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Although green training has been shown in past research to promote environmentally responsible behaviors at work, scholars have paid less attention to its influence on employees' eco‐friendly behaviors outside of work. This omission is critical because confining green training research to the work domain obscures its benefits in promoting employees' pro‐environmental behaviors beyond the workplace, and thus its role in supporting organizational efforts to conserve the natural environment. To address this gap, we examine the direct and indirect (via connectedness to nature) relationships between green training and employees' eco‐friendly behaviors outside of work, including consumption of eco‐friendly products, reuse of items and materials, and reduced consumption of resources such as water, electricity, and paper. We also examine the moderating influence of intrinsic spirituality on the direct link between green training and connectedness to nature, as well as the indirect link between green training and eco‐friendly behaviors beyond the workplace. Using time‐lagged, multisource data, we find support for our hypotheses. Our findings advance knowledge on the important yet largely overlooked role of green training in shaping employees' environmentally responsible behaviors outside of the workplace. [ABSTRACT FROM AUTHOR]

Group-based trajectory modeling (GBTM) is applied to the citation curves of articles in six journals and to all citable items in a single field of science (virology, 24 journals) to distinguish among the developmental trajectories in subpopulations. Can citation patterns of highly-cited papers be distinguished in an early phase as "fast-breaking" papers? Can "late bloomers" or "sleeping beauties" be identified? Most interesting, we find differences between "sticky knowledge claims" that continue to be cited more than 10 years after publication and "transient knowledge claims" that show a decay pattern after reaching a peak within a few years. Only papers following the trajectory of a "sticky knowledge claim" can be expected to have a sustained impact. These findings raise questions about indicators of "excellence" that use aggregated citation rates after 2 or 3 years (e.g., impact factors). Because aggregated citation curves can also be composites of the two patterns, fifth-order polynomials (with four bending points) are needed to capture citation curves precisely. For the journals under study, the most frequently cited groups were furthermore much smaller than 10%. Although GBTM has proved a useful method for investigating differences among citation trajectories, the methodology does not allow us to define a percentage of highly cited papers inductively across different fields and journals. Using multinomial logistic regression, we conclude that predictor variables such as journal names, number of authors, etc., do not affect the stickiness of knowledge claims in terms of citations but only the levels of aggregated citations (which are field-specific). [ABSTRACT FROM AUTHOR]

Performance assessment is ubiquitous and crucial in people analytics. Scientific impact, particularly, plays a significant role in the academia. This paper attempts to understand researchers' career trajectories by considering the research community as a social network, where individuals build ties with each other via coauthorship. The resulting linkage facilitates information flow and affects researchers' future impact. Consequently, we systematically investigate the career trajectories of researchers with respect to research impact using the social capital theory as our theoretical foundation. Specifically, for early‐stage and mid‐career academics, we find that connections with prominent researchers associate with greater impact. Brokerage positions, in addition, are beneficial to a researcher's research impact in the long run. For senior researchers, however, the only social network feature that significantly affects their future impact is the reputation of their recently built ties. Finally, we build predictive models on future research impact which can be leveraged by both organizations and individuals. This paper provides empirical evidence for how social networks provide signals on researchers' career dynamics guided by social capital theory. Our findings have implications for individual researchers to strategically plan and promote their careers and for research institutions to better evaluate current as well as prospective employees. [ABSTRACT FROM AUTHOR]

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

Background: Maternal input plays an important role in influencing linguistic development during the first years of life, and it is evident that mothers adapt their language according to their child's characteristics. Recently, it was demonstrated that maternal input addressed to children with sex chromosome trisomies (SCTs) at 8 months of age is prosodically and functionally different from that addressed to typically developing (TD) peers. Aims: The study aimed at analysing maternal input at 24 months when the presence of a language delay could be more evident than during the preverbal stage. We were interested in examining if maternal input was influenced by a diagnosis of SCT (by comparing children with SCT and TD children) or by children's linguistic level (by comparing children with weak lexical ability versus children with typical lexical ability regardless of the presence of genetic diagnosis). Methods and Procedures: Forty‐four mother–child dyads in which the children had an SCT and 20 mother–child dyads in which the children were TD participated in the study. Of these 64 dyads, 23 children (21 with SCTs and two TD children) formed the group of children with weak lexical ability (children with a vocabulary size lower than 50 words at 24 months). Maternal utterances were collected during one video‐recorded play session and were then coded considering both the linguistic and functional features of the input. Outcomes and Results: The results showed that the input addressed to 24‐month‐old children with SCTs is as rich and complex as that addressed to TD peers. Moreover, no significant differences in the functions expressed by maternal input were found (all ps > 0.05). Comparing the children with weak lexical ability and the children with typical lexical ability in our sample, having a poor vocabulary at 24 months of age showed a significant influence on the maternal input features: the input addressed to children with weak lexical ability was characterised by a higher presence of attention getters (U = 217.00, p = 0.007) and a lower proportion of questions (U = 236.00, p = 0.017) than that of mothers of typically‐talking children. Conclusions and Implications: At 24 months of age, it seems that the presence of a language delay and not belonging to the clinical group of children with SCTs influences the functional characteristics of the maternal input. It is important to support the parents of children with SCTs during the communication process and later during their child's development, leading them to observe their children's manifested skills rather than looking for possible predicted difficulties. WHAT THIS PAPER ADDS: What is already known on the subject: Studies in the literature demonstrated how mothers can generally adapt their input to their child's characteristics. To our knowledge, only two recent studies analysed the maternal input addressed to children with SCT at 8 months of age, highlighting significant differences. What this paper adds to existing knowledge: The maternal input addressed to children with SCT at 24 months of age is not different from that addressed to TD children. At 24 months of age, the mothers adapt their input to the verbal competence shown by their child (weak lexical ability versus typically‐talking), while belonging to the clinical group does not show an influence. What are the potential or actual clinical implications of this work?: All the participants of the present study received prenatal diagnosis disclosure by an expert team of professionals, and they were all involved in a longitudinal study aimed at monitoring the children's development and supporting their parents. These results show that giving clear and complete information about possible development paths to parents of children with SCTs during diagnosis disclosure is crucial. Moreover, supporting the parents during the communication process and later during their child's development is fundamental, leading them to observe their children's manifested skills rather than looking for possible predicted difficulties. [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready‐to‐use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatment protocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight‐for‐height z‐score ≥ −3 or mid‐upper arm circumference [MUAC] ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol [MTP]). In this paper, we report the results of this nonweight‐based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol (n = 269) or the MTP protocol (n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per‐protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate [93.3% vs. 90.2%; ∆ (95% confidence interval, CI) = 3.1 (−0.9; 7.2) %] and length‐of‐stay [82.6 vs. 75.6 days; ∆ (95% CI) = 6.9 (3.3; 10.5) days], considering the margin of noninferiority of −10% and +14 days, respectively. Weight gain velocity was smaller in the MTP protocol group than in the STD protocol group [3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95% CI) = −1.5 (−1.8, −1.2); p < 0.001]. The STD group had a significantly higher mean than the MTP group for absolute MUAC gain [∆ (95% CI) = 1.7 (1.0; 2.3) mm; p < 0.001] and the MUAC velocity [∆ (95% CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001]. Our results confirm the noninferiority of a nonweight‐based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource‐constrained contexts. Key messages: More evidence supporting the use of the nonweight‐based daily ready‐to‐use therapeutic food (RUTF) dosage for treating uncomplicated severe acute malnutrition (SAM), in specific contexts, is needed.Our real‐world prospective nonrandomized study showed that the fixed nonweight‐based daily RUTF dosage protocol is as effective as the standard weight‐based protocol for treating uncomplicated SAM in children <5 in the Afghanistan context.Our findings support the reflection of a nonweight‐based daily RUTF dosage in resource‐constrained contexts in national and global policies and guidelines to improve coverage of all children in need of treatment. [ABSTRACT FROM AUTHOR]

