‐speaking children. These studies have shown that the comprehension and production of prosody is severely impaired, especially when considering affect and focus production, as well as the perception and production of prosodic forms. During childhood, greater efficacy is found in prosody comprehension than in prosody expression. What this study adds: This is the first study analysing the prosodic profile of a large group of Spanish‐speaking teenagers and young adults with DS. Poorer performance in the perception and production of both prosodic functions and forms was observed in participants with DS compared to participants with intellectual disability of unknown origin matched on chronological age and nonverbal cognition. Unlike what has been previously found in children, teenagers and young adults with DS performed at the same level as the control group on the understanding and expression of affect through prosodic cues. Results also showed that a generalization about a better prosody profile in comprehension versus production is not possible. What are the clinical implications of this work?: This study provides new data on the prosodic skills of Spanish‐speaking teenagers and young adults with DS. Given the impact of prosody on effective communication and the pattern of difficulties found in this study, speech and language therapists working with individuals with DS should consider including prosodic skills in interventions not only in childhood but also in adolescence and adulthood. Therefore, the prosodic profile of strengths and weaknesses in individuals with DS found in this research has direct implications for clinical practice. [ABSTRACT FROM AUTHOR]

Wrist fractures are common injuries associated with high disability in the early recovery period. The impact of wrist fractures on safe return to drive is not understood. (1) To compare the proportion of adults who were drivers in car crashes before and after wrist fracture; (2) To examine potential factors (demographic and/or clinical) associated with increased odds of being a driver in a car crash following wrist fracture. Retrospective cohort study. Three state-wide government datasets (MainRoads Western Australia [WA], Hospital Morbidity Data Collection and the Emergency Department Data Collection) were used to obtain and link demographic, clinical and car crash information relating to adults with a wrist fracture sustained between 2008 and 2017. McNemar's tests were used to compare the proportion of drivers in a car crash within the 2 years prior to and following the fracture date. Multivariable logistic regressions were used to identify if any variables were associated with increased odds of crashing in the post-fracture period. Data relating to 37,107 adults revealed a 3.3% (95% CI 3.0%–3.6%, p < 0.05) decrease in the proportion of drivers in a car crash following wrist fracture, persisting for the entire 2 years post-fracture, when compared to the proportion who crashed before their fracture. Those with more severe wrist fracture injury patterns had 79%(95% CI 1.07–3.0, p = 0.03) higher odds of having a crash in the first 3 months following their injury, compared to those with isolated wrist fracture injuries. These results inform and update return to drive recommendations. The reduced proportion of drivers involved in crashes following wrist fracture persisted for 2 years; longer than the expected physical recovery timeframe. It is important that hand therapists actively educate the sub-group of adults with more severe wrist fracture injury patterns of the increased likelihood of car crash for the 3 months following their fracture. • This the first paper to report on car crashes following wrist fracture. • We provide much needed information to assist with return to drive decision-making. • Those with severe injury had 79% higher odds of crashing in the initial 3-months. • Education is recommended for the sub-group with 3-months of increased crash risk. [ABSTRACT FROM AUTHOR]

This paper studies density estimation and regression analysis with data observed on a general unit hypersphere and contaminated by measurement errors. We establish novel density and regression estimators, and study their asymptotic properties such as the rates of convergence and asymptotic normality. We also provide two types of asymptotic confidence intervals for both density and regression functions. One type is based on the asymptotic normality of their estimators and the other type is based on the empirical likelihood technique. We present practical details on the implementation of our method as well as simulation studies and real data analysis. [ABSTRACT FROM AUTHOR]

In this paper, we present a practical approach for computing the sandwich variance estimator in 2-stage regression model settings. As a motivating example for 2-stage regression, we consider regression calibration, a popular approach for addressing covariate measurement error. The sandwich variance approach has rarely been applied in regression calibration, despite its requiring less computation time than popular resampling approaches for variance estimation, specifically the bootstrap. This is probably because it requires specialized statistical coding. Here we first outline the steps needed to compute the sandwich variance estimator. We then develop a convenient method of computation in R for sandwich variance estimation, which leverages standard regression model outputs and existing R functions and can be applied in the case of a simple random sample or complex survey design. We use a simulation study to compare the sandwich estimator to a resampling variance approach for both settings. Finally, we further compare these 2 variance estimation approaches in data examples from the Women's Health Initiative (1993–2005) and the Hispanic Community Health Study/Study of Latinos (2008–2011). In our simulations, the sandwich variance estimator typically had good numerical performance, but simple Wald bootstrap confidence intervals were unstable or overcovered in certain settings, particularly when there was high correlation between covariates or large measurement error. [ABSTRACT FROM AUTHOR]

Background: Central monitoring aims at improving the quality of clinical research by pro-actively identifying risks and remediating emerging issues in the conduct of a clinical trial that may have an adverse impact on patient safety and/or the reliability of trial results. This paper, focusing on statistical data monitoring (SDM), is the second of a series that attempts to quantify the impact of central monitoring in clinical trials. Material and Methods: Quality improvement was assessed in studies using SDM from a single large central monitoring platform. The analysis focused on a total of 1111 sites that were identified as at-risk by the SDM tests and for which the study teams conducted a follow-up investigation. These sites were taken from 159 studies conducted by 23 different clinical development organizations (including both sponsor companies and contract research organizations). Two quality improvement metrics were assessed for each selected site, one based on a site data inconsistency score (DIS, overall -log10P-value of the site compared with all other sites) and the other based on the observed metric value associated with each risk signal. Results: The SDM quality metrics showed improvement in 83% (95% CI, 80–85%) of the sites across therapeutic areas and study phases (primarily phases 2 and 3). In contrast, only 56% (95% CI, 41–70%) of sites showed improvement in 2 historical studies that did not use SDM during study conduct. Conclusion: The results of this analysis provide clear quantitative evidence supporting the hypothesis that the use of SDM in central monitoring is leading to improved quality in clinical trial conduct and associated data across participating sites. [ABSTRACT FROM AUTHOR]

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

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

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

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

Background We examined differences in response to self-reported alcohol use items by survey mode, whether self-report differences were the result of modality effects or self-selection, and whether these differences varied across the treatment and control arms of a preventative intervention trial. Methods Data from an existing alcohol prevention trial were used to estimate the effect of survey modality on adolescent's self-reported alcohol use at ages 17 to 18. Estimates were derived from regression models controlling for self-reported alcohol use during 8th grade, measured using a single survey modality, as well as time invariant selection factors. Results No statistically significant survey modality effects were found. No differential effects of survey modality were observed by assigned intervention group. Conclusions We provide initial evidence that adolescent alcohol prevention trials may use multiple survey modalities when necessary to increase response rates without harming interpretation of intervention effects. [ABSTRACT FROM AUTHOR]

