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Effective cognitive learning strategies are beneficial for learning and long-term retention. However, higher education students often rely on surface-level strategies like reading and underlining. Interventions to support effective cognitive strategy use have addressed knowledge, beliefs, planning, and commitment. This latter aspect and its relation with motivation has remained underexposed. Therefore, this study aimed to answer the following research question: What factors contribute to student motivation for effective cognitive strategy use during self-study in higher education? First-year vocational university students participated in focus group discussions (N = 100), and completed a strategy questionnaire (N = 217). Results showed that students used combinations of effective cognitive and surface-level strategies based on successful past experiences. Perceived utility value of strategies for students' performance-oriented goals contributed considerably to motivation, and students reduced perceived costs by combining self-study with non-academic activities. Incorporating these aspects in strategy support could be next steps for future interventions.

This study investigates feature acquisition and feature reassembly associated with Clitic Left Dislocation (CLLD). The article compares the acquisition of CLLD in second language (L2) Italian to L2 Romanian to examine effects of first language (L1) transfer, construction frequency and the type of interface involved (external vs. internal interface) within the same syntactic construction. The results from an acceptability judgment task and a written elicitation task show that while English near-native speakers of Italian/Romanian acquired the L2 constraints on CLLD, which is [+anaphor] for Italian and [+specific] for Romanian, data from both Romanian L2 learners of Italian and Italian L2 learners of Romanian showed persistent L1 transfer effects. Target-like acquisition for these groups requires both grammatical expansion and retraction; Romanian CLLD requires the addition of an L1-unavailable [+specific] feature and the loss of a [+anaphor] feature, while Italian CLLD requires the addition of an L1-unavailable [+anaphor] and the loss of a [+specific] feature. The reported findings extend evidence in favour of the Feature Reassembly Hypothesis to the syntax-discourse interface, as reassembly of interpretational features associated with CLLD proved more difficult than feature acquisition. While learners at the near-native levels were able to broaden the contexts that allow a clitic in the L2 (grammatical expansion), L1 preemption difficulties were attested as well. This was the case regardless of the frequency of the relevant construction in the input and the type of L2 feature that needed to be added/removed.

Abstract In the vicinity of plasmonic nanostructures that support highly confined light fields, spontaneous emission processes, such as two-photon spontaneous emission (TPSE), exhibit higher-order multipolar emission pathways beyond the dipolar one. These multipolar emission channels occur simultaneously and can interfere with each other. We develop a novel framework that computes these interference effects for TPSE of a quantum emitter close to an arbitrary nanostructure. The model is based on the computation of Purcell factors that can be calculated with conventional electromagnetic simulations, which avoids complex analytic calculations for the environment. For a transition of a hydrogen-like emitter close to a graphene nanotriangle, we demonstrate a breakdown of the dipolar selection rule in the TPSE process. This breakdown is due to a huge enhancement of the two-electric dipole (2ED) and of the two-electric quadrupole (2EQ) transitions. We observe an important interference between these multipolar transitions, as it increases the total rate by $$67 \, \%$$ 67 % . In the end, our framework is a complete tool to design emitters and nanostructures for TPSE, where the exploitation of previously ignored interference effects provides an additional degree of freedom, for example to boost desired transitions and to supress undesirable ones.

Abstract To gain insights into the impact of upper limb (UL) dysfunctions after breast cancer treatment, this study aimed to develop a temporal convolutional neural network (TCN) to detect functional daily UL use in breast cancer survivors using data from a wrist-worn accelerometer. A pre-existing dataset of 10 breast cancer survivors was used that contained raw 3-axis acceleration data and simultaneously recorded video data, captured during four daily life activities. The input of our TCN consists of a 3-axis acceleration sequence with a receptive field of 243 samples. The 4 ResNet TCN blocks perform dilated temporal convolutions with a kernel of size 3 and a dilation rate that increases by a factor of 3 after each iteration. Outcomes of interest were functional UL use (minutes) and percentage UL use. We found strong agreement between the video and predicted data for functional UL use (ICC = 0.975) and moderately strong agreement for %UL use (ICC = 0.794). The TCN model overestimated the functional UL use by 0.71 min and 3.06%. Model performance showed good accuracy, f1, and AUPRC scores (0.875, 0.909, 0.954, respectively). In conclusion, using wrist-worn accelerometer data, the TCN model effectively identified functional UL use in daily life among breast cancer survivors.