Introduction: Although Jordan has made significant progress toward expanding the utilization of facility‐based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. Methods: Utilizing a pre–post design, quality gaps in intrapartum care were assessed among 959 women pre‐ and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. Results: The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was −0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, −0.24 (±0.39) and −0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = −0.60), admission timing (β = −0.41), continuity of midwifery care (β = −0.43), physician's gender (β = −0.62), active labour duration (β = 0.37), and pain management (β = −0.33) to be the key determinants of the overall quality gap in intrapartum care. Conclusion: Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. Patient or Public Contribution: This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan. [ABSTRACT FROM AUTHOR]

Background Studies: Captioning and repetition are widely used multimedia instructional devices for non‐native students. Generally, studies in this area have tended to focus on second language literacy skills rather than on learning new content knowledge. Additionally, posttests were administered immediately after the treatments, while the delayed influences of captioning and repetition have never been investigated. Objectives: This paper addressed these research gaps in two separate studies. More specifically, this study attempted to examine the influences of captioning and repetition on non‐native students' immediate and relayed retention. Methods: In Study One, three captioning conditions; word‐by‐word captions, closed captions, and no‐captions; were compared to examine their efficacies in immediate and delayed content knowledge retention on 82 Chinese university students. To address the limitations in Study One as the multimedia lesson was short and played only once, Study Two incorporated captioning and two repetition types in its design. One hundred and eleven Chinese university students watch a video lesson in one of four captioning and repetition conditions. Results: The statistical analyses of Study One indicated that there were no significant differences in both immediate and delayed retention test scores across the three captioning condition. Similarly, in Study Two, there were no significant differences in retention tests scores across the four captioning and repetition conditions. Findings: Neither the availability of captions nor the repetition types had any impact on the Chinese students' immediate or delayed content knowledge retention, which lent support to existing studies. Based on the research results, the limitations and future study possibilities are discussed. Lay Description: What Is Already Known About This TopicEmpirical studies on captioning have focused on immediate learning right after the treatment, so have studies on repetition.Empirical studies on multimedia lessons for non‐native students have focused on English language learning. What This Paper AddsThree types of captioning were compared to examine their efficacies in both immediate and delayed content retention of Chinese students.Two types of repetition were compared to examine their efficacies in both immediate and delayed content retention of Chinese students. Implications for Practice and/or Policy:Neither the availability of captions nor the repetition types had any impact on the Chinese students' immediate or delayed content knowledge retention.The availability of textual keywords adjacent to their corresponding graphics might have compromised the efficacy of captioning. [ABSTRACT FROM AUTHOR]

Women veterans (WV) are the fastest growing veteran subpopulation and recognized to be at increased risk for suicide compared with civilians. Improving engagement (e.g., response rates) of WV in survey research is critical to ensuring valid and generalizable findings, which can inform suicide prevention programs tailored for this population. Many factors are known to influence response rates, yet little is known about ways to optimize survey response rates among WV. Three recruitment cohorts (Waves 1 [W1], 2a [W2a], and 2b [W2b]) of WV were invited to participate in an online survey for a national, mixed‐methods study examining suicide risk among WV using reproductive health care services paid for or provided by the Veterans Health Administration. To examine the effects of enhanced recruitment efforts, standard recruitment materials were mailed to all three cohorts, with the additions of: a study flyer aiming to build trust between participants and researchers (W2a, W2b) and a paper survey (W2b). Characteristics of responders and non‐responders were compared by wave and across survey modalities. Response rates were significantly higher for groups receiving enhanced (W2a = 17.1%; W2b = 24.6%) versus standard (W1 = 12.2%) recruitment materials. WV residing in rural areas were significantly more likely to respond by paper (37.1%) than online (19.8%). Non‐respondents were disproportionately racial and ethnic minorities. Disclosure of sensitive information (e.g., military sexual trauma) did not differ by survey modality. Findings suggest that enhanced recruitment materials improve survey response rates among WV, an important consideration for future research with this population. [ABSTRACT FROM AUTHOR]

