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Background: Social annotation has emerged as a promising educational technology that fosters collaborative reading and discussion of digital resources among learners. While the positive impact of social annotation on students' learning process and performance is widely acknowledged, students' behavioural patterns in social annotation are underexplored. Objectives: This study investigated patterns in students' use of annotation and response behaviours in social annotation activities. We also explored how students' performance in the behavioural, cognitive, emotional, and social dimensions varied based on their behavioural patterns. Methods: We recruited 93 undergraduates who were enrolled in an elective course at a large North American University. Students were tasked with collaboratively annotating the class readings uploaded to Perusall, a social annotation platform, over 7 weeks. We used metaclustering to determine the optimal number of clusters pertaining to student behaviours. We compared the differences among clusters across multiple performance dimensions. Results and Conclusions: Two distinct clusters were identified and defined as initiators and responders. We found that responders had significantly longer active reading time and exhibited greater social annotation effort compared to initiators. However, initiators received more peer acknowledgement, as evidenced by higher upvotes. No significant difference was found in cognitive insight between initiators and responders, but responders demonstrated significantly higher cognitive discrepancy. Additionally, there were no significant differences in positive and negative tones between initiators and responders; however, responders displayed higher levels of prosocial behaviours than initiators. This study has significant practical implications regarding promoting students' collaborative learning experience in social annotation. Lay Description: What is already known about this topic: Annotation and response behaviours are two primary actions in social annotation.Understanding how students navigate through annotations and respond to their peers' contributions is essential for optimizing their learning experience.Social annotation outcomes can be assessed in the behavioural, cognitive, emotional, and social dimensions. What this paper adds: This paper revealed students' behavioural patterns in social annotation activities.This study offered a comprehensive understanding of the various dimensions of performance among students with different behavioural tendencies. Implications for practice and/or policy: The two student clusters, initiators and responders, revealed distinct engagement patterns in social annotation and informed the design of targeted scaffoldings.Responders were not passive learners since they demonstrated significantly longer active reading time, greater social annotation effort, and higher level of prosocial behaviours.Educators might not need to place significant emphasis on monitoring participants' emotional expressions in social annotation.Social annotation platforms should incorporate features that encourage and reward both initiation and response behaviours. [ABSTRACT FROM AUTHOR]

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

Background: Dementia is a cognitive decline that leads to the progressive deterioration of an individual's ability to perform daily activities independently. As a result, a considerable amount of time and resources are spent on caretaking. Early detection of dementia can significantly reduce the effort and resources needed for caretaking. Aims: This research proposes an approach for assessing cognitive decline by analysing speech data, specifically focusing on speech relevance as a crucial indicator for memory recall. Methods & Procedures: This is a cross‐sectional, online, self‐administered. The proposed method used deep learning architecture based on transformers, with BERT (Bidirectional Encoder Representations from Transformers) and Sentence‐Transformer to derive encoded representations of speech transcripts. These representations provide contextually descriptive information that is used to analyse the relevance of sentences in their respective contexts. The encoded information is then compared using cosine similarity metrics to measure the relevance of uttered sequences of sentences. The study uses the Pitt Corpus Dementia dataset for experimentation, which consists of speech data from individuals with and without dementia. The accuracy of the proposed multi‐QA‐MPNet (Multi‐Query Maximum Inner Product Search Pretraining) model is compared with other pretrained transformer models of Sentence‐Transformer. Outcomes & Results: The results show that the proposed approach outperforms the other models in capturing context level information, particularly semantic memory. Additionally, the study explores the suitability of different similarity measures to evaluate the relevance of uttered sequences of sentences. The experimentation reveals that cosine similarity is the most appropriate measure for this task. Conclusions & Implications: This finding has significant implications for the early warning signs of dementia, as it suggests that cosine similarity metrics can effectively capture the semantic relevance of spoken language. The persistent cognitive decline over time acts as one of the indicators for prevalence of dementia. Additionally early dementia could be recognised by analysis on other modalities like speech and brain images. WHAT THIS PAPER ADDS: What is already known on this subject: It is already known that speech‐ and language‐based detection methods can be useful for dementia diagnosis, as language difficulties are often early signs of the disease. Additionally, deep learning algorithms have shown promise in detecting and diagnosing dementia through analysing large datasets, particularly in speech‐ and language‐based detection methods. However, further research is needed to validate the performance of these algorithms on larger and more diverse datasets and to address potential biases and limitations. What this paper adds to existing knowledge: This study presents a unique and effective approach for cognitive decline assessment through analysing speech data. The study provides valuable insights into the importance of context and semantic memory in accurately detecting the potential in dementia and demonstrates the applicability of deep learning models for this purpose. The findings of this study have important clinical implications and can inform future research and development in the field of dementia detection and care. What are the potential or actual clinical implications of this work?: The proposed approach for cognitive decline assessment using speech data and deep learning models has significant clinical implications. It has the potential to improve the accuracy and efficiency of dementia diagnosis, leading to earlier detection and more effective treatments, which can improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background: At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7–8 years, but later development remains unstudied. Aims: To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non‐adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. Methods & Procedures: In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow‐ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC‐Sum) for single words and rated on a three‐point scale (VPC‐Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in‐depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s‐errors. Information on secondary palatal surgery and number of visits to an SLP was collected. Outcomes & Results: VPF differed significantly between the groups at both ages when assessed with VPC‐Sum, but not with VPC‐Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s‐errors at age 5 years, and CSCs and s‐errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. Conclusions & Implications: CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre‐school years. WHAT THIS PAPER ADDS: What is already known on this subject: At the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7–8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft‐related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledge: This longitudinal study provides additional knowledge based on longer follow‐ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft‐related articulation errors. What are the potential or actual clinical implications of this work?: Speech and language therapy should target both cleft‐related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre‐school years, not least for adopted children. [ABSTRACT FROM AUTHOR]

Background: The potential of learning analytics dashboards in virtual reality simulation‐based training environments to influence occupational self‐efficacy via self‐reflection phase processes in the Chemical industry is still not fully understood. Learning analytics dashboards provide feedback on learner performance and offer points of comparison (i.e., comparison with one's own past performance or comparison with peer performance) to help learners make sense of their feedback. Objectives: We present a theoretical framework for describing learning analytics reference frames and investigate the impact of feedback delivered through dashboards with different reference frames on occupational self‐efficacy, while controlling for workplace self‐reflection. Methods: This experimental study engaged 42 chemical operator employees, aged between 18 and 55 years, each with at least one year of experience. We utilised a two‐group design to ask two research question each with three competing hypotheses related to changes in occupational self‐efficacy, employing Bayesian informative hypothesis evaluation. Results and Conclusions: Results for the primary research question suggest that dashboards with progress reference frames do not elicit greater change to self‐efficacy than those with social reference frames, however, they may elicit equal change. Furthermore, dashboards with social reference frames may elicit greater change to self‐efficacy than those with progress reference frames. Exploratory results found that dashboards with progress reference frames may elicit greater positive directional change than those with social reference frames and that they may elicit equal directional change. These findings contribute to the understanding of self‐efficacy beliefs within the Chemical industry, with potential impacts on skill development. The research may inform the design of targeted interventions and training programs to influence self‐efficacy. From a practical perspective, this research suggests that careful consideration is needed when choosing reference frames in learning analytics dashboards due to their potential consequences on the formation of learner self‐efficacy. Lay Description: What is already known about this topic?: Learning analytics dashboards often aim to stimulate self‐regulated learning by providing feedback.Feedback plays a crucial role in simulation‐based learning and learning analytics dashboards can be a valuable tool to deliver feedback and facilitate the learning process by providing learners with insights into their performance and progress.Previous research has highlighted the importance of reference frames as critical design features of learning analytics dashboards, as they assist learners in making sense of learning analytics feedback.Self‐efficacy is a powerful determine factor of workplace performance and is influenced by mastery experiences and social modelling information. What the paper adds?: A theoretical framework describes the mediating role self‐reflection phase processes of the self‐regulated learning cycle plays in the formation of occupational self‐efficacy.This paper introduces the concept of three learning analytics reference frame components which include the performance outcome component, point of comparison component and score delta component.The paper indicates that learning analytics dashboards designed with a progress reference frame does not elicit greater change to occupational self‐efficacy than the social reference frame.Exploratory results suggest dashboards with progress reference frames might produce greater positive directional change compared to social reference frames or elicit equal change. Implications for practice?: Learning analytics system designers who use reference frames to help learners make sense of their feedback should carefully consider which reference frames they use as these decisions likely have consequences on the formation of learner self‐efficacy beliefs.For LAD designers and stakeholders, recognising the absolute change and directional shift in self‐efficacy is crucial, as LAD designs significantly influence these dynamics and guide the tailoring of effective tools.In industries like the chemical sector, where overconfidence can result in severe consequences, understanding the nuance of self‐efficacy changes is especially pertinent. [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence relating to cognitive‐communication difficulties following traumatic brain injury (TBI) sustained in older adulthood. A prominent area in which post‐TBI cognitive‐communication difficulties manifest is at the level of social communication. An investigation of social communication focusing on comparison of those injured in older and younger adulthood is a practical starting point for age‐related cognitive‐communication outcome comparison. Aims: The overall objective of this study was to explore the social communication of individuals who sustained severe TBI in an early period of older adulthood (50–70 years) compared to younger adulthood (18–40 years), as informed by self and close other reports. Methods & Procedures: This exploratory controlled group comparison study involved analysis of self‐reported and close other reported La Trobe Communication Questionnaire data for 22 adults with severe TBI (11 older at injury; 11 younger at injury) and 22 control participants (11 older; 11 younger). TBI participants were matched for injury variables and participant groups were matched for sex, age and education. Outcomes & Results: The close others of the older and younger adults with TBI reported them to have significantly more frequent difficulty with social communication than the close others of age‐matched control groups. Older adults with TBI reported significantly more frequent difficulty with social communication than uninjured older adults. In contrast, younger adults with TBI and uninjured younger adults reported a similar frequency of difficulty with social communication. No age‐based difference in the frequency of social communication difficulty was evident when comparing the self or close other reports of older and younger adults with TBI. Awareness of social communication difficulty, as indexed by comparing self and close other perceptions, showed a different pattern across the TBI groups. The older TBI group rated themselves as having significantly less frequent social communication difficulty than was perceived by their close others. In contrast, no statistically significant difference was evident between the self and close other social communication ratings of the younger TBI group. Conclusions and Implications: Where possible clinicians need to work with close communication partners to understand the nature and degree of social communication difficulty following severe TBI. This may be especially important when working with people who sustain TBI in older adulthood if future research shows that this population have greater difficulty with self‐awareness of social communication difficulty. What this paper adds: What is already known on the subject: Cognitive‐communication difficulties are a common consequence of traumatic brain injury (TBI) that can have long‐term impact on everyday functioning. These challenges have primarily been investigated in individuals who sustained TBI in younger adulthood. What this paper adds to existing knowledge: Individuals who sustain severe TBI in early older adulthood have a higher frequency of reported social communication difficulty to non‐injured adults of a similar age, albeit they may underreport such difficulties potentially in the context of reduced self‐awareness. What are the potential or actual clinical implications of this work?: Social communication difficulty is an issue for people who sustain severe TBI in early older adulthood. However, a poorer overall social communication outcome in comparison to those injured in younger adulthood should not be assumed. Clinical service delivery for these challenges is most optimally delivered in a collaborative manner with the individual and their close others. Future research is required to investigate the identified trends from this study. [ABSTRACT FROM AUTHOR]