Statistical synthesis of research findings via meta-analysis is widely used to assess the relative effectiveness of competing interventions. A series of three papers aimed at familiarising mental health scientists with the key statistical concepts and problems in meta-analysis was recently published in this journal. One paper focused on the selection and interpretation of the appropriate model to synthesise results (fixed effect or random effects model) whereas the other two papers focused on two major threats that compromise the validity of meta-analysis results, namely publication bias and missing outcome data. In this paper we provide guidance on how to undertake meta-analysis using Stata, one of the most commonly used software packages for meta-analysis. We address the three topics covered in the previous issues of the journal, focusing on their implementation in Stata using a working example from mental health research. [ABSTRACT FROM AUTHOR]

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

Background & Aims: The goal of medical science, which is progressing on a daily basis, is not only to avoid diseases but also to increase the quality of life of people (1). Quality of life is an important indicator of health beyond physical health and includes the feeling of healthiness, some degree of satisfaction and the general sense of self-worth (2), namely a mental state of well-being that can be influenced by culture, value system and the stressful environment (3). According to WHO definition, the quality of life is people's understanding of their position in life in terms of culture, value system in which they live, their goals, expectations, standards and priorities (4), which is affected in different ways by social, economic, environmental and individual factors (5). In fact, economic, psychological, social and environmental factors (6), as well as age, health status, occupation (7), gender, culture, education along with general behavioral, job and adaptation elements can influence the quality of life (8). Failure to pay attention to quality of life can lead to disappointment, reduction in social, cultural, economic, and health activities, loss of work motivation, decreased job performance, occupational burnout and early retirement (8, 9). On the other hand, paying attention to quality of life increases efficiency and reduces psychological pressures (10). Quality of life is one of the most important aspects of human health, and improving the health of employees may reduce medical costs, disability and absenteeism, improve job satisfaction and increase productivity (9, 11). The operating room is a closed environment associated with risks and anomalies, which can be considered a unit with environmental factors of stress causing dissatisfaction with personal responsibilities and professional work of surgical technologists, which may lead to physical and mental disorders adversely affecting a person's health and quality of life (13). Because we need employees who enjoy their high quality of life in order to provide satisfactory health care (14), the physical, mental health and emotional management of staff should not be neglected (15). In the operating room, the common goal of the surgical team is to provide effective, systematic and safe care, and failure of each member to perform their role can have a serious impact on the success of the entire team, and on the other hand, the success of an individual as a member of the team creates personal satisfaction in him/her (16) because surgical technologists are responsible for maintaining safety and comfort for patients in the operating room (17). Any negligence on the part of technologists may endanger the life of patients. According to the search for sources on this issue in Iran and abroad, it was observed that there were limited studies on quality of life of surgical technologists. Therefore, the researcher decided to conduct the present study with the aim of determining the quality of life and its related factors among surgical technologists of the medical training hospitals affiliated with Iran University of Medical Sciences. Methods: In this cross-sectional study that was conducted in hospitals affiliated with Iran University of Medical Sciences hospitals, 125 surgical technologists were recruited. Inclusion criterion was holding an associate or bachelor degree in surgical technology. The cluster sampling method was used, in which each of the centers was considered a separate cluster. According to the number of staff in the center, the personnel IDs of individuals were written on small sheets of paper. Then, the IDs were randomly selected by a person outside the study, the number was matched with that in the staff list, the desired person was chosen and sampling completed. A total of 150 questionnaires was distributed among surgical technologists in hospitals. The data were collected using demographic information questionnaire (age, gender, marital status, work experience, type of shift work, level of education, income, night shift hours per month and employment status) as well as 26-item WHOQOL-BREF. After obtaining permission from Research Vice-Chancellor (ethics code IR.IUMS.REC 1395.9411101009), OR was visited to collect data. The research goal was explained to all the research units, and there was no compulsion to participate in the study. In all stages of the research, the utmost confidentiality was observed for personal information, and anonymous questionnaires were completed as self-reports by the research units themselves in presence of the researcher. The normal distribution of data was confirmed by Kolmogorov-Smirnov test in SPSS-22. The results of descriptive analysis for qualitative variables were reported using frequency (percentage). The values of variables related to different dimensions of quality of life in each level of the studied variables were reported using mean±SD. To examine the relationship between different dimensions of quality of life with the studied variables, independent t-test was used for two-level qualitative variables, and one-way ANOVA was employed for qualitative variables with more than two levels. Bonferroni's post hoc test was used for pairwise comparisons. To investigate the effect of each variable on different dimensions of quality of life by controlling the effect of other variables, we used linear regression analysis, so that the significant variables entered at 0.2 level in univariate analysis. P<0.05 was considered the significance level in the rest of tests. Results: The participants of this research were 125 surgical technologists. More than half of the research units (52%) were <30 years, 40.8% were 30-40 years and the rest >49 years. The majority of research units (79.2%) were women and the rest were men. The mean and standard deviation of the quality of life was 63.10 ± 18.57; quality-of-life score in dimension of physical health was 54.77 ± 18.87, social health 54.60 ± 18.07, mental health 54.40±14.19, and environmental health 48.27±12.25, which shows that the lowest quality of life score of research units was related to the environmental dimension. By controlling the effect of each of the dependent variables, the variables of marital status and time of night shift had a significant effect on the level of physical health, so that after controlling the effect of night shift variable, the physical health score of married people was on average 13.23 units higher than single people [B=13.23, SE=2.96, P=<0.001, 95%CI= (7.36, 19.09)]. Also, after controlling the effect of the variable of marital status, physical health score of people who had >36 hours of night shift per month was on average 8.73 points lower than those who had <12 hours of night shift per month [B=- 8.73, SE=4.01, P=0.031, 95% CI= (-16.66, -0.790)]. Conclusion: The quality of life of surgical technologists was at an average level, and it was lower than other dimensions in the environmental dimension. Married people had a higher quality of physical health than unmarried people, and physical health was lower in those who had >36 hours of night shift per month relative to people with <12 hours of night shift per month. [ABSTRACT FROM AUTHOR]