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

To systematically explore the effects of minimally invasive plate osteosynthesis (MIPO) versus intramedullary nail (IMN) on wound infection and wound healing in patients with distal tibia fractures. A computerised search of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database (CBM) and China National Knowledge Infrastructure databases was performed, from their inception to October 2023, to identify relevant studies on the application of MIPO and IMN in patients with distal tibial fractures. The quality of the included literature was evaluated by two researchers based on inclusion and exclusion criteria, and basic information of the literature was collected, with wound infection, postoperative complications and wound healing time as the main indicators for analysis. Stata 17.0 software was applied for analysis. Overall, 23 papers and 2099 patients were included, including 1026 patients in the MIPO group and 1073 patients in the IMN group. The results revealed, when compared with IMN treatment, patients with distal tibia fractures who underwent MIPO treatment had a lower incidence of postoperative complications (OR = 0.33, 95% CI: 0.25–0.42, p < 0.001) and a shorter wound healing time (SMD = −1.00, 95% CI: −1.51 to −0.49, p < 0.001), but the incidence of postoperative wound infection was higher (OR = 2.01, 95% CI: 1.35–3.01, p = 0.001). Both MIPO and IMN are excellent treatments for distal tibia fractures. MIPO is effective in reducing the incidence of complications as well as shortening the time of wound healing time but increases the risk of wound infection. In clinical practice, surgeons can make individual choices based on the patient's wishes and proficiency in both techniques. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of job control and work‐related loneliness on employee work behaviors and well‐being during the massive and abrupt move to remote work amid the COVID‐19 pandemic. We draw on job‐demands control and social baseline theory to link employee perceived job control and work‐related loneliness to emotional exhaustion and work‐life balance and posit direct and indirect effects on employee minor counterproductive work behaviors, depression, and insomnia. Using a two‐wave data collection with a sample of U.S. working adults to test our predictions, we find that high job control was beneficially related to emotional exhaustion and work‐life balance, while high work‐related loneliness showed detrimental relationships with our variables of interest. Moreover, we find that the beneficial impact of high perceived job control was conditional on individual segmentation preferences such that the effects were stronger when segmentation preference was low. Our research extends the literature on remote work, job control, and workplace loneliness. It also provides insights for human resource professionals to manage widespread remote work that is likely to persist long after the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: To identify how speech‐language pathologists (SLPs) in the United States are screening for and identifying dysphagia. To do this, we examined the approaches most often used to screen for dysphagia and the influence of contextual factors such as setting, continuing education and means of staying up to date with the most current literature on screening approaches. Method: A web‐based survey composed of 32 questions was developed and field tested for content, relevance and workflow. The survey was distributed online, via social media, online SLP forums and through the American Speech‐Language‐Hearing Association's Special Interest Group 13 (swallowing disorders). One hundred and thirty‐seven clinicians from the United States completed the survey and were included for analysis using descriptive statistics and linear regression modelling to assess associations of continuing education and years practicing with screening protocols and consumption of evidence. Results: Respondents worked in a variety of settings, including acute care, skilled nursing facilities, and inpatient rehabilitation. Most respondents worked with adult populations (88%). The most common screening protocols reported were a volume‐dependent water swallow test (74%), subjective patient report (66%), and trials of solids/liquids (49%). Twenty‐four percent (24%) reported using a questionnaire, the Eating Assessment Tool (80%) being most common. How clinicians consume their evidence was significantly associated with the types of screening approaches used. Continuing education hours were significantly associated with dysphagia screening protocol choice (p < 0.001) and how clinicians stayed up to date with evidence (p < 0.001). Conclusions: Results from this study provide an in‐depth look at the choices clinicians are making in the field regarding how to effectively screen patients for the presence of dysphagia. Contextual factors such as evidence base consumption patterns should serve researchers to continue seeking alternative ways to share evidence with clinicians, accessibly. Associations between continuing education and protocol choice show the need for continued evidence‐based and high‐quality continuing education opportunities. WHAT THIS PAPER ADDS: This study provides an in‐depth look at the choices clinicians are making in the field regarding effective dysphagia screening practices. Clinician screening choices are examined with contextual factors such as evidence base consumption patterns and continuing education. This paper increases knowledge of the most used dysphagia screening practices and context for clinicians and researchers to improve use, evidence and dissemination of best practices. [ABSTRACT FROM AUTHOR]

Background: Individuals with developmental language disorder or Williams syndrome are reported to use more gestures than individuals with typical development. However, these two groups differ considerably in visuospatial and language skills, two skills that are hypothesized to shape gesture rate. Aims: We first examined whether children with both developmental language disorder and children Williams syndrome do indeed use more gestures. Our second aim was to disentangle the role of vocabulary and visuospatial skills in the use of supplementary gestures (i.e., containing unique information). To account for participant heterogeneity, analyses included both group comparisons and vocabulary and visuospatial skills at an individual level. As a third aim, the role of visuospatial skills was further examined in relation to gestures containing spatial content. Methods & Procedures: In a cross‐sectional group design, three participant groups watched and then retold a cartoon: children with typical development (n = 25), children with developmental language disorder (n = 25) and children/young people with Williams syndrome (n = 14). Their narrations were transcribed and hand gestures were coded based on gesture–speech integration (redundant, adds information to particular lexical items, gives information that is entirely absent from speech) and spatial content. Participants' expressive vocabulary and visuospatial skills were measured. Outcomes & Results: Between‐group comparisons showed that individuals with developmental language disorder or Williams syndrome did indeed use more gestures. Poisson loglinear modelling demonstrated that a relative higher use of supplementary gestures was determined by lower expressive vocabulary skills. Neither the group distinction nor visuospatial skills shaped the supplementary gesture rate nor spatial gesture rate. Conclusions & Implications: Regardless of neurodevelopmental condition or typical development, a higher use of supplementary gestures was influenced by expressive vocabulary skills. Children with lower vocabulary skills spontaneously capitalized on the multimodality of communication to express constituents that were not present in their verbal speech. This finding is a promising starting point for future gesture intervention studies examining whether implicit modelling of gesture use can encourage gestures even more in these children and if this allows them to achieve higher linguistic complexity. On a methodological note, the observed intra‐group skill variability demonstrates that group comparisons need to be complemented with correlational measures accounting for skills at an individual level. What this paper adds: What is already known on the subject: Children with developmental language disorder and children with Williams syndrome are more inclined to use gestures than typically developing children. Research conducted in adults with typical development points towards the role of lexical and visuospatial skills in gesture use, but it is unclear how these skills shape gesture use in children with atypical development. What this paper adds to existing knowledge: This study compares the rate of gestures that convey meaning that is not expressed in speech between the three aforementioned populations. Novel is the inclusion of the group distinction, individual lexical skills, and visuospatial skills in one encompassing statistical model. What are the potential or actual clinical implications of this work?: The inclination to use gestures that replace speech is related to lexical skills. Visuospatial skills do not seem to play a role and should not be considered as a factor when thinking about gesture intervention. Understanding how gestures relate to specific skills is a first step to understanding how gesture interventions can bolster language production. [ABSTRACT FROM AUTHOR]