Employee mental health is a central issue in today's global workplace. This paper analyzes the effect of high performance work systems (HPWSs) on employee mental health. We integrate HPWS concepts with job demands‐resources (JD‐R) theory to examine competing theoretical perspectives—a positive HPWS influence and a negative HPWS influence on employee mental health. We examine employees' perceptions of psychological empowerment as an indicator of the motivational pathway of the JD‐R and work‐role overload as an indicator of the strain pathway to explain the differential effect of HPWSs on mental health. We also incorporate organizational identification theory to demonstrate how one's identification with the organization can either accentuate or attenuate feelings of both psychological empowerment and work‐role overload. Findings from a study of 999 employees in 174 South Korean organizations indicate that HPWSs are positively associated with employee mental health via employee perceptions of empowerment and that HPWSs are negatively associated with employee mental health through perceptions of work‐role overload. Furthermore, the study finds that organizational identification attenuates the relationship between HPWS and both empowerment and overload. Practice‐level post hoc analyses also reveal that the job design characteristics, pay level, and participative decision‐making are linked to empowerment. In addition, participative decision‐making is most strongly associated with work overload. [ABSTRACT FROM AUTHOR]

Background: In everyday conversations, a person with aphasia (PWA) compensates for their language impairment by relying on multimodal and material resources, as well as on their conversation partners. However, some social actions people perform in authentic interaction, proposing a joint future activity, for example, ordinarily rely on a speaker producing a multi‐word utterance. Thus, the language impairment connected to aphasia may impede the production of such proposals, consequently hindering the participation of PWAs in the planning of future activities. Aims: To investigate (1) how people with post‐stroke chronic aphasia construct proposals of joint future activities in everyday conversations compared with their familiar conversation partners (FCPs); and (2) how aphasia severity impacts on such proposals and their uptake. Methods & Procedures: Ten hours of video‐recorded everyday conversations from seven persons with mild and severe aphasia of varying subtypes and their FCPs were explored using conversation analysis. We identified 59 instances where either party proposed a joint future activity and grouped such proposals according to their linguistic format and sequential position. Data are in Finnish. Outcomes & Results: People with mild aphasia made about the same number of proposals as their FCPs and used similar linguistic formats to their FCPs when proposing joint future activities. This included comparable patterns associated with producing a time reference, which was routinely used when a proposal initiated a planning activity. Mild aphasia manifested itself as within‐turn word searches that were typically self‐repaired. In contrast, people with severe aphasia made considerably fewer proposals compared with their FCPs, the proposal formats being linguistically unidentifiable. This resulted in delayed acknowledgement of the PWAs' talk as a proposal. Conclusions & Implications: Mild aphasia appears not to impede PWAs' ability to participate in the planning of joint future activities, whereas severe aphasia is a potential limitation. To address this possible participatory barrier, we discuss clinical implications for both therapist‐led aphasia treatment and conversation partner training. WHAT THIS PAPER ADDS: What is already known on the subject: PWAs use multimodal resources to compensate for their language impairment in everyday conversations. However, certain social actions, such as proposing a joint future activity, cannot ordinarily be accomplished without language. What this paper adds to existing knowledge: The study demonstrates that proposing joint future activities is a common social action in everyday conversations between PWAs and their family members. People with mild aphasia used typical linguistic proposal formats, and aphasic word‐finding problems did not prevent FCPs from understanding the talk as a proposal. People with severe aphasia constructed proposals infrequently using their remaining linguistic resources, a newspaper connecting the talk to the future and the support from FCPs. What are the potential or actual clinical implications of this work?: We suggest designing aphasia treatment with reference to the social action of proposing a joint future activity. Therapist‐led treatment could model typical linguistic proposal formats, whereas communication partner training could incorporate FCP strategies that scaffold PWAs' opportunities to construct proposals of joint future activities. This would enhance aphasia treatment's ecological validity, promote its generalization and ultimately enable PWAs to participate in everyday planning activities. [ABSTRACT FROM AUTHOR]

Background: Patients with anomic aphasia experience difficulties in narrative processing. General discourse measures are time consuming and require necessary skills. Core lexicon analysis has been proposed as an effort‐saving approach but has not been developed in Mandarin discourse. Aims: This exploratory study was aimed (1) to apply core lexicon analysis in Mandarin patients with anomic aphasia at the discourse level and (2) to verify the problems with core words among people with anomic aphasia. Methods & Procedure: The core nouns and verbs were extracted from narrative language samples from 88 healthy participants. The production of core words for 12 anomic aphasia and 12 age‐ and education‐matched controls were then calculated and compared. The correlation between the percentages and the Aphasia Quotients of the revised Western Aphasia Battery was analyzed as well. Outcomes & Results: The core nouns and verbs were successfully extracted. Patients with anomic aphasia produced fewer core words than healthy people, and the percentages differed significantly in different tasks as well as word classes. There was no correlation between the core lexicon use and the severity of aphasia in patients with anomic aphasia. Conclusions & Implications: Core lexicon analysis may potentially serve as a clinician‐friendly manner of quantifying core words produced at the discourse level in Mandarin patients with anomic aphasia. WHAT THIS PAPER ADDS: What is already known on the subject: Discourse analyses in aphasia assessment and treatment have increasingly garnered attention. Core lexicon analysis based on English AphasiaBank has been reported in recent years. It is correlated with microlinguistic and macrolinguistic measures in aphasia narratives. Nevertheless, the application based on Mandarin AphasiaBank is still under development in healthy individuals and patients with anomic aphasia. What this paper adds to existing knowledge: A Mandarin core lexicon set was developed for different tasks. The feasibility of core lexicon analysis to evaluate the corpus of patients with anomic aphasia was preliminarily discussed and the speech performance of patients and healthy people was then compared to provide a reference for the evaluation and treatment of clinical aphasia corpus. What are the potential or actual clinical implications of this work?: The purpose of this exploratory study was to consider the potential use of core lexicon analysis to evaluate core word production in narrative discourse. Moreover, normative and aphasia data were provided for comparison to develop clinical use for Mandarin patients with anomic aphasia. [ABSTRACT FROM AUTHOR]