Handwriting is a complex task that includes planning the content and the execution of handwriting movements on paper or on a tool (e.g., a tablet). This execution depends on the involvement of specific muscles in the hand (distal) and arm (proximal). The present study combines the parallel recording of the writing process on tablets and the related muscle activity with electromyography to investigate the differences in handwriting movements in two groups. A total of 37 intermediate writers (third and fourth graders, mean age 9.6 years, SD 0.5) and 18 skilled adults (mean age 28.6 years, SD 5.5) participated in three handwriting tasks. The tablet data results replicate previous findings in handwriting research for the writing process. The muscle activity data reflected a differential relationship between distinct muscle activity and handwriting performance depending on the handwriting skill (intermediate or advanced writers). Furthermore, the combination of both methods revealed that skilled writers tend to involve rather distal muscles to control the pressure of the writing pen on the surface, whereas developing writers mainly use their proximal muscles to control the velocity of their handwriting movements. This research contributes to a deeper understanding of the underlying processes of handwriting and the development of efficient handwriting execution. [ABSTRACT FROM AUTHOR]

Consistency of word production contributes to carers' ability to understand children's speech. Reports of the proportion of words produced consistently by typically developing preschool children, however, vary widely from 17% to 87%. This paper examines the quantitative (consistency count) and qualitative (e.g. phonemic analysis) characteristics of word consistency in 96 children aged 36–60 months. Children named 15 pictures twice, in separate trials, in the same assessment session. The mean consistency of the production for the whole group was 82%. Older children were more consistent than younger children. Girls were more consistent than boys. Words produced correctly in one trial and in error in another may indicate resolving error patterns. Words produced in error in two different ways provided useful evidence about the nature of inconsistent word production in typically developing children. The clinical and theoretical implications are discussed. [ABSTRACT FROM AUTHOR]

Aim: As individuals adjust to new 'norms' and ways of living during the COVID-19 lockdown, there is a continuing need for up-to-date information and guidance. Evidence suggests that frequent media exposure is related to a higher prevalence of mental health problems, especially anxiety and depression. The aim of this study was to determine whether COVID-19 related media consumption is associated with changes in mental health outcomes. Methods: This paper presents baseline data from the COVID-19 Psychological Wellbeing Study. The cross-sectional study data was collected using an online survey following the Generalised Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), with some other basic information collected. Logistic regression analysis was used to examine the influence of socio-demographic and media specific factors on anxiety and depression. Results: The study suggested that media usage is statistically significantly associated with anxiety and depression on the GAD-7 and PHQ-9 scales with excessive media exposure related to higher anxiety and depression scores. Conclusion: This study indicated that higher media consumption was associated with higher levels of anxiety and depression. Worldwide it should be acknowledged that excessive media consumption, particularly social media relating to COVID-19, can have an effect on mental health. However, as this was a cross-sectional study we cannot infer any directionality as we cannot infer cause and effect; therefore, future research involving longitudinal data collection and analyses of variables over time is warranted. [ABSTRACT FROM AUTHOR]

"Fusion" study designs combine data from different sources to answer questions that could not be answered (as well) by subsets of the data. Studies that augment main study data with validation data, as in measurement-error correction studies or generalizability studies, are examples of fusion designs. Fusion estimators, here solutions to stacked estimating functions, produce consistent answers to identified research questions using data from fusion designs. In this paper, we describe a pair of examples of fusion designs and estimators, one where we generalize a proportion to a target population and one where we correct measurement error in a proportion. For each case, we present an example motivated by human immunodeficiency virus research and summarize results from simulation studies. Simulations demonstrate that the fusion estimators provide approximately unbiased results with appropriate 95% confidence interval coverage. Fusion estimators can be used to appropriately combine data in answering important questions that benefit from multiple sources of information. [ABSTRACT FROM AUTHOR]

Background: To determine the effects of an educational playful intervention on nasal hygiene behaviors among preschool (3-4 years old) children. Methods: A quasi-experimental before-after study was conducted with 39 children attending public daycare center in Sao Paulo, Brazil. A group-based intervention consisted of two educational sessions to promote healthy behaviors for nasal hygiene. It was adopted playful strategies such as a story told by puppets, card games and simulation of nasal hygiene in front of the mirror. The outcome was evaluated by observing six healthy behaviors for nasal hygiene one week before and after the intervention. Differences in the outcome before and after the intervention were tested using Wilcoxon signed rank test and McNemar's test. Results: The median of healthy nasal hygiene behaviors went from 3.0 to 4.0 after the intervention, with a significant statistical difference (P=0.0004) and a difference of behaviors. After the intervention, forcing the air out of one opened nostril increased from 5.1%to 30.8% (P=0.001, CI 95%: 0-0.440), forcing the air out of the other nostril increased from 5.1% to 28.2% (P=0.003/CI 95%: 0-0.50), throwing the piece of toilet paper in the garbage increased from 53.8% to 87.21% (P=0.04, CI 95%: 0.035-0.65), and sanitizing the hands with soap and water increased from 15.4% to 43.6% (P=0.039-0.76). Conclusion: the educational playful intervention improved the autonomy of preschoolers to adopt healthy nasal hygiene behaviors. [ABSTRACT FROM AUTHOR]