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

The relationship between structural changes in the cerebral gray matter and diminished balance control performance in patients with chronic ankle instability (CAI) has remained unclear. This paper aimed to assess the difference in gray matter volume (GMV) between participants with CAI and healthy controls (HC) and to characterize the role of GMV in the relationship between disease duration and balance performance in CAI. 42 participants with CAI and 33 HC completed the structural brain MRI scans, one‐legged standing test, and Y‐balance test. Regional GMV was measured by applying voxel‐based morphometry methods. The result showed that, compared with HC, participants with CAI exhibited lower GMV in multiple brain regions (familywise error [FWE] corrected p < 0.021). Within CAI only, but not in HC, lower GMV in the thalamus (β = −0.53, p = 0.003) and hippocampus (β = −0.57, p = 0.001) was associated with faster sway velocity of the center of pressure (CoP) in eyes closed condition (i.e., worse balance control performance). The GMV in the thalamus (percentage mediated [PM] = 32.02%; indirect effect β = 0.119, 95% CI = 0.003 to 0.282) and hippocampus (PM = 33.71%; indirect effect β = 0.122, 95% CI = 0.005 to 0.278) significantly mediated the association between the disease duration and balance performance. These findings suggest that the structural characteristics of the supraspinal elements is critical to the maintenance of balance control performance in individuals suffering from CAI, which deserve careful consideration in the management and rehabilitation programs in this population. [ABSTRACT FROM AUTHOR]

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

Background: Molar incisor hypomineralisation (MIH) is a developmental enamel defect in the first permanent molars and frequently in the incisors. It poses a unique challenge to the dental practitioner because of its nature, clinical presentations and treatment strategies. Aim: This study assessed the perception of Libyan dentists in Benghazi regarding MIH and its management. Design: Paper‐based, self‐administered questionnaires were distributed to dentists in Benghazi, Libya. The questionnaires investigated the awareness of MIH, knowledge of MIH aetiology, clinical challenges of MIH treatment and choices of restorative management. Descriptive statistics, chi‐squared test and binary logistic regression analysis were performed at a significance level of ≤.05. Results: A total of 389 questionnaires were completed and analysed, giving an overall response rate of 76% (389/511). Most participants were female (85%, 332), with an average of 6.05 (SD = 6.24) years of experience. The majority of participants (67%) recognised MIH in their practice. Statistically significant differences in the awareness of MIH and its prevalence were observed according to the type of practice (p ≤.001) and experience of dentists (p ≤.001). Dentists working in public dental practice were less familiar with MIH and less likely to report it. Likewise, novice dentists were less aware of MIH than more experienced colleagues. The most reported aetiological factor in MIH was genetics by 60.2% of respondents, followed by environmental contamination (47.6%) and fluorides (42.9%). Most participants (92.3%) considered MIH a clinical problem. Aesthetics and diagnosis were the most reported challenging aspects (59.4% and 44.2%, respectively). The most commonly selected restorative options were high‐fluoride glass ionomer cement (43.2%) and preformed metal crowns (41.6%). Conclusion: The majority of participants reported awareness of the existence of MIH condition. Nevertheless, variations in estimating MIH prevalence and its proper treatment, as well as factors influencing its treatment and diagnosis, were recorded. It is recommended that the current dental curriculum is reviewed, and scientific evidence providing dental practitioners with updated information on the diagnosis and clinical management of MIH should be circulated. [ABSTRACT FROM AUTHOR]

The article presents a research paper on the link between physical performance and long-term survival in a cohort of community-dwelling older people from the "Aging and Longevity in the Sirente Geographic Area" study. Topics discussed include the methods used in the study, the definition of long-term survival, and the implications of the study for assessing mortality risk in octogenarians.

Background: Artificial intelligence–generated content (AIGC) has stepped into the spotlight with the emergence of ChatGPT, making effective use of AIGC for education a hot topic. Objectives: This study seeks to explore the effectiveness of integrating AIGC into programming learning through debugging. First, the study presents three levels of AIGC integration based on varying levels of abstraction. Then, drawing on extended effective use theory, the study proposes the underlying mechanism of how AIGC integration impacts programming learning performance and computational thinking. Methods: Three debugging interfaces integrated with AIGC by ChatGPT were developed for this study according to three levels of AIGC integration design. The study conducts a between‐subject experiment with one control group and three experimental groups. Analysis of covariance and a structural equation model are employed to examine the effects. Results and Conclusions: The results show that the second and third levels of abstraction in AIGC integration yield better learning performance and computational thinking, but the first level shows no difference compared to traditional debugging. The underlying mechanism suggests that the second and third levels of abstraction promote transparent interaction, which enhances representational fidelity and consequently impacts learning performance and computational thinking, as evidenced in test of the mechanism. Moreover, the study finds that learning fidelity weakens the effect of transparent interaction on representational fidelity. Our research offers valuable theoretical and practical insights. Lay Description: What is currently known about the subject matter?: In the present information era, programming and computational thinking are important.AIGC has attracted remarkable attention from both academics and managers.If it is appropriately utilised, AIGC can facilitate education. What this paper adds: Three forms of AIGC integration based on the level of abstraction, which enhance programming learning and computational thinking.Application of extended effective use theory to propose an underlying mechanism for how AIGC integration affects learning performance and computational thinking.Concrete information on the utilisation of AIGC in the education domain.Evidence that shows the importance of interaction transparency and representational fidelity for leveraging information technologies in education. Implications of the study findings for practitioners: AIGC can be an effective tool for teachers, learners, and institutions.Platform designers and teachers should carefully design AICG integration.Platform designers and teachers could make use of various methods and other forms of AIGC integration to promote interaction transparency. [ABSTRACT FROM AUTHOR]

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

The article criticizes the degree of validity of the results of the paper-pencil test for Piagetian developmental levels. Researchers states that the results of the chi-square statistics will not provide the amount of agreement of validity of contingency. However, in the Piagetian testing the results are qualitative and less accurate, it will not increase the confidence intervals for scores though yields a greater number of misclassification of students. The convenience of a paper-pencil test justifies trade-off in accuracy.