Background: In scientific inquiry learning, students often have difficulties conducting hypothetical reasoning with multiple intertwined variables. Concept maps have a potential to facilitate complex thinking and reasoning. However, there is little investigation into the content of student‐constructed concept maps and its association with inquiry task performance. Objectives: This study explored students' concept mapping style and its association with task performance in computer‐based inquiry learning. Methods: An exploratory study was conducted with 80 Grade 11 students, who collaboratively constructed concept maps in a free style to support inquiry learning with a virtual ecosystem. Student‐constructed concept maps was analysed by firstly identifying different types of propositions formed in the maps and then determining the style of each concept map based on the dominant type of propositions in the map. Finally, the association between the concept map style and inquiry task performance was explored. Results and Conclusions: Two major concept map styles were identified: (1) knowledge‐oriented concept maps (KCMs) mainly representing problem‐related subject knowledge as a set of concepts and their relationships, and (2) problem‐oriented concept maps (PCMs) mainly representing problem situation as a sequence of changes and their causal relationships. Compared with those constructing KCMs, the students constructing PCMs formed higher‐quality propositions in their maps and performed better in hypothesising, reasoning, and drawing conclusions in the inquiry task. Implications: Besides KCMs, students in inquiry learning can be encouraged to construct PCMs to foster effective thinking and reasoning; that is, constructing a concept map to represent the problem situation as a sequence of changes and the causal relationships between the changes. Lay Description: What is currently known about the subject matter: Concept maps (CMs) can facilitate complex thinking and reasoning in inquiry learning.There is little investigation into the content of student‐constructed CMs.It is unknown how CM content might associate with inquiry task performance. What this paper adds: Students constructed two major styles of CMs in computer‐based inquiry learning.The two styles of CMs are problem‐oriented and knowledge‐oriented CMs.Students constructing problem‐oriented CMs performed better in the inquiry task. Implications for practitioners: Analysing student‐constructed CMs helps understand student thinking in inquiry.Students are encouraged to build problem‐oriented CMs in inquiry learning. [ABSTRACT FROM AUTHOR]

Background: Public involvement in health services research is encouraged. Descriptions of public involvement across the whole research cycle of a major study are uncommon and its effects on research conduct are poorly understood. Aim: This study aimed to describe how we implemented public involvement, reflect on process and effects in a large‐scale multi‐site research study and present learning for future involvement practice. Method: We recorded public involvement roles and activities throughout the study and compared these to our original public involvement plan included in our project proposal. We held a group interview with study co‐applicants to explore their experiences, transcribed the recorded discussion and conducted thematic analysis. We synthesized the findings to develop recommendations for future practice. Results: Public contributors' activities went beyond strategic study planning and management to include active involvement in data collection, analysis and dissemination. They attended management, scrutiny, planning and task meetings. They also facilitated public involvement through annual planning and review sessions, conducted a Public Involvement audit and coordinated public and patient input to stakeholder discussions at key study stages. Group interview respondents said that involvement exceeded their expectations. They identified effects such as changes to patient recruitment, terminology clarification and extra dissemination activities. They identified factors enabling effective involvement including team and leader commitment, named support contact, building relationships and demonstrating equality and public contributors being confident to challenge and flexible to meet researchers' timescales and work patterns. There were challenges matching resources to roles and questions about the risk of over‐professionalizing public contributors. Conclusion: We extended our planned approach to public involvement and identified benefits to the research process that were both specific and general. We identified good practice to support effective public involvement in health services research that study teams should consider in planning and undertaking research. Public Contribution: This paper was co‐conceived, co‐planned and co‐authored by public contributors to contribute research evidence, based on their experiences of active involvement in the design, implementation and dissemination of a major health services research study. [ABSTRACT FROM AUTHOR]

Child stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0–59 months old in 94 low‐ and middle‐income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age—presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months—presumably mostly due to further adverse exposures being less detrimental for older children, and catch‐up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch‐up growth may be achieved after age 2, screening around this time can be beneficial. Key message: Stunting prevalence was higher for older children until around age 28 months.The age with the highest stunting prevalence was fairly consistent across UNICEF regions.However, the stunting prevalence and gradient of the rise and fall in stunting prevalence across age varied between countries, living standards and sex.Programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence.Some catch‐up growth may be achieved after age 2, so screening around this time can be beneficial. [ABSTRACT FROM AUTHOR]

Background: Violence exacts staggering personal and financial costs – a burden disproportionally born by adolescents and young adults. This may be partially due to an increased sensitivity to social rejection during this critical phase of development. Irritability, a transdiagnostic symptom, is often elicited by social interactions. Yet, little is known about age differences in social rejection‐elicited aggression and irritability. Progress toward testing such relations has been hindered by a lack of ecologically‐valid tasks that enable the measurement of in‐the‐moment social rejection‐elicited aggression. Methods: In this paper, we describe an initial study of young adults (n = 55) that demonstrates the efficacy of a novel Virtual School and Aggression Paradigm (VS‐AP). Next, we replicate these results in a second study of adolescents and young adults (ages 11–25 years; n = 173) and examine relations between social rejection‐elicited aggression, irritability, and age. Results: We found that aggressive behavior in the VS‐AP differed for accepting, rejecting, and unpredictable peer types (Study 1: F(2, 108) = 20.57, p <.001, ε2 =.28; Study 2: F(2, 344) = 152.13, p <.001, ε2 =.47), demonstrating that the VS‐AP successfully models social rejection‐elicited aggression. In Study 2, age was negatively correlated with aggressive behavior (r = −.29, p <.001) and irritability (r = −.28, p <.001), while irritability was positively correlated with aggressive behavior (r =.28, p <.001). Age moderated the relation between social rejection‐elicited aggression and irritability. Specifically, irritability was more predictive of aggression in young adults than in adolescents (F(3, 167) = 7.07, p <.001). Conclusions: Data suggest mechanisms promoting rejection‐elicited aggression may differ across development and vary for those with and without high levels of irritability. The VS‐AP is a promising tool for probing neurocognitive, developmental, and clinically relevant mechanisms underlying social rejection‐elicited aggression. [ABSTRACT FROM AUTHOR]

Various models of specialized foster care have been developed, but research on them is limited. This longitudinal, exploratory study analysed data on adaptive functioning, emotional and social problems and self‐concept in a specialized foster care service in Sweden. The focus of the study was on the development of the children and young people in placement. The Adaptive Behaviour Assessment System (ABAS‐II) was used to measure adaptive functioning, and the Beck Youth Inventories of Emotional and Social Impairment (BYI) was used to measure self‐rated emotional and social problems and self‐concept. Self‐ratings showed significant improvements in disruptive behaviour, anger, anxiety and depression. Adaptive functioning as rated by foster parents improved but not enough to catch up with the non‐clinical norm group. The average adaptive functioning among the participants at baseline was considerably below the Swedish norm group. Similar to the results of a previous study of the same treatment model, children and young people rated improvement while their foster parents did not do so to the same extent. Possible explanations for this are discussed in the paper. The study is limited by the lack of a control group and by data attrition. [ABSTRACT FROM AUTHOR]

Aims: This study compared two dose frequency conditions of an explicit intervention with 50 trials per session designed to improve past tense marking in early school‐aged children with developmental language disorder (DLD). The influence of allomorphs on intervention effects was also examined. Methods: Data from previously conducted intervention studies were combined and analysed. Participants included nine children (mean age = 6;5 years) who received 20–30‐min intervention sessions provided twice per week for 10 weeks (1000 trials; 400–600 min) and 20 children (mean age = 6;6) who received 20–30‐min intervention sessions provided once per week for 10 weeks (500 trials; 200–300 min). Repeated measures included criterion‐referenced probes for production of untrained past tense verbs collected throughout baseline, intervention, and maintenance phases. The rate of progress in each phase was analysed using logistic regression. The proportion of participants who produced past tense allomorphs correctly at pre‐intervention, post‐intervention, and maintenance testing points was analysed. Results: Logistic regression showed a stable baseline, highly significant progress during the intervention phase, and a marginally significant shallow decline during the maintenance phase. Those in the twice per week group showed a greater rate of progress during the intervention phase leading to significantly higher scores in the maintenance period when compared with the once per week group. The allomorphic category of past tense verbs did not appear to influence outcomes. Conclusions: Participants receiving intervention twice per week appeared to demonstrate a greater rate of progress with intervention than those receiving it once per week, although once per week was also effective. However, these results should be interpreted with caution. Limitations to study design indicate that a larger randomised controlled trial is required. All past tense allomorphs improve to a similar degree when treated with this intervention. What this paper adds: What is already known on the subject: Understanding the parameters of dosage and intensity are important for clinical practice.Research evaluating the efficacy and/or effectiveness of interventions delivered in different dose/intensity conditions is scarce.There appears to be different interpretations of what constitutes dosage and intensity in published research. What this paper adds to existing knowledge: This study retrospectively compared dosage and intensity conditions of intervention provided twice per week to intervention provided once per week. Both dose frequencies could be delivered in clinical settings.Results from this study were analysed by grouping data from multiple testing points, rather than comparing pre‐post results. This approach demonstrated the variability of individual performance that would otherwise be lost with conventional methods of analysis.This study demonstrated that all past tense allomorphs improve to a similar degree when treated with this intervention. What are the potential or actual clinical implications of this work?: Parameters of dosage and intensity are still not clearly defined well enough for translation to clinical practice. In consideration of current research, this intervention may be more effective if delivered twice per week.If clinicians are treating past tense, all allomorphs should be considered as priorities for intervention targets. [ABSTRACT FROM AUTHOR]