Background & Aims: Given that standardized language measures alone are inadequate for identifying functionally defined developmental language disorder (fDLD), this study investigated whether non‐linguistic cognitive abilities (procedural learning, motor functions, executive attention, processing speed) can increase the prediction accuracy of fDLD in children in linguistically diverse settings. Methods & Procedures: We examined non‐linguistic cognitive abilities in mono‐ and bilingual school‐aged children (ages 8–12) with and without fDLD. Typically developing (TD) children (14 monolinguals, 12 bilinguals) and children with fDLD (28 monolinguals, 12 bilinguals) completed tasks measuring motor functions, procedural learning, executive attention and processing speed. Children were assigned as fDLD based on parental or professional concerns regarding children's daily language functioning. If no concerns were present, children were assigned as TD. Standardized English scores, non‐verbal IQ scores and years of maternal education were also obtained. Likelihood ratios were used to examine how well each measure separated the fDLD versus TD groups. A binary logistic regression was used to test whether combined measures enhanced the prediction of identifying fDLD status. Outcomes & Results: A combination of linguistic and non‐linguistic measures provided the best distinction between fDLD and TD for both mono‐ and bilingual groups. For monolingual children, the combined measures include English language scores, functional motor abilities and processing speed, whereas for bilinguals, the combined measures include English language scores and procedural learning. Conclusions & Implications: A combination of non‐linguistic and linguistic measures significantly improved the distinction between fDLD and TD for both mono‐ and bilingual groups. This study supports the possibility of using non‐linguistic cognitive measures to identify fDLD in linguistically diverse settings. What this paper adds: What is already known on the subject: Given that standardized English language measures may fail to identify functional language disorder, we examined whether supplementing English language measures with non‐linguistic cognitive tasks could resolve the problem. Our study is based on the hypothesis that non‐linguistic cognitive abilities contribute to language processing and learning. This is further supported by previous findings that children with language disorder exhibit non‐linguistic cognitive deficits. What this paper adds to existing knowledge: The results indicated that a combination of linguistic and non‐linguistic cognitive abilities increased the prediction of functional language disorder in both mono‐ and bilingual children. What are the potential or actual clinical implications of this work?: This study supports the possibility of using non‐linguistic cognitive measures to identify the risk of language disorder in linguistically diverse settings. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is a highly prevalent condition and affects a wide range of cohorts. A common compensatory strategy to manage dysphagia is diet modification. However, this technique is often associated with poor patient quality of life and adverse long‐term effects. Carbonated liquids have shown promise as an alternative compensatory strategy for the management of dysphagia. Aims: To examine the effect of genetic taste status and intensity of carbonation on swallowing and palatability in a healthy young adult population. To examine the palatability of carbonated liquids over time. Methods & Procedures: A total of 35 healthy young adults were recruited for this prospective, quantitative cohort study. They each drank 150 ml of still water (SW), lightly carbonated water (LCW) and highly carbonated water (HCW). Swallow function, palatability and genetic taste status were assessed using the timed water swallow test, the hedonic general labelled magnitude scale and participant ratings of the bitterness of propylthiouracil strips, respectively. Participants were divided into groups of supertasters, moderate tasters and non‐tasters. Outcomes & Results: A significant difference was found between SW and HCW on three tests of swallow function. Average time per swallow increased (p = 0.03), average swallow velocity decreased (p = 0.001) and average volume per swallow decreased (p = 0.017) on HCW compared with SW. HCW had a greater impact on swallow function than LCW. A significant mean difference in palatability ratings was found across intensity levels of carbonated fluids (p = 0.002), specifically between SW and HCW (p = 0.001). HCW was less palatable than SW. The palatability of carbonated liquids, investigated within a subgroup of five participants, did not decrease after a 24‐h period during which participants only drank carbonated liquids (p = 0.102). A significant difference was found between supertasters' (n = 9) (mean = 13.33) and non‐tasters' (n = 20) (mean = –24.5) palatability ratings of HCW (p = 0.03). Despite differences in swallow function between SW and HCW, no differences were detected between supertasters' and non‐tasters' swallow function on SW, LCW or HCW. Conclusions & Implications: Carbonated liquids have the ability to alter swallow function in a healthy young adult population; however, liquids must be highly carbonated in order to have an effect. Additionally, highly carbonated liquids are less palatable than SW, but the palatability of carbonated liquids does not decrease over time. Furthermore, supertasters find HCW more palatable than non‐tasters. These findings suggest that carbonated liquids alter swallowing in a healthy population. Further research in a clinical population is needed to better understand the potential role of sensory stimulation as a dysphagia intervention. What this paper adds: What is already known on the subject: Several studies have found that carbonated liquids have the ability to alter swallow function in both healthy and clinical populations. However, there is a lack of evidence around the optimum intensity of CO2 in carbonated liquids and the palatability of carbonated liquids as well as the palatability of carbonated fluids over time. What this paper adds to existing knowledge: The findings from this study suggest that carbonated liquids can alter swallow function in a healthy young adult population, but liquids must be highly carbonated in order to have an effect. HCW is less palatable than SW, but the palatability of carbonated liquids does not decrease over time. Additionally, supertasters find HCW more palatable than non‐supertasters (non‐tasters). What are the potential or actual clinical implications of this work?: The findings from this study suggest that carbonated liquids may be suitable for use as a sensory stimulation technique for people with dysphagia, as their palatability does not decrease over time; however, further research in a clinical population is needed in order to determine this. Additionally, intensity of stimulus is an important factor to consider during dysphagia evaluation to identify what intensity is required to optimize swallowing. [ABSTRACT FROM AUTHOR]