Objective This study aimed to investigate the efficacy of Bacillus-based probiotics supplemented at two different levels to modulate the productive performance, egg quality, tibia traits, and specific cecal bacteria counts of Hy-Line Brown layers from 25 to 37 weeks of age. Methods A total of 216 twenty-five-week-old hens were randomly distributed into 3 experimental diets with 12 replicates of 6 birds per cage. Diets included basal diet supplemented with 0 (CON), 3×108 (PRO1), or 3×109 (PRO2) colony-forming unit (CFU) of the test probiotic containing Bacillus subtilis PB6, Bacillus subtilis FXA, and Bacillus licheniformis G3 per kilogram of feed. Results Improved egg weights and mass at 29 weeks; and feed intake at 31 weeks (p

Binary feedback, providing information solely about task success or failure, can be sufficient to drive motor learning. While binary feedback can induce explicit adjustments in movement strategy, it remains unclear if this type of feedback also induces implicit learning. We examined this question in a center-out reaching task by gradually moving an invisible reward zone away from a visual target to a final rotation of 7.5° or 25° in a between-group design. Participants received binary feedback, indicating if the movement intersected the reward zone. By the end of the training, both groups modified their reach angle by about 95% of the rotation. We quantified implicit learning by measuring performance in a subsequent no-feedback aftereffect phase, in which participants were told to forgo any adopted movement strategies and reach directly to the visual target. The results showed a small, but robust (2-3°) aftereffect in both groups, highlighting that binary feedback elicits implicit learning. Notably, for both groups, reaches to two flanking generalization targets were biased in the same direction as the aftereffect. This pattern is at odds with the hypothesis that implicit learning is a form of use-dependent learning. Rather, the results suggest that binary feedback can be sufficient to recalibrate a sensorimotor map.

Abstract Objectives This study aimed to evaluate the potential clinical value of a new brain age prediction model as a single interpretable variable representing the condition of our brain. Among many clinical use cases, brain age could be a novel outcome measure to assess the preventive effect of life-style interventions. Methods The REMEMBER study population (N = 742) consisted of cognitively healthy (HC,N = 91), subjective cognitive decline (SCD,N = 65), mild cognitive impairment (MCI,N = 319) and AD dementia (ADD,N = 267) subjects. Automated brain volumetry of global, cortical, and subcortical brain structures computed by the CE-labeled and FDA-cleared software icobrain dm (dementia) was retrospectively extracted from T1-weighted MRI sequences that were acquired during clinical routine at participating memory clinics from the Belgian Dementia Council. The volumetric features, along with sex, were combined into a weighted sum using a linear model, and were used to predict ‘brain age’ and ‘brain predicted age difference’ (BPAD = brain age–chronological age) for every subject. Results MCI and ADD patients showed an increased brain age compared to their chronological age. Overall, brain age outperformed BPAD and chronological age in terms of classification accuracy across the AD spectrum. There was a weak-to-moderate correlation between total MMSE score and both brain age (r = -0.38,p

Abstract Background The proportion of patients with breast cancer and obesity is increasing. While the therapeutic landscape of breast cancer has been expanding, we lack knowledge about the potential differential efficacy of most drugs according to the body mass index (BMI). Here, we conducted a systematic review on recent clinical drug trials to document the dosing regimen of recent drugs, the reporting of BMI and the possible exclusion of patients according to BMI, other adiposity measurements and/or diabetes (leading comorbidity of obesity). We further explored whether treatment efficacy was evaluated according to BMI. Methods A search of Pubmed and ClinicalTrials.gov was performed to identify phase I-IV trials investigating novel systemic breast cancer treatments. Dosing regimens and exclusion based on BMI, adiposity measurements or diabetes, documentation of BMI and subgroup analyses according to BMI were assessed. Results 495 trials evaluating 26 different drugs were included. Most of the drugs (21/26, 81%) were given in a fixed dose independent of patient weight. BMI was an exclusion criterion in 3 out of 495 trials. Patients with diabetes, the leading comorbidity of obesity, were excluded in 67/495 trials (13.5%). Distribution of patients according to BMI was mentioned in 8% of the manuscripts, subgroup analysis was performed in 2 trials. No other measures of adiposity/body composition were mentioned in any of the trials. Retrospective analyses on the impact of BMI were performed in 6 trials. Conclusions Patient adiposity is hardly considered as most novel drug treatments are given in a fixed dose. BMI is generally not reported in recent trials and few secondary analyses are performed. Given the prevalence of patients with obesity and the impact obesity can have on pharmacokinetics and cancer biology, more attention should be given by investigators and study sponsors to reporting patient’s BMI and evaluating its impact on treatment efficacy and toxicity.

Author(s): Mark J. R. Smeets 1,*, Suzanne C. Cannegieter 1,2 We read with great interest how Powell and colleagues in this issue [1] used a trial emulation approach to obtain [...]