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

Background: Moral distress is recognized as an international problem that contributes to decreased work productivity, job dissatisfaction and intent to leave for adult Critical Care nurses. Aim: To explore Critical Care nurses moral distress levels using the Moral Distress Scale Revised (MDS‐R) and its relationship with intention to stay. The study reported in this paper was part of a larger study that also investigated Critical Care nurses' work environment in Canada and the Midlands region of the UK. Study design: During January to August 2017 a cross‐sectional survey was distributed to adult Critical Care nurses in the Midlands region of the UK. Methods: Surveys were distributed to adult Critical Care Registered Nurses in the Midlands region of the UK examining moral distress levels and intention to stay in Critical Care, the organization (NHS Trust) and in the nursing profession. Results: Two hundred sixty‐six number of a potential sample of 1066 Critical Care nurses completed the survey (25% response rate). Age and moral distress were significantly positively correlated with intention to stay on their current unit (r = 0.16, P =.05), indicating older nurses were more likely to stay in the critical care unit. Moral distress was negatively correlated with intent to stay scores, showing critical care nurses with higher levels of moral distress were less likely to stay on their unit (r = −0.20, P =.02). Moral distress was also significantly negatively correlated with intention to stay with their current employer (r = −0.28, P <.001). Nurses that stated they had high rates of moral distress were more likely to consider leaving their current employer. Conclusion: Moral distress appears to be an issue among adult Critical Care nurses requiring further exploration and development of effective strategies to reduce this phenomenon and stabilize the workforce by reducing turnover. Relevance to clinical practice: By identifying the top causes of moral distress, tools and strategies can be developed to allow the Critical Care nurse to work within an ethically safe clinical environment and reduce the turnover of experienced adult Critical Care nurses. [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]

Objective: The aim of this study was to examine modifiable mediators for socioeconomic disparities in childhood obesity in the United States.Methods: This study used the data of 1,211 mother-child dyads from a US national birth cohort from pregnancy to 6 years post partum. Socioeconomic status was indicated by maternal education (college graduate vs. less) and family income (>185% vs. ≤185% of the poverty line). Single- and multiple-factor mediation analyses were conducted for socioeconomic disparities in childhood obesity at 6 years, adjusting for demographics.Results: The confounder-adjusted relative risk of childhood obesity was 1.79 for low maternal education and 1.42 for low family income. Low-maternal-education-related obesity was individually mediated by maternal preconception BMI (percentage of indirect effect, 8.8%), smoking during pregnancy (7.0%), infant weight gain (14.4%), child sleep duration (11.4%), and TV viewing during weekdays at 6 years (4.9%). Low-family-income-related obesity was mediated by maternal preconception BMI (18.5%), smoking during pregnancy (6.3%), child sleep duration (12.8%), and the home learning environment at 6 years (26.2%). In multiple-mediator analysis, significant mediators together mediated 54.0% of maternal-education-related or 39.4% of family-income-related disparities.Conclusions: Maternal preconception BMI, smoking during pregnancy, infant weight gain, child sleep, TV viewing, and the home learning environment substantially mediated socioeconomic disparities in childhood obesity in the United States. [ABSTRACT FROM AUTHOR]

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

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

Aim: To explore the effects of demographic characteristics, mental workload, and Adversity quotient (AQ) on the job engagement of nurses in East China. Design: A quantitative and cross‐sectional study. Method: The survey collected questionnaire data on mental workload, adversity quotient, and job engagement from 473 nurses selected working in 12 Grade‐A tertiary hospitals based on informed consent in East China between July 2020 and March 2021. Results: The total score of mental workload was 78.24 ± 11.65, the adversity quotient score was 128.26 ± 15.84, job engagement score was 42.32 ± 7.79. Job engagement has a remarkable positive correlation with adversity quotient (r = 0.613, p<0.001), and a negative correlation with mental workload (r = −0.499, p<0.001). Mental workload has an apparent negative correlation with adversity quotient (r = −0.291, p<0.001). Labor‐management relationship with current organization, department, study to get a degree or diploma in spare time, attitude towards a career in Nursing, attitude towards the current career position, satisfaction with marriage, social support, load feelings, self‐assessment, control, and endurance could predict 70.9% of job engagement of nurses. Conclusions: The mental workload of nurses was higher, the AQ was at a medium level, and the job engagement of nurses was also slightly higher. Labor‐management relationship with current organization, department, study to get a degree or diploma in spare time, attitude towards a career in Nursing, attitude towards the current career position, satisfaction with marriage, social support, load feelings, self‐assessment, control, and endurance had predictive effects on nurses' job engagement. It is necessary to take a variety of measures according to the social‐demographic characteristics, improve the adversity quotient, and evaluate the mental workload correctly, to improve the job engagement of nurses. Impact: The epidemic situation and other emergencies make the work pressure of nurses in Grade‐A tertiary hospitals increase suddenly. It should pay attention to the influence of different demographic factors, and pay attention to the correct guidance of work demand‐mental workload, as well as the cultivation, and improvement of job resource‐AQ, which can improve the job engagement of nurses to some extent. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Value chain interventions have become widespread throughout the international development sector over the last 20 years, and there is a need to evaluate their effectiveness in improving women's welfare across multiple dimensions. Agricultural value chains are influenced by socio‐cultural norms and gender dynamics that have an impact on the distribution of resources, benefits, and access to opportunities. While women play a critical role in agriculture, they are generally confined to the least‐valued parts of the value chain with the lowest economic returns, depending on the local, social and institutional contexts. Objectives: The review assesses the effectiveness of approaches, strategies and interventions focused on women's engagement in agricultural value chains that lead to women's economic empowerment in low‐ and middle‐income countries. It explores the contextual barriers and facilitators that determine women's participation in value chains and ultimately impact their effectiveness. Search Methods: We searched completed and on‐going studies from Scopus, Web of Science Core Collection (Social Sciences Citation Index [SSCI], Science Citation Index Expanded [SCI‐EXPANDED], Conference Proceedings Citation Index – Science [CPCI‐S], Conference Proceedings Citation Index – Social Science & Humanities [CPCI‐SSH], and Emerging Sources Citation Index [ESCI]), International Bibliography of the Social Sciences, EconLit, Business Source Premier, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane, Database of Systematic Reviews, CAB Abstracts and Sociological Abstracts. We also searched relevant websites such as Consortium of International Agricultural Research Centers (CGIAR); the International Fund for Agricultural Development (IFAD); AgriProFocus; the Bill & Melinda Gates Foundation (BMGF); Donor Committee for Enterprise Development; the UN Food and Agriculture Organisation (FAO); the International Labour Organisation (ILO); the Netherlands Development Organisation; USAID; the Swiss Agency for Development and Cooperation; the International Food Policy Research Institute; World Agroforestry; the International Livestock Research Institute; the Foreign, Commonwealth & Development Office; the British Library for Development Studies (BLDS); AGRIS; the IMMANA grant database; the 3ie impact evaluation database; Innovations for Poverty Action (IPA); The Abdul Latif Jameel Poverty Action Lab (J‐PAL); the World Bank IEG evaluations; the USAID Development Data Library; Experience Clearinghouse; the proceedings of the Agriculture, Nutrition and Health Academy conference; the proceedings of the Centre for the Study of African Economies (CSAE) Conference; the proceedings of the North East Universities Development Consortium (NEUDC) Conference; and the World Bank Economic Review. The database search was conducted in March 2022, and the website search was completed in August 2022. Selection Criteria: The review includes value chain interventions evaluating the economic empowerment outcomes. The review includes effectiveness studies (experimental and non‐experimental studies with a comparison group) and process evaluations. Data Collection and Analysis: Two review authors independently assessed studies for inclusion, extracted data, critically appraised the studies, and synthesised findings. Results: We found that value chain interventions are successful in improving the economic conditions of their intended beneficiaries. The interventions were found to improve women's economic outcomes such as income, assets holdings, productivity, and savings, but these effects were small in size and limited by low confidence in methodological quality. The meta‐analysis suggests that this occurs more via the acquisition of skills and improved inputs, rather than through improvement in access to profitable markets. The qualitative evidence on interventions points to the persistence of cultural barriers and other constraints. Those interventions implemented in Sub‐Saharan Africa and South Asia are consistently more successful for all outcomes considered, although there are few studies conducted in other areas of the world. Conclusions: The review concludes that value chain interventions empower women, but perhaps to a lesser extent than expected. Economic empowerment does not immediately translate into empowerment within families and communities. Interventions should either moderate their expectations of empowerment goals, or they should be implemented in a way that ensures higher rates of participation among women and the acquisition of greater decision‐making power. [ABSTRACT FROM AUTHOR]