Background: Speech intelligibility is a global indicator of the severity of a speech problem. It is a measure that has been used frequently in research and clinical assessment of speech. Previous studies have shown that factors, such as measurement method and listener experience, can influence speech intelligibility scores. However, these factors of speech intelligibility assessment have not yet been investigated in people with Down syndrome (DS). Aims: To compare the speech intelligibility scores in speakers with DS measured using two methods: orthographic transcription and visual analogue scale (VAS), by two groups of listeners, experienced listeners and naïve listeners. Also, to examine the relationship across the four sets of speech intelligibility scores by means of correlational analysis. Methods & Procedures: A total of 30 adolescents and adults with DS read or repeated 12 sentences from a standardized test of intelligibility for adults with dysarthria. Each sentence was saved as a separate sound file and the 360 sentences were divided to form eight sets of stimuli. A total of 32 adults (16 experienced and 16 naïve) served as listeners of speech intelligibility. Each listener heard a single set of sentences and independently estimated the level of intelligibility for each sentence using a VAS in one task and wrote down the words perceived (i.e., orthographic transcription) in another task. The order of the two tasks was counterbalanced across listeners and the tasks were completed at least 1 week apart. Outcomes & Results: Repeated‐measures analysis of variance (ANOVA), confirmed by mixed‐methods analysis, showed that the scores obtained using orthographic transcription were significantly higher than those obtained using VAS; and the experienced listeners' scores were significantly higher than the naïve listeners' scores. Spearman rank correlation analysis showed that the four sets of scores across all conditions were strongly positively correlated with each other. Conclusions & Implications: Listeners, both experienced and naïve, may udge speech in DS differently when using orthographic transcription versus VAS as the method of measurement. In addition, experienced listeners can judge speech intelligibility differently compared with listeners who are less exposed to unclear speech, which may not represent 'real‐world' functional communicative ability. Speech and language therapists should be aware of the effect of these factors when measuring intelligibility scores and direct comparison of scores obtained using different procedures and by different groups of listeners is not recommended. What this paper addsWhat is already known on the subjectPrevious research on other clinical groups (e.g., Parkinson's disease) has shown that speech intelligibility scores can vary across different measurement methods and when judged by listeners with different experience. However, these factors have not yet been investigated in people with DS.What this paper adds to existing knowledgeSimilar to the findings reported for other clinical groups, using an impressionistic measurement method, such as VAS, can result in different speech intelligibility scores compared with scores obtained from orthographic transcription in speakers with DS. Furthermore, experienced listeners can perceive intelligibility as better compared with naïve (untrained) listeners for this group.What are the potential or actual clinical implications of this work?When measuring speech intelligibility, speech and language therapists should be aware that scores obtained using orthographic transcription can be higher than those obtained using VAS. They should also be aware that their increased exposure to hearing atypical speech may cause them to judge the speech difficulty as less severe and lead to an inaccurate representation of speech performance. Speech and language therapists should consider these factors when interpreting assessment results and especially when using intelligibility measures for treatment outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking cessation is the best strategy for reducing tobacco-related morbimortality. The goal of this randomized controlled trial was to test whether using the genetically favorable markers to choose a smoking cessation drug treatment (precision medicine) was superior to using the most effective drug (varenicline) in terms of abstinence rates. Additionally, combination therapy was tested when monotherapy failed. METHODS This partially blind, single-center study randomized (1:1) 361 participants into two major groups. In the genetic group (n=184), CYP2B6 rs2279343 (genotype AA) participants started treatment with bupropion, and CHRNA4 rs1044396 (genotype CT or TT) participants started treatment with varenicline; when genetic favorable to both, participants started treatment with bupropion, and when favorable to neither, on both drugs. In the control group (n=177), participants started treatment with varenicline, regardless of genetic markers. Drug treatment lasted 12 weeks. Efficacy endpoints were abstinence rates at Weeks 4, and Weeks 8-12, biochemically validated by carbon monoxide in exhaled air. Participants who did not achieve complete abstinence at Week 4, regardless of group, were given the choice to receive combination therapy. RESULTS Abstinence rates were 42.9% (95% CI: 36-64) in the control group versus 30.4% (95% CI: 23-37) in the genetic group at Week 4 (p=0.01); and 74% (95% CI: 67-80) versus 52% (95% CI: 49-64) at Week 12 (p<0.001), respectively. The strategy of combining drugs after Week 4 increased abstinence rates in both groups and the significant difference between genetic and control groups was maintained. CONCLUSIONS Results show that using these selected genetic markers was inferior to starting treatment with varenicline (control group), which is currently the most effective smoking cessation drug; moreover, the addition of bupropion in cases of varenicline monotherapy failure improves the efficacy rate until the end of treatment. CLINICAL TRIAL IDENTIFIER: NCT03362099 [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking stands as a primary contributor to preventable deaths globally and is linked to an increased risk of developing kidney failure and other diseases. A few studies have focused on the negative correlation between serum cotinine and estimated glomerular filtration rate (eGFR), indicating decreased kidney function. This study investigated the associations between urinary cotinine metabolite concentration and serum eGFR among active smokers in urban households. METHODS This was a cross-sectional study of active smokers in urban households' community Bangkok, Thailand from January to April 2023. The study involved 85 participants aged ≥18 years who were active smokers. Both urinary cotinine and serum eGFR concentrations were used as biomarkers. Independent sample t-tests were used to compare the urinary cotinine metabolite based on differences in the characteristic variable. We used multiple linear regression to test the association between cotinine metabolite and characteristics variables. Spearman's analysis was used to test the correlation between cotinine metabolite and eGFR concentration. RESULTS The association between urinary cotinine metabolite and serum eGFR concentration decreased with increasing cotinine concentrations (r= -0.223, p=0.041), suggesting a decline in kidney function. However, this study found no significant difference between urinary cotinine metabolite and characteristic variables (p>0.05). Additionally, those who smoked for ≥10 years (117.40 ± 89.80 ng/mL), smoked ≥10 cigarettes per day (117.40 ± 89.80 ng/mL) and used conventional cigarettes (124.53 ± 115.10 ng/mL). The results of the multiple linear regression models analysis indicated that those who were smokers for ≥10 years (β=0.076; 95% CI: -31.575--59.715) and those who were smoked ≥10 cigarettes/day (β=0.126; 95% CI: -65.636--18.150) were not associated with urinary cotinine metabolite level. CONCLUSIONS This study shows that the urinary cotinine metabolite level is associated with serum eGFR concentration among active smokers in urban households. The current study suggests that clinical identification and a prospective cohort study are needed before robust conclusions about how tobacco affects kidney efficiency. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

In this paper, we study the empirical likelihood and estimation of parameters of interest in a partially linear varying coefficient model with right censored data. Two cases are considered: censoring is independent of the covariates, and censoring depends on the covariates. The bias-corrected empirical log-likelihood ratios for the regression parameters are presented, Wilks' theorem is proved, and thus the confidence regions of the regression parameters are constructed. The estimators of parametric and nonparametric components are constructed, their asymptotic distributions are obtained, and the consistent estimators of the asymptotic variances are also given. Furthermore, the partial profile empirical log-likelihood ratios for each component of the regression parameters and the coefficient functions are constructed, and show they are asymptotically chi-squared. The obtained results can be directly used to construct the confidence regions/intervals for the regression parameters and the pointwise confidence intervals for the coefficient functions. Our approach is to directly calibrate the empirical log-likelihood ratio so that the resulting ratio is asymptotically chi-squared, undersmoothing of the coefficient functions is avoided, and existing data-driven methods can be effectively used to select the optimal bandwidth. Simulation studies compare the empirical likelihood method with one based on normal approximation and perform real data analysis. [ABSTRACT FROM AUTHOR]

This paper explores the potential of using Chat Generative Pre-Trained Transformer (ChatGPT), a powerful language model, as an innovative tool to enhance education in the classroom. Drawing from firsthand experience, this paper demonstrates how ChatGPT can be integrated into the teaching and learning process of statistics and data analytics classes. We provided concrete examples of how ChatGPT can be used to clarify concepts such as p-values and confidence intervals, facilitate data analytics by providing step-by-step guidance, and provide explanations for analytical outputs. The benefits of using ChatGPT help improve student engagement, foster critical thinking, and provide personalized assistance. However, the limitations of using ChatGPT, including its potential for bias in responses, should also be addressed. [ABSTRACT FROM AUTHOR]

This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0–10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany. [ABSTRACT FROM AUTHOR]