Rationale, aims and objectives Open-label extension (OLE) studies following blinded randomized controlled trials (RCTs) of pharmaceuticals are increasingly being carried out but do not conform to regulatory standards and questions surround the validity of their evidence. OLE studies are usually discussed as a homogenous group, yet substantial differences in study design still meet the definition of an OLE. We describe published papers reporting OLE studies focussing on stated objectives, design, conduct and reporting. Method A search of Embase and Medline databases for 1996 to July 2008 revealed 268 papers reporting OLE studies that met our eligibility criteria. A random sample of 50 was selected for detailed review. Results Over 80% of the studies had efficacy stated as an objective. The most common methods of allocation at the start of the OLE were for all RCT participants to switch to one active treatment or for only participants on the new drug to continue, but in three studies all participants were re-randomized at the start of the OLE. Eligibility criteria and other selection factors resulted in on average of 74% of participants in the preceding RCT(s) enrolling in the OLE and only 57% completed it. Conclusions Published OLE studies do not form a homogenous group with respect to design or retention of participants, and thus the validity of evidence from an OLE should be judged on an individual basis. The term 'open label' suggests bias through lack of blinding, but slippage in relation to the sample randomized in the preceding RCT may be the more important threat to validity. [ABSTRACT FROM AUTHOR]

Background: Understanding the natural history of developmental speech and language impairments can support the selection of children whose difficulties are persistent rather than transitory. It can also provide information against which the effectiveness of intervention can be evaluated. However, natural history data are difficult to collect ethically. Furthermore, as soon as an impairment is identified, the behaviour of those around changes, thus creating some level of intervention. Longitudinal cohort studies, where intervention is minimal, or the control arm of randomized trials have provided the best evidence. However, occasional opportunities arise where service waiting lists can provide data about the progress of children who have not received intervention. This natural history study arose within an ethnically diverse, community paediatric speech and language therapy service in the UK where levels of social disadvantage are high. Aims: To identify (1) the characteristics of the children who attended initial assessment and were selected for treatment; (2) the differences between children who did and did not attend reassessment; and (3) the factors associated with outcomes. Methods & Procedures: A cohort of 545 children were referred and assessed as in need of therapy. Due to resource constraints, intervention was not available for an average of 12 months. Children were invited to attend for a reassessment of need. Initial and follow‐up assessments were conducted by experienced clinicians using service guidelines and the Therapy Outcomes Measures Impairment Scale (TOM‐I). Descriptive and multivariate regression analyses examined child outcomes for changes in communication impairment, demographic factors and length of wait. Outcomes & Results: At initial assessment, 55% of children presented with severe and profound communication impairments. Children offered appointments at clinics in areas of high social disadvantage were less likely to attend reassessment. By reassessment, 54% of children showed spontaneous improvement (mean TOM‐I rating change = 0.58). However, 83% were still judged to require therapy. Approximately 20% of children changed their diagnostic category. Age and impairment severity at initial assessment were the best predictors of continuing requirement for input. Conclusions & Implications: Although children do make spontaneous progress post‐assessment and without intervention, it is likely that the majority will continue to be assigned case status by a Speech and Language Therapist. However, when evaluating the effectiveness of interventions, clinicians need to factor in the progress that a proportion of the caseload will make spontaneously. Services should be mindful that a lengthy wait may disproportionately impact children who already face health and educational inequalities. What This Paper Adds: What is already known on the subject: Data from longitudinal cohorts (where intervention has been minimal) and the no treatment control arms of randomized controlled trials have provided the best evidence of the natural progression of speech and language impairments in children. These studies provide a varied rate of resolution and progress depending on the case definitions and measurements used. What this study adds to existing knowledge: Uniquely, this study has evaluated the natural history of a large cohort of children who had been waiting for treatment for up to 18 months. Data showed that, over a period of waiting for intervention, the majority of those identified as a case by a Speech and Language Therapist remained a case. Using the TOM, on average children in the cohort made just over half a rating point progress during their waiting period. What are the potential or actual clinical implications of this work?: The maintenance of treatment waiting lists is probably an unhelpful service strategy for two reasons: first, the case status of the majority of the children is unlikely to change whilst they await intervention and thus children and their families are subjected to further limbo waiting time; second, the dropout from the waiting list may disproportionately affect children who are offered appointments in clinics where there are higher levels of social disadvantage, thus exacerbating inequalities in the system. Currently, a suggested reasonable outcome of intervention is a 0.5 rating change in one domain of TOMs. Study findings suggest this is insufficiently stringent for a paediatric community clinic caseload. There is a need to evaluate spontaneous improvement which may occur in other TOM domains (i.e., Activity, Participation and Wellbeing) and to agree an appropriate change metric for a community paediatric caseload. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sexting is common among adolescents and is associated with numerous health risk behaviors and negative psychosocial constructs. This study examined the relationships between high school students' experiences with sexual violence victimization, dating violence victimization, and engagement in risky sexual behaviors with experiences of receiving sexts. METHODS: Cross‐sectional data from the 2014 to 2016 data from Pennsylvania Youth Risk Behavior. Participants were selected using an independent 2‐stage cluster sample design to produce a statewide population‐based sample. The pencil and paper surveys were conducted in school. Participants included 6734 Pennsylvania high school students in grades 9‐12. RESULTS: Overall, 29.0% of Pennsylvania high school students had received a sext, which varied by sex, race/ethnicity, school grade, and sexual identity. Students who engaged in sexual risk behaviors, experienced dating violence, or experienced lifetime sexual violence outside of the dating context had a significantly higher prevalence of receiving a sext than students who did not engage in those behaviors or have those experiences. CONCLUSIONS: Early screening and prevention efforts that include discussions about sexting behaviors may help prevent other negative outcomes, such as risky sexual behaviors and interpersonal violence. Addressing sexting in the education and health sectors may help to prevent other related harmful health and violence experiences during adolescence. [ABSTRACT FROM AUTHOR]