Background: Early plasma transfusion is life-saving for bleeding trauma patients. Freeze-dried plasma (FDP) provides unique formulation advantages for infusion in the prehospital setting. We describe characterization and clinical safety data of the first, next-generation FDP stored in plastic bags with rapid reconstitution.Study Design and Methods: Coagulation and chemistry parameters on 155 pairs of fresh frozen plasma (FFP) and their derivative FDP units were compared. Next, a first-in-human, dose-escalation safety evaluation of FDP, involving 24 healthy volunteers who donated either whole blood or apheresis plasma to create autologous FDP, was performed in three dose cohorts (270, 540, and 810 ml) and adverse events (AEs) were monitored. Cohort 3 was randomized, double-blind with a cross-over arm that compared FDP versus FFP using descriptive analysis for AEs, coagulation, hematology, and chemistry parameters.Results: FDP coagulation factors, clotting times, and product quality (pH, total protein, and osmolality) post-lyophilization were preserved. FDP infusions, of up to 810 ml per subject, were found to be safe and with no serious AEs (SAEs) related to FDP. The average time to reconstitute FDP was 67 s (range: 43-106). No differences in coagulation parameters or thrombin activation were detected in subjects infused with 810 ml of FDP compared with FFP.Conclusion: This first next-generation FDP product preserves the potency and safety of FFP in a novel rugged, compressible, plastic container, for rapid transfusion, allowing rapid access to plasma in resuscitation protocols for therapy in acute traumatic hemorrhage. [ABSTRACT FROM AUTHOR]

Background: To elucidate the treatment and surgery outcomes with or without perioperative therapies in Japanese patients with clinical stage III non‐small cell lung cancer (NSCLC) in real‐world settings. Methods: We performed subset analyses of the SOLUTION study, a multicenter, noninterventional, observational study of Japanese patients diagnosed with clinical stage III NSCLC, for those who started first‐line treatment (surgery±perioperative therapy) between January 2013 and December 2014 (study registration: UMIN000031385). Follow‐up data were obtained using medical records from diagnosis to March 1, 2018. Results: Of 149 eligible patients, 67 underwent surgery alone (median age 71 years) and 82 underwent surgery+perioperative therapy (median age 63 years). Lung resection was performed in 137 patients and the others underwent exploratory thoracotomy or other procedures. Perioperative therapies included adjuvant therapy only (n = 41), neoadjuvant therapy only (n = 24), and neoadjuvant+adjuvant therapy (n = 17). The median overall survival (OS) and 3‐year OS rate were 29.3 months and 44.0%, respectively, in patients who underwent surgery alone, and not reached and 61.1%, respectively, in patients who underwent surgery+perioperative therapy. The 3‐year progression‐free survival (PFS) and disease‐free survival (DFS) rates were 42.4% and 47.1%, respectively, in patients who underwent surgery+perioperative therapy and 28.5% and 28.9%, respectively, in patients who underwent surgery alone. In multivariable Cox regression, perioperative therapy was associated with improved OS (hazard ratio [95% confidence interval] 0.49 [0.29–0.81]), PFS (0.62 [0.39–0.96]), and DFS (0.62 [0.39–0.97]) versus surgery alone. Conclusions: Our study suggested that perioperative therapy may be associated with better survival among patients undergoing surgical treatment of clinical stage III NSCLC. [ABSTRACT FROM AUTHOR]

We aimed to describe how breastfeeding relates to adherence to complementary feeding (CF) recommendations, diet diversification and feeding skills development and whether sociodemographic factors explain any differences observed. The Scottish Maternal Infant and Nutrition Survey for infants aged 8–12 months collected breastfeeding history, CF practices, diet and sociodemographic data using a self‐completion questionnaire. Non‐healthful CF practices were starting CF < 6 months, any consumption of sugar‐sweetened beverages (SSBs), sweet or salty snacks (treats) or unmodified cow's milk and regular consumption of commercial baby foods. Diet diversification and feeding skills were assessed by amount of self‐feeding and number of food groups, meals and snacks eaten daily. Of the 2730 mothers, 20% were solely infant formula fed (IFF) and 48% continued breastfeeding ≥6 months. Compared to IFF babies, mothers who gave any breast milk ≥6 months were more likely to start CF ≥ 6 months compared to those IFF (66% vs. 37%) and less likely to give treats (15% vs. 45%), SSBs (11% vs. 20%) and commercial baby foods (31% vs. 53%). These associations remained highly significant (p < 0.001) even after sociodemographic factor adjustment. Despite starting CF later, infants breastfed ≥6 months ate the same number of food groups and meals as those IFF, were just as likely to self‐feed purees and more likely to self‐feed finger foods daily (87% vs. 81% p < 0.001). Mothers who breastfeed beyond 6 months adhere more to CF recommendations and start CF later compared to IFF, but their babies eat a similarly diverse diet and have similar feeding skills. Key messages: Adhering to breastfeeding recommendations is associated with delayed introduction of complementary foods, without influencing diet diversity or development of infant feeding skills.Breastfeeding duration is a predictor for healthful complementary feeding practices.These associations between breastfeeding duration and healthful complementary feeding practices are not explained by differences in maternal age or deprivation level. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the psychometric properties of the Advance Care Planning Readiness Scale (ACPRS‐C) within the context of community‐dwelling older adults with chronic diseases residing in suburban counties in China. Design: Descriptive, cross‐sectional survey. Method s : The research method employed in this study is characterized as a methodological study. Self‐reported survey data were collected among community‐dwelling older adults with chronic diseases residing in suburban counties in China. Including the following psychometric characteristics, item analysis was performed using the decision value method and Pearson's correlation analysis. Content validity was assessed through expert panel evaluation. The internal consistency of the questionnaire was determined by calculating Cronbach's alpha coefficient and corrected item‐total correlation. Additionally, confirmatory factor analysis (CFA) was utilized to assess the construct validity of the ACPRS‐C. Results: A total of 228 older adults participated in this psychometric study from August to October 2023. The item content validity index ranged from 0.80 to 1.00, while the scale content validity index was 0.945. The scale demonstrated excellent internal consistency (Cronbach's alpha = 0.931), and the correlation between items and total score was satisfactory. The structural validity was deemed robust (CFA model fit: chi‐square/df = 1.121, comparative fit index = 0.992). Conclusion: The ACPRS‐C is a scale with strong psychometric properties to assess the ACP readiness within the context of community‐dwelling older adults with chronic diseases residing in suburban counties in China. Its reliability and validity hold considerable significance for both research and clinical practice. [ABSTRACT FROM AUTHOR]

As the incidence of diabetic foot ulcers (DFU) increases, better treatments that improve healing should reduce complications of these ulcers including infections and amputations. We conducted a randomized controlled trial comparing outcomes between a novel purified reconstituted bilayer membrane (PRBM) to the standard of care (SOC) in the treatment of non‐healing DFUs. This study included 105 patients who were randomized to either of two treatment groups (n = 54 PRBM; n = 51 SOC) in the intent to treat (ITT) group and 80 who completed the study per protocol (PP) (n = 47 PRBM; n = 33 SOC). The primary endpoint was the percentage of wounds closed after 12 weeks. Secondary outcomes included percent area reduction, time to healing, quality of life, and cost to closure. The DFUs that had been treated with PRBM healed at a higher rate than those treated with SOC (ITT: 83% vs. 45%, p = 0.00004, PP: 92% vs. 67%, p = 0.005). Wounds treated with PRBM also healed significantly faster than those treated with SOC with a mean of 42 versus 62 days for SOC (p = 0.00074) and achieved a mean wound area reduction within 12 weeks of 94% versus 51% for SOC (p = 0.0023). There were no adverse events or serious adverse events that were related to either the PRBM or the SOC. In comparison to the SOC, DFUs healed faster when treated with PRBM. Thus, the use of this PRBM is an effective option for the treatment of chronic DFUs. [ABSTRACT FROM AUTHOR]

Resistance exercise training is effective to counteract the adverse effects of androgen deprivation therapy (ADT) on body composition, muscle mass and leg strength in prostate cancer patients (PCa). However, it is unknown whether these effects can be autonomously maintained after cessation of the supervised program. Sixty‐eight PCa patients on ADT were included. The exercise intervention group (EX, n = 37) performed 20 weeks of supervised resistance exercise training. Thereafter, patients were advised to autonomously continue exercise training. The control group (CON, n = 31) only received usual care. Outcome measures were compared between baseline and after 1 year. Changes during the intervention (baseline vs. 20 weeks) and follow‐up period (20 weeks vs. 1 year) were descriptively explored. In EX, 83% reported to have continued exercise training themselves. After 1 year, fat mass gains were attenuated in EX compared to CON (1.2 ± 2.6 and 2.8 ± 1.9 kg, respectively; time × treatment effect p = 0.032). The fat percentage increased, and lean mass and quadriceps muscle cross‐sectional area decreased over time, with no differences between groups (overall 1.6 ± 2.1%, −0.7 ± 2.3 kg and −2.2 ± 2.9 cm2, respectively; time effects, all p < 0.05). For muscle strength, an increase of ∼5% in EX was observed, significantly different from the ∼10% decrease in CON (p < 0.001). Subsequent analyses showed that the initial exercise training‐obtained gains in lean mass, muscle mass and strength in EX compared to CON, declined during the follow‐up period. In conclusion, PCa patients on ADT are not capable to autonomously maintain the exercise‐obtained gains of a 20‐week supervised training program over a subsequent 1‐year period. Highlights: ADT for prostate cancer results in many side effects, including muscle mass lossA supervised resistance exercise training program can counteract many side effectsAfter cessation of the supervised program, exercise benefits are not effectively preservedMore focus on sustainability of exercise programs during ADT is required [ABSTRACT FROM AUTHOR]