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In this paper, the basic structure of an ICT platform of energy indicators, Openergy, is analytically presented, leveraging energy open data to help address the energy crisis more democratically. More specifically, its applicability as a dynamic tool for the management of climate, environmental, and socioeconomic information is described, and its efficiency in helping uncover insights for optimal data-driven decisions is depicted. Openergy uses data from the official portal for European data and the Eurostat site. Its database consists of data related to six energy categories, EU 2020 energy targets, energy balance, electricity production, transport fuels, heat production, and gas emissions, and each one includes its own indicators for EU countries. The platform includes visualizations of these data as well as time series modeling and forecasting, and the results are depicted at Openergy platform. The time series modeling provides forecasts with confidence intervals of each indicator until 2020 in each energy category. Empirical validation, RMSE, and MAE values showed that in almost all cases and estimations, the predicted values are in very good agreement with the observed values. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to determine the effect of professional values of nurses on their attitudes towards caregiving roles. Methods: This is a cross‐sectional, correlational and descriptive study. The data were collected from 319 nurses working at different units in a public hospital between January and May 2019. The data collection tool included a 10‐question participant information form, the nursing professional values scale and the attitude scale for nurses in caregiving roles. The variables were analysed using the multiple linear regression. Results: The nurses had professional values and attitudes towards caregiving roles at high levels. Significant differences were found in the overall scales and their subscales especially due to nurses loving their profession (P < 0.05). Attitudes of the nurses towards caregiving roles were predicted by human dignity (β = 0.52, P < 0.01), action (β = 0.34, P < 0.01) and autonomy (β = −0.29, P < 0.01). Human dignity, action and autonomy accounted for 30% of the variance in their attitudes towards caregiving roles (∆R2 = 0.30). Conclusion: Scores obtained by the nurses loving their profession from the nursing professional values scale and the attitude scale for nurses in caregiving roles were higher. In addition, nurses' caregiving roles were explained with professional values. SUMMARY STATEMENT: What is already known about this topic? Professional values are the primary source of nursing practices and guide the interaction of nurses with patients, colleagues and society.Acquiring professional values enhances the quality of care.Caregiving is the oldest role of nurses forming the basis of both their traditional practices and modern nursing roles.Effectively performing the caregiving roles by nurses increases the quality of healthcare, job satisfaction and performance. What this paper adds? Total scores obtained by nurses from the nursing professional values scale and the attitude scale for nurses in caregiving roles were found to be above the average.There were significant differences between professional values and caregiving roles of the nurses in terms of their sociodemographic characteristics especially due to those loving their profession.A significant correlation was determined between professional values and caregiving roles of the nurses, and their caregiving roles were explained with professional values. The implications of this paper: Comprehending the importance of professional values directly affecting the caregiving roles of the nurses.Comprehending the importance of professional values forming the basis of professionalization and gaining these values by nurses. [ABSTRACT FROM AUTHOR]

Objective: Health registries and discharge-level databases are powerful tools. Commonly used data sets include the Nationwide Inpatient Sample (NIS); Surveillance, Epidemiology, and End Results Program (SEER); National Cancer Database (NCDB); and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). This study investigated the frequency with which these resources are being used and categorized their contributions to literature. Design: A literature review from 2005 to 2016 for papers utilizing the aforementioned databases and publishing in The Laryngoscope, JAMA-Otolaryngology, Head and Neck, Otolaryngology-Head and Neck Surgery, and International Forum of Allergy and Rhinology was conducted. Results were categorized based on the contribution(s) of the paper. The incidence rate of database publications was calculated for each year along with the 95% confidence intervals using a Poisson distribution. Results: Three hundred ten studies were identified. Seventy percent report descriptive findings, and 65% report outcomes/survival. Approximately 18% made clinical recommendations. In 2005, the incidence rate of database publications was 3 per 1000 journal publications (95% CI, 1-9) and remained relatively stable until 2008. From 2010 onward, there was a persistent increase in publications, culminating in the highest incidence rate in 2016 of 26 database publications per 1000 journal publications (95% CI, 20-32). Conclusions: There was a nearly 10-fold increase in database publications in 2016 compared to 2005. The majority provide descriptive data and outcomes measures. The role of these studies warrants further investigation. [ABSTRACT FROM AUTHOR]

Ecological inference refers to the study of individuals using aggregate data and it is used in an impressive number of studies; it is well known, however, that the study of individuals using group data suffers from an ecological fallacy problem (Robinson in Am Sociol Rev 15:351–357, 1950). This paper evaluates the accuracy of two recent methods, the Rosen et al. (Stat Neerl 55:134–156, 2001) and the Greiner and Quinn (J R Stat Soc Ser A (Statistics in Society) 172:67–81, 2009) and the long-standing Goodman's (Am Sociol Rev 18:663–664, 1953; Am J Sociol 64:610–625, 1959) method designed to estimate all cells of R 9 C tables simultaneously by employing exclusively aggregate data. To conduct these tests we leverage on extensive electoral data for which the true quantities of interest are known. In particular, we focus on examining the extent to which the confidence intervals provided by the three methods contain the true values. The paper also provides important guidelines regarding the appropriate contexts for employing these models. [ABSTRACT FROM AUTHOR]

Background: Several medications have been applied to Alzheimer's dementia patients (AD) but their efficacies have been insufficient. The efficacy and safety of 4 weeks of repetitive transcranial magnetic stimulation (rTMS) in Japanese AD were evaluated in this exploratory clinical trial. Methods: Forty-two patients, aged 60-93 years (average, 76.4 years), who were taking medication (> 6 months) and had Mini-Mental State Examination (MMSE) scores ≤ 25 and Clinical Dementia Rating Scale scores (CDR-J) of 1 or 2, were enrolled in this single-center, prospective, randomized, three-arm study [i.e., 120% resting motor threshold (120% RMT), 90% RMT for the bilateral dorsolateral prefrontal cortex, and Sham]. Alzheimer's Disease Assessment Scale-Japanese Cognitive (ADAS-J cog), Montreal Cognitive Assessment (MoCA-J), Clinical Global Impression of Change (CGIC), Neuropsychiatric inventory (NPI), and EuroQOL 5 Dimensions 5-Level (EQ-5D-5L) were administered. The primary endpoint was the mean change from baseline in the MMSE score (week 4). An active rTMS session involved applying 15 trains bilaterally (40 pulses/train at 10 Hz; intertrain interval, 26 s). Participants received ≥ 8 interventions within the first 2 weeks and at least one intervention weekly in the 3rd and 4th weeks. Full Analysis set (FAS) included 40 patients [120% RMT (n = 15), 90% RMT (n = 13), and Sham (n = 12)]. Results: In the FAS, MMSE, ADAS-J cog, MoCA-J, CDR-J, CGIC, NPI, and EQ-5D-5L scores between the three groups were not significantly different. Two patients were erroneously switched between the 120% RMT and 90% RMT groups, therefore, "as treated" patients were mainly analyzed. Post hoc analysis revealed significant treatment efficacy in participants with MMSE scores ≥ 15, favoring the 120% RMT group over the Sham group. Responder analysis revealed 41.7% of the 120% RMT group had a ≥ 3-point improvement in the ADAS-J cog versus 0% in the Sham group (Fisher's exact test, p = 0.045). The MoCA-J showed the same tendency but was not significant. Efficacy disappeared in week 20, based on the ADAS-cog and MoCA-J. No intervention-related serious adverse events occurred. Conclusion: This paper is the first report of using rTMS in Japanese AD patients. The treatment seems safe and moderate-mild stage AD should be target population of pivotal clinical trial with 120% RMT rTMS. [ABSTRACT FROM AUTHOR]