Objective: Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state‐wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined. Methods: Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository. Design: Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis). Setting: All people diagnosed with HNC in Queensland, Australia. Participants: The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner‐regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015. Main Outcome Measures: This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co‐morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post‐acute outcomes (readmission rates, causes of readmission and 2‐year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed. Results: Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2‐year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment. Conclusions: This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas. [ABSTRACT FROM AUTHOR]

Background: Medical adhesives are used to affix components to the skin. They are part of procedures performed by medical specialties because of their participation as constituents of different products, such as tapes, dressings, and electrodes. Aim: This study aims to assess the prevalence of, and factors associated with, the development of medical adhesive‐related skin injuries (MARSIs) in patients treated with medical tapes in the neonatology department of a large teaching hospital in Brazil. Study Design: Cohort study. Methods: All premature newborns (gestational age from 28 to <37 weeks) admitted in the neonatal intensive care unit of a teaching hospital, from March to August 2019, were followed up. Neonate skin condition was assessed based on the Neonatal Skin Condition Scale (NSCS). Data analyses were conducted in R software. Results: In total, 46 premature newborns were included in the study; 552 evaluations were performed—mean of 11.7 per patient. Most neonates (n = 41; 89.1%) used adhesive tapes, either paper tape (n = 37; 80.4%) or transparent film dressing (n = 34; 73.9%). Newborns' face and head were the most affected body regions (n = 125; 50.2%). Eight patients had MARSIs (19.5% of patients who used tape). NSCS scores (P value <.001) and the adopted warming system (P value =.01302) were associated with the occurrence of MARSIs. Incubators seem to be a protective factor for MARSI (OR = 0.048; IC95% = 0.0008‐0.75; P value =.013). Conclusion: Adhesive tapes in premature newborns should be considered a risk factor for injuries. Although NSCS showed mild‐to‐moderate impairment and lesion severity was low, this event is relatively frequent in neonatal units. Relevance to Clinical Practice: Awareness of the risk associated with adhesive tape application and removal in newborns allow health services to better address the problem by enforcing good practices, elaborating better protocols, qualifying the health care professionals, and potentially selecting softer tapes for neonates. [ABSTRACT FROM AUTHOR]

Background: School Health Profiles assesses school health policies and practices among US secondary schools. Methods: The 2020 School Health Profiles principal and teacher questionnaires were used for a test‐retest reliability study. Cohen's kappa coefficients tested the agreement in dichotomous responses to each questionnaire variable at 2 time points. The aggregate prevalence estimates between time 1 and time 2 were compared for each questionnaire item via overlapping 95% confidence intervals. Chi‐square tests examined whether the prevalence at time 2 differed between paper and web administration for both questionnaires. Results: For the principal (N = 50) and teacher (N = 34) data, there were no significant differences in the prevalence of any items between time 1 and time 2. For the principal survey, the mean kappa for 191 variables was 0.49. For the teacher survey, the mean kappa for 260 variables was 0.65. Overall, 60.7% of principal and 91.1% of teacher questionnaire items had at least "moderate" reliability. Conclusions: School Health Profiles offers education and health agencies a reliable tool to monitor school policies and practices. [ABSTRACT FROM AUTHOR]

Adolescents in secure residential care mostly suffer from serious behavioural problems, often accompanied by trauma and adverse family circumstances. This paper presents findings of a comparison of behavioural problems and risk factors of 255 boys and girls (aged 12 to 18 years) in secure residential care in the Netherlands and their association with behavioural problems. A cross‐sectional design and standardized questionnaires were used to measure behavioural problems and individual and familial risk factors. By using independent‐sample t tests, the severity of these factors in boys and girls was compared, and by using structural equation modelling (SEM), associations between these factors and behavioural problems were investigated. The findings of the study show that post‐traumatic stress disorder (PTSD) symptoms, maladaptive emotion regulation, impaired perceived competence and internalizing behavioural problems were more severe in girls than in boys. Boys experienced more severe externalizing behavioural problems and more family problems than girls. Maladaptive emotion regulation, PTSD symptoms, perceived competence and parenting problems were related to behavioural problems. The results indicate that treatment for girls should address PTSD symptoms, perceived competence and maladaptive emotion regulation and that extra attention for family problems in the treatment of boys is warranted. [ABSTRACT FROM AUTHOR]

Accurately evaluating a researcher and the quality of his or her work is an important task when decision makers have to decide on such matters as promotions and awards. Publications and citations play a key role in this task, and many previous studies have proposed using measurements based on them for evaluating researchers. Machine learning techniques as a way of enhancing the evaluating process have been relatively unexplored. We propose using a machine learning approach for evaluating researchers. In particular, the proposed method combines the outputs of three learning techniques (logistics regression, decision trees, and artificial neural networks) to obtain a unified prediction with improved accuracy. We conducted several experiments to evaluate the model's ability to: (a) classify researchers in the field of artificial intelligence as Association for the Advancement of Artificial Intelligence (AAAI) fellows and (b) predict the next AAAI fellowship winners. We show that both our classification and prediction methods are more accurate than are previous measurement methods, and reach a precision rate of 96% and a recall of 92%. [ABSTRACT FROM AUTHOR]