High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post‐natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post‐natal social context, infant feeding method and post‐natal emotional well‐being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post‐natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post‐natal anxiety score. While guilt acted as mediator of infant feeding method to increase post‐natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed. Key messages: Guilt and shame are empirically evidenced as distinct, overlapping concepts: guilt is more behaviour‐orientated, while shame is more social context‐orientated.Guilt and shame both predict postnatal depression and anxiety, supporting their conceptualisation as transdiagnostic phenomena.While guilt acts indirectly through one's social context and infant feeding method to increase depression and anxiety, shame acts independently of infant feeding method. General definitions of guilt and shame are thus deemed transferable to an infant feeding context.Recommendations are made to address issues regarding perceived insufficient healthcare professional support and pressure to breastfeed, so to improve postnatal wellbeing and extend any breastfeeding continuation. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore and describe the barriers affecting Registered Nurses in undertaking clinical teaching in clinical settings. The exploration was based on the experiences of Registered Nurses at a selected teaching hospital in Namibia. The researcher intended to identify strategies that could be used to mitigate the negative effects of barriers to effective clinical teaching. Design: A qualitative explorative, descriptive and contextual research design was used. Methods: Purposive sampling was used to select 16 participants. Data were collected through in‐depth, semi‐structured interviews, which were audio‐recorded and transcribed verbatim. Data were analysed using thematic analysis. Results: Clinical teaching is negatively affected by several barriers that hamper clinical teaching and nursing students' learning outcomes. Seven main themes were identified: (1) participants' understanding of clinical teaching; (2) organizational barriers; (3) patient barriers; (4) Registered Nurse barriers; (5) student barriers; (6) training institution barriers; and (7) strategies to mitigate barriers to clinical teaching. Conclusion: The findings revealed that several barriers negatively affect clinical nursing education and hamper the clinical teaching and learning of nursing students. Patient or Public Contribution: This study may assist in the development of targeted interventions that address the barriers that hinder clinical teaching at teaching hospitals. Additionally, this study could assist in improving the health care that is provided by nursing students to patients. The findings may assist with improved quality by reducing nursing students' theory‐practice gap and by promoting collaboration between Registered Nurses and nurse educators in clinical settings. [ABSTRACT FROM AUTHOR]

A novel autologous heterogeneous skin construct (AHSC) was previously shown to be effective versus standard of care (SOC) treatment in facilitating complete wound healing of Wagner 1 diabetic foot ulcers in an interim analysis of 50 patients previously published. We now report the final analysis of 100 patients (50 per group), which further supports the interim analysis findings. Forty‐five subjects in the AHSC treatment group received only one application of the autologous heterogeneous skin construct, and five received two applications. For the primary endpoint at 12 weeks, there were significantly more diabetic wounds closed in the AHSC treatment group (35/50, 70%) than in the SOC control group (17/50, 34%) (p = 0.00032). A significant difference in percentage area reduction between groups was also demonstrated over 8 weeks (p = 0.009). Forty‐nine subjects experienced 148 adverse events: 66 occurred in 21 subjects (42%) in the AHSC treatment group versus 82 in 28 SOC control group subjects (56.0%). Eight subjects were withdrawn due to serious adverse events. Autologous heterogeneous skin construct was shown to be an effective adjunctive therapy for healing Wagner 1 diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

To evaluate the status of a 7‐month phase 3 study conducted to test the effect of intramuscular injections of VM202 (ENGENSIS), a plasmid DNA encoding human hepatocyte growth factor, into the calf muscles of chronic nonhealing diabetic foot ulcers with concomitant peripheral artery disease. The phase 3 study, originally aimed to recruit 300 subjects, was discontinued because of slow patient recruitment. An unprespecified interim analysis was performed for the 44 subjects enrolled to assess the status and determine the future direction. Statistical analyses were carried out for the Intent‐to‐Treat (ITT) population and separately for subjects with neuroischemic ulcers, using a t‐test and Fisher's exact test. A logistic regression analysis was also conducted. VM202 was safe and potentially should have benefits. In the ITT population (N = 44), there was a positive trend toward closure in the VM202 group from 3 to 6 months but with no statistical significance. Levels of ulcer volume or area were found to be highly skewed between the placebo and VM202 groups. Forty subjects, excluding four outliers in both arms, showed significant wound‐closing effects at month 6 (P =.0457). In 23 patients with neuroischemic ulcers, the percentage of subjects reaching complete ulcer closure was significantly higher in the VM202 group at months 3, 4, and 5 (P =.0391,.0391, and.0361). When two outliers were excluded, a significant difference was evident in months 3, 4, 5, and 6 (P =.03 for all points). A potentially clinically meaningful 0.15 increase in Ankle‐Brachial Index was observed in the VM202 group at day 210 in the ITT population (P =.0776). Intramuscular injections of VM202 plasmid DNA to calf muscle may have promise in the treatment of chronic neuroischemic diabetic foot ulcers (DFUs). Given the safety profile and potential healing effects, continuing a larger DFU study is warranted with modifications of the current protocol and expansion of enrolling sites. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to refine the Falling Risk Assessment Tool in Ophthalmology Inpatients (FRAT) and assess its psychometric properties. Design: A cross‐sectional design was used. Methods: A convenience sample of 730 patients in the ophthalmology department was recruited in a level A tertiary hospital in Guangdong Province from July 2021 to January 2022. Data were analysed using item analysis, interrater reliability, content validation, internal consistency reliability and exploratory factor analysis. Results: Five factors were extracted, accounting for 63.039% of the variance. The interrater reliability of the tool was 0.97. Cronbach's α was 0.658. The I‐CVI was 0.75–1.00, the S‐CVI/UA was 0.95 and the adjusted mean values of Kappa for indicators ranged from 0.72 to 1.00, as evaluated by the expert group. The FRAT showed satisfactory reliability and validity, and can be used to measure the fall risk assessment in ophthalmology inpatients. Patient or Public Contribution: After explaining the purpose, the patients received our fall risk assessment and answered the corresponding questionnaire questions. [ABSTRACT FROM AUTHOR]

Background: Different instruments were devised for assessing emotional development (ED) level in persons with an intellectual disability (ID), that is, the Scale of Emotional Development – Short (SED‐S), the Scheme for Appraisal of Emotional Development (SAED), the Scale for Emotional Development – Second Revision (SED‐R2) and the Schaal voor Emotionele Ontwikkeling – Lukas (SEO‐Lukas). The aim of this study was to compare the level of emotional functioning as assessed with the SED‐S with the SAED, SED‐R2 and SEO‐Lukas. Methods: Emotional development was measured in adults with ID with the SED‐S (N = 186) and the SAED (n = 85), the SED‐R2 (n = 50) and the SEO‐Lukas (n = 51). Correlation analysis and Cohen's kappas were calculated between the SED‐S and the three respective scales. Internal consistencies (Cronbach's alpha) of the four scales were determined. Results: The SED‐S results correlated most with the SEO‐Lukas (γ = 1; кω = 0.936) followed by the SAED (γ = 0.809; кω = 0.343) and least by the SED‐R2 (γ = 0.665; кω = 0.182). The stage of ED assessed with the SED‐S was lower than the ED results measured with the SAED, but higher than with the SED‐R2 and most similar to the SEO‐Lukas. Cronbach's alphas were high, ranging from 0.853 to 0.975. Conclusions: Given the respective differences between the scales, the SED‐S may equalise the results as compared with previous versions. [ABSTRACT FROM AUTHOR]

Background: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. Methods: This is a cross‐sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann–Whitney or Pearson's chi‐squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal–Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. Results: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0–30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high‐quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302–2.729) and 1.566 (95% CI = 1.097–2.235), as well as physical activity of 1.391 (95% CI = 1.107–1.749) and 1.346 (95% CI = 1.086–1.667), respectively. In addition, associations were observed between diet quality and region of residence. Conclusions: A low‐quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country. Key points: A better diet quality was observed for individuals who practiced physical activity, with a medium or high family income, as well as for individuals residing in the Northeast region of Brazil. By contrast, poor diet quality was observed in individuals residing in the South Region. When analysing the level of education, the increase in the consumption of vegetables, whole grains and fruits was associated with education, being higher for those with 13 years or more of study (p = 0.047; p = 0.012) and 9–12 years of study (p = 0.008), respectively, compared to those who studied up to 8 years. These findings are relevant to understanding the factors that may be associated with diet quality in different regions of the country. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to investigate how the COVID‐19 pandemic since 2020 has affected the homeostasis model assessment of insulin resistance (HOMA‐IR), body mass index (BMI) and degree of obesity among Japanese children. HOMA‐IR, BMI and degree of obesity were calculated for 378 children 14–15 years old (boys/girls, 208/170) who underwent checkups during 2015–2021. Changes in these parameters over time and correlations between parameters were assessed, and the proportions of participants with IR (HOMA‐IR ≥2.5) were compared. HOMA‐IR values increased significantly over the study period (p < 0.001), with a significantly large proportion of participants with IR in 2020–2021 (p < 0.001). Conversely, BMI and degree of obesity did not change significantly. HOMA‐IR did not correlate with BMI or degree of obesity during 2020–2021. In conclusion, the COVID‐19 pandemic may have had an impact on the increase in the proportion of children with IR, regardless of BMI or degree of obesity. [ABSTRACT FROM AUTHOR]