This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks. This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990–2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation. All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990–2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values. An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions. Asia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa. The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data. The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level. [ABSTRACT FROM AUTHOR]

Simple Summary: Although the deep inferior epigastric perforator flap (DIEP) has become the most frequent autologous flap in breast reconstruction, it remains unclear whether reconstruction should be performed at the same time as the mastectomy or delayed. Therefore, we conducted a meta-analysis to offer an overview of recipient site postoperative complications and help guide practicians toward the ideal timing for breast reconstruction. A pooled analysis using the Mantel and Haenszel methods with a fixed effect model provided results as an odd ratio with a 95% confidence interval. Among most complications including hematoma, infection, fat necrosis, and flap loss, no significant differences were observed. However, delayed wound healing was significantly higher for patients who underwent delayed breast reconstruction. This paper offers evidence that both surgical timings offer similar outcomes and are, therefore, valid surgical strategies. Purpose: The setting regarding the ideal timing for deep inferior epigastric perforator flap (DIEP) reconstruction remains unclear. Immediate breast reconstruction (IBR) is performed at the same time as mastectomy, while delayed breast reconstruction (DBR) is performed at any time after mastectomy except immediately. We compared both strategies to assess whether IBR or DBR should be performed to reduce postoperative adverse events. Methods: A systematic review of PubMed, Embase, Medline, Cochrane, and Web of Science was conducted, aiming at articles comparing the recipient site outcomes of IBR versus DBR with DIEP. We used the Mantel–Haenszel method with a fixed effects model. Results were expressed as the OR with a 95% CI. Results: Two retrospective and two prospective studies were identified involving 5784 DIEPs (1744 immediate and 4040 delayed). We showed a significant difference in favor of IBR for wound healing issues (OR = 0.57, 95% CI 0.41, 0.77; p = 0.0003). However, no significant differences for hematoma, infection, fat necrosis, partial flap loss, and total flap loss rate were seen. Conclusions: Despite variability in the choice of the ideal time for breast reconstruction and outcomes reported among studies, immediate DIEP surgery appears to be a reliable setting with less delayed healing issues. [ABSTRACT FROM AUTHOR]

Background: A total of 68% of pre‐school children with cleft palate have speech problems requiring speech therapy. There is a lack of access to regular targeted therapy. Parent training leads to positive outcomes in early communication skills in cleft palate and non‐cleft speech disorders. Connected health has been used to address inadequate access to therapy, providing intervention to those who would not otherwise receive therapy. Aims: To evaluate the speech, activity and participation outcomes of Parent Led, Therapist Supervised, Articulation Therapy (PLAT) compared with routine speech therapy intervention in parent–child dyads. Methods & Procedures: A total of 44 children, aged 2.9–7.5 years, were included in a two‐centre, two‐phase randomized controlled trial. Informed consent and assent were obtained. Participants and speech and language therapists (SLTs) were unblinded to the groups. Parents, in the parent‐trained group (n = 23), attended 2 days' training, received a detailed speech therapy programme, and undertook intervention over 12 weeks supported by the cleft specialist SLT using FaceTime and one face‐to‐face session. In the control arm (n = 21), parent–child dyads received six therapy sessions over 12 weeks with a research SLT, comparable with usual care. Speech recordings were undertaken pre‐ and post‐intervention. Percent consonant correct (PCC) was analysed by external SLTs blinded to the time and group. Activity and participation were measured using the Intelligibility in Context Scale (ICS) and Focus on Outcomes for Children Under Six (FOCUS) questionnaire. Outcomes & Results: There was no evidence of an interaction between Time and Group or an overall statistical difference between groups for PCC scores. There was a statistically significant difference over time for both groups (words: p < 0.002; confidence interval (CI) = 9.38–16.27; d = 0.57; sentences: p < 0.002; CI = 16.04–25.97; d = 0.23). Effect sizes were medium for words and small for sentences. For intelligibility and participation, there was no evidence of an interaction between Time and Group or an overall statistical difference between groups. A statistically significant difference over time was found for intelligibility (F = 29.97, d.f. = 1, 42, p < 0.001, 95 % CI = 1.45–3.15 d = 0.46) and for participation (F = 14.19, d.f. = 1, 41, p < 0.001 95% CI = 7.63–25.03; d = 0.36) with FOCUS results indicating clinically meaningful (parent‐led group) and significant (control group) change in participation. Conclusions & Implications: PLAT can be as effective as routine care in changing speech, activity and participation outcomes for children with cleft palate, when supported by a specialist cleft SLT using connected health. What this paper addsWhat is already known on this subjectOver 50% of children with cleft palate require speech therapy. However, there is a lack of timely, accessible speech therapy services in the UK and Ireland. Previous studies have shown that parents can deliver therapy effectively, and that connected health can support the delivery of speech therapy. This study aims to provide evidence that parent‐led therapy with the supervision of a specialist cleft therapist using FaceTime is effective.What this paper adds to existing knowledgeThis randomized controlled trial indicates that parents can be trained to deliver therapy for children with cleft palate speech disorders, under the supervision of an SLT. This approach results in improved speech, activity and participation outcomes similar to routine care.What are the potential or actual clinical implications of this work?This study indicates that both parent‐led articulation therapy and routine care showed meaningful gains in speech, activity and participation, and that parent‐led articulation therapy when supported by a cleft SLT using connected health could be an additional service delivery model for children with cleft palate speech disorders. [ABSTRACT FROM AUTHOR]