OBJECTIVES This study aimed to investigate the relationship between the authenticity of instructional formats and outcome measures within a pre-clerkship clinical reasoning course. METHODS We conducted a randomised, prospective, crossover study with Year 2 medical students taking a pre-clerkship clinical reasoning course. Students were randomised to small groups and exposed to three formats of differing instructional authenticity (paper case, DVD presentation, standardised patient [SP] presentation) across three subject areas (abdominal pain, anaemia, polyuria). Three student cohorts were taught using one instructional format per subject area so that each cohort received a different instructional format for each of the three subject areas. Outcome measures (objective structured clinical examination, video quiz, written examination) were selected to determine the effect of each instructional format on the clinical reasoning of students. RESULTS Increasingly authentic instructional formats did not significantly improve clinical reasoning performance across all outcome measures and subject areas. However, the results of the video quiz showed significant differences in the anaemia subject area between students who had been instructed using the paper case and live SP-based formats (scores of 47.4 and 57.6, respectively; p = 0.01) and in the abdominal pain subject area, in which students instructed using the DVD format scored higher than students instructed using either the paper case or SP-based formats (scores of 41.6, 34.9 and 31.2, respectively; p = 0.002). CONCLUSIONS Increasing the authenticity of instructional formats does not appear to significantly improve clinical reasoning performance in a pre-clerkship course. Medical educators should balance increases in authenticity with factors such as cognitive load, subject area and learner experience when designing new instructional formats. [ABSTRACT FROM AUTHOR]

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

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

Introduction: Patients in emergency departments (EDs) constitute a diverse population with multiple health‐related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines the interaction effect of depression, posttraumatic stress disorder (PTSD), impulsivity, drug use, adverse childhood experiences (ACEs), at‐risk drinking, and having a hazardous drinker partner with gender on mutual physical IPV in an urban ED sample. Methods: Research assistants surveyed 1037 married, cohabiting, or partnered patients in face‐to‐face interviews (87% response rate) regarding IPV exposure, alcohol and drug use, psychological distress, ACEs, and other sociodemographic features. IPV was measured with the Revised Conflict Tactics Scale. Interaction effects were examined in multinomial and logistic models. Results: Results showed a significant interaction of gender and PTSD (odds ratio [OR] 3.06, 95% CI 1.21–7.23, p < 0.05) for mutual IPV. Regarding main effects, there were also statistically significant positive associations between mutual physical IPV and at‐risk drinking (OR 1.73, 95% CI 1.07–2.77, p < 0.05), having a hazardous drinker partner (OR 2.19, 95% CI 1.35–3.55, p < 0.01), illicit drug use (OR 2.09, 95% CI 1.18–3.71, p < 0.01), ACEs (OR 1.23, 95% CI 1.06–1.42, p < 0.01), days of cannabis use past in the 12 months (OR 1.003, 95% CI 1.002–1.005, p < 0.001), and impulsivity (OR 2.04, 95% CI 1.29–3.22, p < 0.01). Conclusions: IPV risk assessment in EDs will be more effective if implemented with attention to patients' gender and the presence of various and diverse other risk factors, especially PTSD. [ABSTRACT FROM AUTHOR]

Objectives: This paper reports on the effect of 6‐month dental home visits compared to no dental home visits on 24‐month caries incidence in 5‐ to 6‐year‐olds. Methods: 5‐ to 6‐year‐olds attending kindergartens were randomized to receive either 6‐month dental home visits and education leaflets (Intervention group) or education leaflets alone (Control group) over 24 months. To detect a 15% difference in caries incidence with a significance level of 5% and power of 80%, 88 children were calculated to be needed in the Intervention group and 88 in the Control. Baseline clinical data included oral examinations at the kindergartens. Follow‐up visits were made on the 6th, 12th and 18th month. At the end of the 24 months, both the Intervention and Control groups were visited for oral examinations. The primary outcome was caries incidence, measured by the number and proportion of children who developed new caries in the primary molars after 24 months. The secondary outcome was the number of primary molars that developed new caries (d‐pms). Frequency distributions of participants by baseline socio‐demographic characteristics and caries experience were calculated. The chi‐square test was used to test differences between the caries experience in the Intervention and Control groups. The t test was used to compare the mean number of primary molars developing new caries between the Intervention Group and the Control Group. The number of children needed to treat (NNT) was also calculated. Results: At the 24‐month follow‐up, 19 (14.4%) developed new caries in the Intervention Group, compared to 60 (60.0%) in the Control Group (p =.001). On average, 0.2 (95% CI = 0.1–0.3) tooth per child in the Intervention Group was observed to have developed new caries compared to 1.1 (95% CI = 0.8–1.3) tooth per child in the Control Group (p =.001). The number of children needed to treat (NNT) to prevent one child from developing new caries was 2.2. Conclusions: The present study has demonstrated that 6‐month home visits to families of 5‐ to 6‐year‐olds are effective in caries prevention in 5‐ to 6‐year‐olds of low‐income families in a middle‐income country where access to health services, including oral health promotion services, is limited. [ABSTRACT FROM AUTHOR]

Background: The development and promotion of educational games are still outpacing knowledge of these games' effects, raising calls for evidence of benefits and challenges. Studies suggest that students and teachers like games, but the payoff of the investment in terms of increased motivation and achievement remains unclear. Objectives: This study investigates the pure effect of a marketing simulation game on motivation, perceived learning and achievement, above and beyond regular student‐active instruction. Methods: We applied a randomized, controlled experiment in a marketing course in upper‐secondary schools (Nclasses = 22; Nstudents = 433) comparing a collaborative–competitive marketing simulation game with regular, case‐based, student‐active instruction on three groups of outcome measures: motivation, perceived ability, and achievement. Additionally, students and teachers provided quantitative and qualitative feedback on game experiences. Results and Conclusions: We showcase the importance of a robust study design with valid compound instruments. Moreover, investigations of the game implementation and experiences reveal insights about intervention timing, differential negative consequences by gender and need for reflection opportunities. We find no clear evidence of positive or negative effects of the game, despite students' and teachers' satisfaction. Implications: Beyond the effect evaluation, we offer recommendations to researchers and developers of educational games about scaffolding, timing and teacher competence building. Lay Description: What is already known about this topic: Some curricula contains many terms and complex knowledge links.Simulation games are a popular remedy for these challenges.Prior studies have relied on users' satisfaction with the game and unrealistic comparisons. What this paper adds: This experiment compares game usage and regular student‐active instruction.They use various measures of satisfaction, motivation, perceived learning and achievement.The game has no effect on main outcomes. Implications for practice and/or policy: Game implementation requires digitally acquainted and trained teachers.Uncritical game design and use may motivate competitive boys over collaborative girls. [ABSTRACT FROM AUTHOR]