Current health policy, high‐profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop an in‐depth exploratory narrative, expressed through the voices of the participants. Data collection involved in‐depth face‐to‐face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential–phenomenological approach is demonstrated. [ABSTRACT FROM AUTHOR]

Aim: To assess the psychometric properties of the Arabic version of the Diabetes Self‐Efficacy Scale (A‐DSES). Design: This study used a cross‐sectional design. Methods: This study recruited 154 Saudi adults with type 2 diabetes at two primary healthcare centres in Riyadh, Saudi Arabia. Its instruments were the Diabetes Self‐Efficacy Scale and the Diabetes Self‐Management Questionnaire. The psychometric properties of the A‐DSES were assessed for reliability, including internal consistency and validity using exploratory factor analysis, confirmatory factor analysis and criterion validity. Results: The item‐total correlation coefficients were >0.30 for all items, ranging from 0.46 to 0.70. The Cronbach's alpha for internal consistency was 0.86. One factor was extracted from the exploratory factor analysis (self‐efficacy for diabetes self‐management), and the one‐factor model showed an acceptable fit to the data in the confirmatory factor analysis. Diabetes self‐efficacy levels were positively correlated with diabetes self‐management skills (r = 0.40, p < 0.001), indicating criterion validity. Conclusions: The results indicate that the A‐DSES is a reliable and valid instrument for assessing self‐efficacy related to diabetes self‐management. Relevance to Clinical Practice: The A‐DSES could be used in clinical practice and research to provide a reference for assessing self‐efficacy levels in areas of diabetes self‐management. No Patient or Public Contribution: Participants were not involved in the design, conduct, reporting or dissemination plans of this research. [ABSTRACT FROM AUTHOR]

Focused ultrasound can be used to rapidly diagnose COVID‐19 disease, assess disease severity, and inform management of COVID‐19 and associated pathologies, reducing radiation exposure from other imaging modalities and minimizing spread of infection. Ultrasound examinations performed by trained nurses in the intensive care unit (ICU) enable more patients to receive these assessments. This case series evaluates the use of nurse‐led focused cardiac and lung ultrasound for clinical management of ICU patients with COVID‐19. We describe common pathophysiological findings and how findings were used to inform clinical decision‐making. An ultrasound trained ICU nurse performed Focused Ultrasound in Intensive Care (FUSIC) cardiac and lung scans enabling calculation of a lung severity score on adult ICU patients with a confirmed COVID‐19 diagnosis in a single‐centre setting. Fifteen scans were performed on 15 patients. Thirteen (87%) patients had normal left ventricular function; 12 (80%) normal right ventricular function. All 15 (100%) scans identified abnormal lung findings including irregular thickened pleura, B‐lines, sub‐pleural consolidation and hepatization. Worse lung severity scores were correlated with higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores (r = 0.70; p =.003). Of the 15 scans, 10 (67%) identified abnormal pathology contributing to a change in clinical management. This included targeted fluid removal (4, 27%), change in respiratory management (3, 20%) and need for formal echocardiographic assessment (3, 20%). Findings from five (33%) scans required no intervention. This case series demonstrates nurse‐led ultrasound could be a useful adjunct in the management of the COVID‐19 patient. [ABSTRACT FROM AUTHOR]

Introduction: The role that preprocedural factors have on atrioventricular synchrony (AVS) provided by leadless pacemakers requires investigation. Methods and Results: We aimed to assess the correlation between mitral inflow echocardiographic parameters and p‐wave morphology with the accelerometer A4 signal amplitude. We also sought to identify clinical and echocardiographic predictors of optimal ambulatory AVS (≥85% of cardiac cycles). Forty‐three patients undergoing Micra AV implant from June 2020 to March 2023 were prospectively enrolled. Baseline echocardiogram and 12‐lead resting ECG were performed. Device follow‐up was scheduled at 24 h, 1, 3, and 6 months and yearly after the implant. Ambulatory AVS was studied with a 24 h Holter monitor performed at 3 months follow‐up in 35 patients who remained in VDD mode. A4 signal amplitude at 1 month correlated to peak A wave velocity (r =.376; p =.024) at echocardiogram, but no relationship was found with peak A' wave velocity, E/A, or E'/A' ratio. P‐wave amplitude in lead I and aVF correlated to A4 signal amplitude at 1‐ and 3‐months follow‐up, respectively. Median AVS during 24 h of daily activities was 85.6 ± 7.6% and remained stable up to 100 bpm. Twenty‐three out of 35 patients (65.7%) reached optimal ambulatory AVS. There was no association between mitral inflow echocardiographic parameters and optimal AVS. Diabetes (OR: 0.05, 95% CI: 0.01−0.47; p =.009) and chronic obstructive pulmonary disease (COPD) (OR: 0.06, 95% CI: 0.01−0.63; p =.019) strongly predicted ambulatory AVS <85%. Conclusions: Diabetes and COPD should be considered when selecting candidates for Micra AV. Measurements of pulsed wave Doppler mitral inflow do not systematically reflect the behavior of the A4 signal amplitude. [ABSTRACT FROM AUTHOR]

The 31‐item Practice Environment Scale of the Nursing Work Index (PES‐NWI) has been frequently used globally to measure the nurse work environment. However, due to its length and subsequent respondent burden, a more parsimonious version of the PES‐NWI may be desirable. Item response theory (IRT) is a statistical technique that assists in decreasing the number of items in an instrument without sacrificing reliability and validity. Two separate samples of nurses in the United States (one called the "internal data source" and the other called "external data source"; sample sizes = 843 and 722, respectively) were analyzed. The internal data source was randomly split into training (n = 531) and validating data sets (n = 312), while a separate whole external data source was used as the final validating data set. Using IRT with training data, we removed nine items; two additional items were removed based on recommendations from a previous study. Confirmatory factor analyses supported the validity of the measurement model with the 20‐item of PES‐NWI in both internal and external validation data sources. The correlations among subscales between 31‐ and 20‐item versions were high magnitude for five subscales in both validation data sets (τ = 0.84–0.89). Ultimately, we identified a 20‐item version of the PES‐NWI which demonstrated adequate validity and reliability properties while decreasing data collection burden yet maintaining a similar factor structure to the original instrument. Additional research may be necessary to update the items themselves on the PES‐NWI. NO PATIENT OR PUBLIC CONTRIBUTION: Patients were not involved in setting the research question, the outcome measures, the design, or implementation of the study. [ABSTRACT FROM AUTHOR]

Introduction: Improved sinus rhythm (SR) maintenance rates have been achieved in patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation plus additional ablation of low voltage substrate (LVS) during SR. However, voltage mapping during SR may be hindered in persistent and long‐persistent AF patients by immediate AF recurrence after electrical cardioversion. We assess correlations between LVS extent and location during SR and AF, aiming to identify regional voltage thresholds for rhythm‐independent delineation/detection of LVS areas. (1) Identification of voltage dissimilarities between mapping in SR and AF. (2) Identification of regional voltage thresholds that improve cross‐rhythm substrate detection. (3) Comparison of LVS between SR and native versus induced AF. Methods: Forty‐one ablation‐naive persistent AF patients underwent high‐definition (1 mm electrodes; >1200 left atrial (LA) mapping sites per rhythm) voltage mapping in SR and AF. Global and regional voltage thresholds in AF were identified which best match LVS < 0.5 mV and <1.0 mV in SR. Additionally, the correlation between SR‐LVS with induced versus native AF‐LVS was assessed. Results: Substantial voltage differences (median: 0.52, interquartile range: 0.33–0.69, maximum: 1.19 mV) with a predominance of the posterior/inferior LA wall exist between the rhythms. An AF threshold of 0.34 mV for the entire left atrium provides an accuracy, sensitivity and specificity of 69%, 67%, and 69% to identify SR‐LVS < 0.5 mV, respectively. Lower thresholds for the posterior wall (0.27 mV) and inferior wall (0.3 mV) result in higher spatial concordance to SR‐LVS (4% and 7% increase). Concordance with SR‐LVS was higher for induced AF compared to native AF (area under the curve[AUC]: 0.80 vs. 0.73). AF‐LVS < 0.5 mV corresponds to SR‐LVS < 0.97 mV (AUC: 0.73). Conclusion: Although the proposed region‐specific voltage thresholds during AF improve the consistency of LVS identification as determined during SR, the concordance in LVS between SR and AF remains moderate, with larger LVS detection during AF. Voltage‐based substrate ablation should preferentially be performed during SR to limit the amount of ablated atrial myocardium. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to qualitatively explore the food choice determinants of both Chinese immigrants living in Australia and Chinese people living in mainland China. Methods: Eight Chinese Australian participants (female, n = 5; male, n = 3) and ten mainland Chinese participants (female, n = 5; male, n = 5) were recruited from Australia (primarily in Melbourne, Victoria) and China (predominantly in Zhengzhou, Henan province) between June 2021 and March 2022. Participants were diverse in age, socio‐economic background, occupation and health status. Semi‐structured in‐depth interviews were conducted in Mandarin either face‐to‐face or using online video/voice calls. Interviews were audio‐recorded and transcribed verbatim. Investigator triangulation was used to enhance scientific rigour. Results: Four themes were identified: (1) food choice determinants were shaped by traditional and modern nutrition perceptions and personal food philosophy; (2) physiological responses to food provide direct feedback that impacts future food choices; (3) consideration of convenience was a predominant influencer of food choice; and (4) the differences in food environments between China and Australia promoted distinctive food choice determinants for Chinese people. Conclusions: Chinese Australian and mainland Chinese participants' food choices are shaped by traditional Chinese nutrition philosophy, modern Western nutrition science and the contemporary food environment. There are clear cultural characteristics in their food choice determinants that should be considered by health educators, nutrition professionals and nutrition policymakers when developing culturally appropriate health interventions for Chinese people. Key points: This exploratory study identified various influencers of food choice in Chinese population, informing health educators to consider cultural aspects when planning interventions for Chinese communities. [ABSTRACT FROM AUTHOR]