Serious games have proven to be a powerful tool in education to engage, motivate, and help students learn. However, the change in student knowledge after playing games is usually measured with traditional (paper) prequestionnaires–postquestionnaires. We propose a combination of game learning analytics and data mining techniques to predict knowledge change based on in‐game student interactions. We have tested this approach in a case study for which we have conducted preexperiments–postexperiments with 227 students playing a previously validated serious game on first aid techniques. We collected student interaction data while students played, using a game learning analytics infrastructure and the standard data format Experience API for Serious Games. After data collection, we developed and tested prediction models to determine whether knowledge, given as posttest results, can be accurately predicted. Additionally, we compared models both with and without pretest information to determine the importance of previous knowledge when predicting postgame knowledge. The high accuracy of the obtained prediction models suggests that serious games can be used not only to teach but also to measure knowledge acquisition after playing. This will simplify serious games application for educational settings and especially in the classroom easing teachers' evaluation tasks. Lay Description: What is currently known about the subject matter Serious games are a powerful tool to engage, motivate, and help students learn.Pre‐post experiments are commonly used to measure knowledge acquisition.Game learning analytics can be applied to interaction data from games. What this paper adds We present a two‐step approach combining game learning analytics and data mining to predict players' performance in serious games based on their interactions.The approach is tested in a case study with pre‐post experiments collecting interaction data with 227 students playing a serious game to determine if performance can be accurately predicted.The comparison of prediction models has helped to determine if pretest information is essential.The highly accurate prediction models obtained suggest that games can be used to teach and measure knowledge acquisition after playing. Implications of study findings for practitioners The approach aims to simplify the measurement of players' learning with serious games.It may be generalized at least to similar scenarios (e.g., games for procedural learning or game‐likesimulations) where similar interaction data are feasible.Game mechanics and educational design should define the interaction data to capture.Using an accepted standard tracking profile is a clear recommendation. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to establish the adjuvant clinical effect of brushing with a dentifrice containing purported active ingredients as compared to a regular sodium fluoride dentifrice with respect to the inhibition of overnight dental plaque regrowth from studies with human participants. Methods: MEDLINE‐PubMed, EMBASE and Cochrane CENTRAL were searched, up to June 2019. The inclusion criteria were controlled clinical trials with participants aged ≥ 18 years in good general health. Studies were included that evaluated the effect of toothbrushing with a dentifrice on the inhibition of overnight dental plaque regrowth when an active ingredient was added to the dentifrice as compared to a common sodium fluoride product. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta‐analysis was performed where feasible. Result: Independent screening of 213 unique papers resulted in 10 eligible publications that provided 14 comparisons. Stannous fluoride and triclosan dentifrices were found as the active ingredients. The descriptive analysis indicated that all, but two comparisons demonstrated an additional effect on the active‐ingredient dentifrice. The meta‐analysis supported and strengthened these findings. It showed that when plaque was scored digitally, a DiffM was −3.15(95% CI [−4.61:‐1.69], P <.001, prediction interval [−5.07;‐1.24]). When plaque was scored clinically, the difference of means (DiffM) was −0.33(95% CI [−0.49:‐0.16], P <.001, prediction interval [−0.87; 0.21]). Conclusion: The results of this review demonstrate moderate‐quality evidence that brushing with an active‐ingredient dentifrice with stannous fluoride or triclosan does provide an added clinically relevant effect concerning plaque inhibition capabilities that surpass the effect of a regular sodium fluoride dentifrice. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS; January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. Methods: The study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, individuals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. Results: In December 2004, there were 22 495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. Individuals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. Conclusions: Patients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic?: Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add?: Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners?: This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs. [ABSTRACT FROM AUTHOR]

Aim: The awareness for the need for end‐of‐life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end‐of‐life care needs of noncancer patients who were receiving care and wanted to die at home. Methods: A cross‐sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end‐of‐life care needs, in April and May, 2016. Results: Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end‐of‐life care needs. Conclusion: By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end‐of‐life stages. SUMMARY STATEMENT: What is already known about this topic? Noncancer patients at the end‐of‐life stage have complex needs and problems that are difficult to solve, compared with cancer patients.Noncancer patients need to receive effective symptom management or sufficient support for satisfactory care.End‐of‐life care is still mainly focused on cancer patients and attention to noncancer patients is lacking. What this paper adds? Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives."Duration of home care nursing and an income level were significantly associated with higher end‐of‐life care needs. The implications of this paper: Home care nurses must clearly assess the care needs of noncancer patients at the end‐of‐life stage and subsequently provide comprehensive patient‐centered care based on this assessment.It is important to adjust the care direction between patient, family, and medical staff from early on for patients who want to die at home.The results highlight needs for the development of interventions that focus on the duration of home care nursing of patients. [ABSTRACT FROM AUTHOR]

The brain dynamics in the electroencephalogram (EEG) data are often challenging to interpret, specially when the signal is a combination of desired brain dynamics and noise. Thus, in an EEG signal, anything other than the desired electrical activity, which is produced due to coordinated electrochemical process, can be considered as unwanted or noise. To make brain dynamics more analyzable, it is necessary to remove noise in the temporal location of interest, as well as to denoise data from a specific spatial location. In this paper, we propose a novel method for noisy EEG analysis with accompanying toolbox which includes adaptive, data-driven noise removal technique based on the improved intersection of confidence interval (ICI)-based algorithm. Next, a local entropy-based method for EEG data analysis was designed and included in the toolbox. As shown in the paper, the relative intersection of confidence interval (RICI) procedure retains the dominant dipole activity projected on electrodes, while the local (short-term) Rényi entropy-based analysis of the EEG representation in the time-frequency domain is efficient in detecting the presence of P300 event-related potential (ERP) at specific electrodes. Namely, the P300 are detected as sharp drop of entropy in the temporal domain that enabled accurate calculation of the index of the noise class for the EEG signals. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the prevalence of psychiatric morbidity, alcohol use, burnout and compassion satisfaction among physician trainees in New South Wales, Australia, and examine links between personal, demographic and lifestyle factors. Methods: A total of 67 physician trainees were recruited to the study. Fifty-nine completed the online survey (88% response rate). Outcome measures included the Depression Anxiety Stress Scale, Professional Quality of Life Scale and Alcohol Use Disorders Identification Test. Results: Approximately half the respondents met screening criteria for depression (53%), stress (51%) and anxiety (46%). Secondary traumatic stress was exceptionally high across the cohort, with higher scores in females (P = 0.001). The main reasons for not seeking help for depression or anxiety were lack of time (81%), fear of lack of confidentiality or privacy (41%), embarrassment (39%) and effect on registration (27%). Eighty-eight per cent of respondents agreed that doctors feel they need to portray a healthy image, but only 54% engaged in regular exercise and 24% slept ≤6 h each day. Conclusion: The results demonstrate high levels of non-psychotic psychiatric morbidity among physician trainees and a need to improve their well-being. Workplace systems need to promote healthy work environments and support physician trainees through good mentorship and supervision. What is known about the topic?: Doctors' health and patient care can be affected when doctors experience burnout and psychiatric morbidity. What does this paper add?: This paper adds to the evidence of psychiatric morbidity, burnout, secondary trauma and increased demographic data on a cohort of junior doctors undertaking speciality training. In addition, it provides reasons for not seeking help and positive and negative coping methods used by these junior doctors. What are the implications for practitioners?: The level of distress is high and requires system changes to support both individual health measures and structural change to work and study programs. [ABSTRACT FROM AUTHOR]

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

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