Since STEM knowledge and skills are increasingly being sought after in our information and technology driven economies, it is pivotal that ideas and human resources that foster these economies also reflect the STEM population. Although it is evident from earlier research that specific demographics are clearly underrepresented, little is known about who constitutes as 'diverse', which makes it challenging to develop and assess effective policies aimed at increasing diversity in STEM. Through content analysis, we explore in recent STEM education literature, which groups of students and faculty are referenced in relation to diversity, i.e., groups that are underrepresented. The results reveal 180 uniquely defined references to underrepresented groups in STEM. Our main results show that across articles, the majority of the references to diversity are related to gender (69%), and a considerable portion of references (12%) can be classified under 'other unspecified minorities'. Consequently, the analyzed articles portray a narrow understanding of diversity, and a variety of groups remain unspecified when it comes to background characteristics. To change this, clear definitions of the target groups are necessary and more consensus among the research community about the justifications to include or exclude these groups is needed.

A question in language acquisition research is whether attrition can affect L1 grammatical representation, and if so, under what conditions. This paper tests the Attrition via Acquisition (AvA) model, which takes a Feature Reassembly approach to predict how, in case on high degrees of similarity between the L1 and L2, the acquisition of L2 discourse-driven morpho-syntactic properties may affect L1 feature representations after a prolonged change in the speaker’s primary linguistic input during adulthood. As a test case, we use the different features (specificity versus discourse anaphoricity) associated with Clitic Left Dislocation (CLLD) in Romanian and Italian, examining the grammars of Romanian first-generation immigrants with either L2 Italian or L2 English (a language without CLLD). Using a context-dependent Acceptability Judgment task and a Written Elicitation task we found evidence for L2-induced grammatical attrition, resulting in the addition of an L2 option without the loss of an L1 option, as predicted by the AvA. Attrition was found for participants who immigrated during adolescence or early adulthood and who are more likely to consider Italian their most proficient and most used language. We compare our findings on attrited L1 grammars to the results of a recent study reporting on near-native L2 Italian and L2 Romanian grammars by Romanian and Italian native speakers. Our findings contribute to an increasing body of literature showing that L1 attriters and L2 learners can end up with very similar grammars and confirm the importance of studying second language acquisition and L1 loss within a broader picture of bilingual development.

Most research papers in psychology study the behaviour of a sample of participants. To characterise this sample, authors report various characteristics, frequently including the mean age and the associated standard deviation. However, based on reports from authors who publish in Acta Psychologica and from respondents on X/Twitter, the present paper shows that some authors use rounded-down ages whereas others don't, which lead to an uncertainty of 0.5 year in the average age. The results furthermore show that the authors tend to report the average age with two decimals precision, irrespective of the uncertainty of this average. I recommend that publications should explicitly mention how the average age is determined and report its value using a number of decimals that reflects its uncertainty.

Objectives: Vaginal assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines the benefits of vaginal and endoscopic surgery. This study presents the results of the first vaginal assisted NOTES hysterectomies (VANH) in The Netherlands. Study design: A prospective cohort study was performed in two non-academic teaching hospitals in The Netherlands. Data was collected from patients who underwent a VANH for benign indications between August 2019 and April 2023. Baseline characteristics and data of intra- and postoperative surgical outcomes were recorded and analysed. The VANHs were performed by four experienced vaginal and endoscopic gynaecological surgeons. Results: A total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61 %; n = 122), abnormal cervical cytology (15.5 %; n = 31), abdominal pain (11.5 %; n = 23), post ablation/sterilization pain syndrome (3.5 %; n = 7), uterine fibroids (5.0 %; n = 10), atypical endometrial hyperplasia (2.5 %; n = 5) and Lynch or BRCA gene mutation carriers (1.0 %, n = 2). The mean surgical time was 61.4 min ( ± 22.8 min) with a mean blood loss of 88 mL ( ± 89 mL) and a mean uterine weight of 150 g ( ± 112 g). In 2.0 % (n = 4) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2 % (n = 105) of the patients planned in day-care. In 2.0 % (n = 4) an intra-operative complication and in 9.0 % (n = 18) a post-operative complication occurred. Conclusion: This study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.

Mark J. R. Smeets and Suzanne C. Cannegieter discuss the use of real world data to complement data generated by clinical trials of systemic anticoagulants.