Background: Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid‐term outcome after TLE. Methods: The study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80–94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12–377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA). Results: The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty‐day mortality after TLE was 6%. During a mean time follow‐up of 22 ± 21 months, 24 patients (29%) died. No procedure‐related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87–10.13; p =.001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20–19.48; p <.001), and TLE for systemic infection (HR 4.24; 95% CI 1.69–10.66; p =.002). Conclusions: At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allowreasonable success and safety in octogenarian with long lead dwell time. Patient's age should not influence the decision to extract or not the leads, although the 30‐day and mid‐term mortality are significant, especially in the present of specific comorbidities. [ABSTRACT FROM AUTHOR]

Summary: Background: The limited research assessing relationships between sleep duration and weight status in infants and toddlers relies primarily on parent‐reported sleep and cross‐sectional studies. Objectives: Examine whether average sleep duration and changes in sleep duration among 6‐24‐month‐old children were associated with weight‐for‐length z‐scores, and whether these associations varied by race/ethnicity, socioeconomic status and sex. Methods: Data were collected when children were approximately 6, 12, 18 and 24 months old (N = 116). Sleep duration was measured using actigraphy. Weight‐for‐length z‐scores were calculated using children's height and weight. Physical activity was assessed using accelerometry. Diet was assessed using a feeding frequency questionnaire. Demographic characteristics included sex, race/ethnicity and socioeconomic status. Separate associations of between‐ and within‐person changes in sleep duration were estimated with weight‐for‐length z‐score treated as the outcome variable in linear mixed model analyses. Additional models were assessed that included interactions between sleep and demographic characteristics. Results: At time points where children slept longer at night compared to their own average, their weight‐for‐length z‐score was lower. This relationship was attenuated by physical activity levels. Conclusions: Increasing sleep duration can improve weight status outcomes in very young children who have low physical activity levels. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Childhood obesity increases risk factors related to metabolic diseases. Watermelon's bioactive components can help reduce these risk factors. However, no study has investigated the effects of whole watermelon including both the flesh and rind or have assessed the impacts of any form of watermelon on children with overweight or obesity. The goal of this study was to examine the effects of whole‐blenderized watermelon (BWM) consumption on cardiometabolic risk factors. Methods: A randomized, cross‐over clinical design was implemented. Boys and girls ages 10–17 years with overweight or obesity (BMI ≥ 85th percentile) consumed one cup of BWM or an isocaloric sugar‐sweetened beverage (control) every day for 8 weeks with a 4‐week washout between trials. Anthropometrics, dietary, biochemical and clinical measures were obtained before and at the end of each trial. Results: A total of 17 participants completed the study. Eight weeks of BWM intake significantly decreased BMI (p = 0.032), BMI percentile (BMIP) (p = 0.038), body fat percentage (p = 0.036), and haemoglobin A1c (HbA1c) (p = 0.012) compared to the sugar‐sweetened beverage. Sugar‐sweetened beverage consumption increased BMIP (p = 0.014) compared to baseline. No significant differences were observed for inflammation, blood glucose, insulin, lipids, liver function enzymes, and satiety hormones. Conclusions: The results support that BWM consumption improved some cardiometabolic risk factors including BMI, BMIP, body fat, and HbA1c. Watermelon is a potential alternative to unhealthful snacks for improving anthropometry and some risk factors related to obesity in children. [ABSTRACT FROM AUTHOR]

Bibliometric‐enhanced information retrieval uses bibliometrics (e.g., citations) to improve ranking algorithms. Using a data‐driven approach, this article describes the development of a bibliometric‐enhanced ranking algorithm for legal information retrieval, and the evaluation thereof. We statistically analyze the correlation between usage of documents and citations over time, using data from a commercial legal search engine. We then propose a bibliometric boost function that combines usage of documents with citation counts. The core of this function is an impact variable based on usage and citations that increases in influence as citations and usage counts become more reliable over time. We evaluate our ranking function by comparing search sessions before and after the introduction of the new ranking in the search engine. Using a cost model applied to 129,571 sessions before and 143,864 sessions after the intervention, we show that our bibliometric‐enhanced ranking algorithm reduces the time of a search session of legal professionals by 2 to 3% on average for use cases other than known‐item retrieval or updating behavior. Given the high hourly tariff of legal professionals and the limited time they can spend on research, this is expected to lead to increased efficiency, especially for users with extremely long search sessions. [ABSTRACT FROM AUTHOR]

Aims: Aim of the current study was to describe the prevalence, incidence, and severity of diabetes mellitus type 2 (T2D) in a cohort of older men and women aged 60 years and above over the course of on average 7 years, since longitudinal data on this topic are scarce for this age group in Germany. Methods: Baseline data of 1671 participants of the Berlin Aging Study II (BASE‐II; 68.8 ± 3.7 years) and follow‐up data assessed 7.4 ± 1.5 years later were analysed. The BASE‐II is an exploratory, observational study on cross‐sectional and longitudinal data of an older population. T2D was diagnosed based on self‐report, antidiabetic medication use and laboratory parameters. T2D severity was determined by the diabetes complications severity index (DCSI). Prognostic capacity of laboratory parameters was evaluated. Results: The proportion of participants with T2D increased from 12.9% (37.3% women) at baseline to 17.1% (41.1% women) with 74 incident cases and 22.2% not being aware of the disease at follow‐up. The incidence rate is 10.7 new T2D diagnoses per 1000 person‐years. More than half of the 41 newly identified incident T2D cases were diagnosed solely by the 2 h‐plasma glucose test (OGTT) and diagnosis based on OGTT as the only criterion among incident cases was found more frequently in women (p = 0.028). T2D severity expressed by the DCSI significantly increased from baseline to follow‐up (mean DCSI 1.1 ± 1.2 vs. 2.0 ± 1.8; range 0–5 vs. 0–6). Cardiovascular complications had the highest impact (43.2% at baseline and 67.6% at follow‐up). Conclusions: A comprehensive picture of T2D with respect to prevalence, incidence, and severity in older people of the Berlin Aging Study II is provided. [ABSTRACT FROM AUTHOR]

In the machine learning subfield of natural language processing, a topic model is a type of unsupervised method that is used to uncover abstract topics within a corpus of text. Dynamic topic modelling (DTM) is used for capturing change in these topics over time. The study deploys DTM on corpus of electronic health record psychotherapy notes. This retrospective study examines whether DTM helps distinguish closely matched patients that did and did not die by suicide. Cohort consists of United States Department of Veterans Affairs (VA) patients diagnosed with Posttraumatic Stress Disorder (PTSD) between 2004 and 2013. Each case (those who died by suicide during the year following diagnosis) was matched with five controls (those who remained alive) that shared psychotherapists and had similar suicide risk based on VA's suicide prediction algorithm. Cohort was restricted to patients who received psychotherapy for 9+ months after initial PTSD diagnoses (cases = 77; controls = 362). For cases, psychotherapy notes from diagnosis until death were examined. For controls, psychotherapy notes from diagnosis until matched case's death date were examined. A Python‐based DTM algorithm was utilized. Derived topics identified population‐specific themes, including PTSD, psychotherapy, medication, communication and relationships. Control topics changed significantly more over time than case topics. Topic differences highlighted engagement, expressivity and therapeutic alliance. This study strengthens groundwork for deriving population‐specific, psychosocial and time‐sensitive suicide risk variables. [ABSTRACT FROM AUTHOR]