Objective To develop and internally validate a prognostic model to predict chronic pain after a new episode of acute or subacute non-specific idiopathic, non-traumatic neck pain in patients presenting to physiotherapy primary care, emphasising modifiable biomedical, psychological and social factors.Design A prospective cohort study with a 6-month follow-up between January 2020 and March 2023.Setting 30 physiotherapy primary care practices.Participants Patients with a new presentation of non-specific idiopathic, non-traumatic neck pain, with a duration lasting no longer than 12 weeks from onset.Baseline measures Candidate prognostic variables collected from participants included age and sex, neck pain symptoms, work-related factors, general factors, psychological and behavioural factors and the remaining factors: therapeutic relation and healthcare provider attitude.Outcome measures Pain intensity at 6 weeks, 3 months and 6 months on a Numeric Pain Rating Scale (NPRS) after inclusion. An NPRS score of ≥3 at each time point was used to define chronic neck pain.Results 62 (10%) of the 603 participants developed chronic neck pain. The prognostic factors in the final model were sex, pain intensity, reported pain in different body regions, headache since and before the neck pain, posture during work, employment status, illness beliefs about pain identity and recovery, treatment beliefs, distress and self-efficacy. The model demonstrated an optimism-corrected area under the curve of 0.83 and a corrected R2 of 0.24. Calibration was deemed acceptable to good, as indicated by the calibration curve. The Hosmer–Lemeshow test yielded a p-value of 0.7167, indicating a good model fit.Conclusion This model has the potential to obtain a valid prognosis for developing chronic pain after a new episode of acute and subacute non-specific idiopathic, non-traumatic neck pain. It includes mostly potentially modifiable factors for physiotherapy practice. External validation of this model is recommended.

Multiple sclerosis (MS) is a devastating immune-mediated disorder of the central nervous system resulting in progressive disability accumulation. As there is no cure available yet for MS, the primary therapeutic objective is to reduce relapses and to slow down disability progression as early as possible during the disease to maintain and/or improve health-related quality of life. However, optimizing treatment for people with MS (pwMS) is complex and challenging due to the many factors involved and in particular, the high degree of clinical and sub-clinical heterogeneity in disease progression among pwMS. In this paper, we discuss these many different challenges complicating treatment optimization for pwMS as well as how a shift towards a more pro-active, data-driven and personalized medicine approach could potentially improve patient outcomes for pwMS. We describe how the ‘Clinical Impact through AI-assisted MS Care’ (CLAIMS) project serves as a recent example of how to realize such a shift towards personalized treatment optimization for pwMS through the development of a platform that offers a holistic view of all relevant patient data and biomarkers, and then using this data to enable AI-supported prognostic modelling.

Summary: The primary objective of the prospective, randomized, multicenter, phase 3 biomarker Microarray Analysis in breast cancer to Taylor Adjuvant Drugs Or Regimens trial (MATADOR: ISRCTN61893718) is to generate a gene expression profile that can predict benefit from either docetaxel, doxorubicin, and cyclophosphamide (TAC) or dose-dense scheduled doxorubicin and cyclophosphamide (ddAC). Patients with a pT1-3, pN0-3 tumor were randomized 1:1 between ddAC and TAC. The primary endpoint was a gene profile-treatment interaction for recurrence-free survival (RFS). We observed 117 RFS events in 664 patients with a median follow-up of 7 years. Hallmark gene set analyses showed significant association between enrichment in immune-related gene expression and favorable outcome after TAC in hormone receptor-negative, human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC) (triple-negative breast cancer [TNBC]). We validated this association in TNBC patients treated with TAC on H&E slides; stromal tumor-infiltrating lymphocytes (sTILs) ≥20% was associated with longer RFS (hazard ratio 0.18, p = 0.01), while in patients treated with ddAC no difference in RFS was seen (hazard ratio 0.92, p = 0.86, pinteraction = 0.02).

IntroductionHead and neck cancer (HNC) is a complex disease, and multiple risk factors can lead to its progression. Observational studies indicated that herpes simplex virus (HSV) may be correlated with the risk of HNC. However, the causal effects and direction between them were still unclear.MethodsThis study utilized a Mendelian randomization (MR) approach for causality assessment between HSV infection and Head and neck cancer based on the latest public health data and Genome-Wide Association Study (GWAS) data. The causal effects were estimated using IVW, weighted median, and MR-Egger. A reverse MR analysis was subsequently performed. Cochrans Q test, MR‐Egger intercept test, leave one out analysis, and the funnel plot were all used in sensitivity analyses.ResultsGenetically predicted higher level of HSV-1 IgG was causally related to HNC (OR=1.0019, 95%CI=1.0003–1.0036, p=0.0186, IVW) and oral and oropharyngeal cancer (OR=1.0018, 95%CI=1.0004–1.0033, p=0.0105, IVW). The reverse MR analysis did not demonstrate a reverse causal relationship between HSV and HNC. However, HSV-2 infection was not causally related to HNC data and oropharyngeal cancer data. Sensitivity analysis was performed and revealed no heterogeneity and horizontal pleiotropy.ConclusionCollectively, a significant association was noted between HSV infection and increased risk of HNC, providing valuable insights into the etiology of this malignancy. Further in-depth study is needed to validate these findings and elucidate the underpinning mechanisms.