Background: Learners in a given massive open online course (MOOC) are usually provided with the same learning materials, guided by the same syllabus, and assessed in the same format. This "one‐size‐fits‐all" approach constrains learners' ability to reap the optimal benefits from online learning. Objectives: This study aims to characterize learners' differences in MOOC learning. Specifically, it examines how learners might vary in their enrolment motivation and the development of continuance intention to learn in a MOOC because of their gender and employment status. Methods: Data were collected via a questionnaire survey. Quantitative and qualitative methods were used to analyse data from 664 learners in a Chinese MOOC. Results and Conclusion: The research revealed significant differences in learners' enrolment motivation across groups defined by employment status, but not for gender groups. Learner groups defined by gender and employment status experienced variant psychological processes when deciding to continue to learn in the MOOC. Major Takeaways: Working adults stressed the instrumental values derived from MOOC learning; therefore, it is vital to design and integrate additional features into the MOOC to satisfy their needs. Besides, it would be critical to understand female learners' and working adults' expectations of MOOC learning, as they are more sensitive to confirmation in determining their attitudes toward learning in a MOOC. A short pre‐course survey of learners' expectations would serve the purpose. Lay Description: What is already known about this topic?: Gender and employment status are associated with varied learning outcomes in MOOCs.Motivation and continuance intention are two critical psychological mechanisms.Confirmation, satisfaction, and attitude are determinants of continuance intention. What this paper adds?: Students' enrolment motivation is significantly different from that of working adults.No significant difference was found in motivation across gender.Working adults' and female learners' attitudes were more determined by confirmation.Students and male learners depended more on satisfaction in forming their attitudes. Implications for practitioners: Working adults stressed the instrumental value derived from MOOC learning.Extra features should be integrated into MOOCs to satisfy working adults' needs.It is critical to understand female learners' and working adults' expectations.A short pre‐course survey could shed light on learners' expectations [ABSTRACT FROM AUTHOR]

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

Introduction: Heavy‐load strength training (HLT) is generally considered the Gold Standard exercise modality for inducing gains in skeletal muscle strength. However, use of heavy external exercise loads may be contraindicative in frail individuals. Low‐load resistance exercise combined with partial blood‐flow restriction (LL‐BFR exercise) may offer an effective alternative for increasing mechanical muscle strength and size. The aim of this study was to compare the effect of LL‐BFR training to HLT on maximal muscle strength gains. Prospero registration‐id (CRD42014013382). Materials and methods: A systematic search in six healthcare science databases and reference lists was conducted. Data selected for primary analysis consisted of post‐intervention changes in maximal muscle strength. A random‐effects meta‐analysis with standardized mean differences (SMD) was used. Results: Of 1413 papers identified through systematic search routines, sixteen papers fulfilled the inclusion criteria, totalling 153 participants completing HLT and 157 completing LL‐BFR training. The magnitude of training‐induced gains in maximal muscle strength did not differ between LL‐BFR training and HLT (SMD of −0.17 (95% CI: −0.40; 0.05)). Low between‐study heterogeneity was noted (I2 = 0.0%, Chi2P = 9.65). Conclusion: Low‐load blood‐flow‐restricted training appears equally effective of producing gains in maximal voluntary muscle strength compared to HLT in 20‐ to 80‐year‐old healthy and habitually active adults. [ABSTRACT FROM AUTHOR]

Background: Tendinopathy is caused by repetitive motion, excessive stress on the tendon, overstretch, and motion past the critical angle of rotation or translation. There are various treatment options available for tendinitis, including those affecting both the upper and lower limbs and those of calcific and non‐calcific types. Hypothesis/purpose: Few reviews have analyzed the efficacy of Extracorporeal Shockwave Therapy (ESWT) in treating upper and lower limb tendinopathies while considering calcific and non‐calcific‐type tendinitis. This paper provides a review and meta‐analysis on Randomized Controlled Trials (RCTs), which compared results from a group undergoing ESWT treatment to another group under different treatments. Study design: Systematic review and meta‐analysis. Methods: A systematic search was conducted on PubMed, Web of Science, Embase, the Cochrane Central Register of Control Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) databases for articles published up to January 2022. The reference lists of identified articles were further scanned. Twenty‐two studies were included in the meta‐analysis. Results: Meta‐analysis showed no difference in pain reduction in ESWT when compared with a comparison group at 4 (p = 0.26) and 12 weeks (p = 0.33). There were no differences in DASH scores at 12 months between the two groups (p = 0.32). Conclusion: Extracorporeal Shockwave Therapy (ESWT) is effective when used to treat lower limb and calcific tendinitis. It does not yield any better results than other treatment options in managing upper limb tendinopathies and non‐calcific tendinopathies. Key points: What is known about the subjectThere are various treatment options available for tendinitis, including those affecting both the upper and lower limbs and those of calcific and non‐calcific types. The most common are extracorporeal shockwave therapy (ESWT), wait and see policy, laser therapy, ultrasound, surgical decompression, Platelet‐ Rich Plasma (PRP) injections, mucopolysaccharide supplements, autologous blood injection, paratendinous dry needling, ibuprofen tablets, intense pulsed therapy, and radiofrequency microdebridement. What this study adds to existing knowledgeThis review concluded that ESWT is better to be used to treat lower limb and calcific tendinitis. It does not yield any better results than other treatment options in the treatment of upper limb tendinopathies and non‐calcific tendinopathies. [ABSTRACT FROM AUTHOR]

Background: Family members provide the majority of informal care for older adults in Sweden. Nevertheless, by providing a range of assistance, peers often emerge as a central to counter social isolation among older adults. Therefore, there is a need to know more about what informal care provision by older adults to their peers means for different groups of older adults. Aim: This study investigated the types of informal care and support that older adults provide to their peers in Sweden, and how these types of care and support are associated with demographic characteristics and social isolation. We also compared older adults who provide informal care and support with those who do not. Method: For this purpose, we used a national online survey named "Involuntary loneliness among senior citizens" answered by 10,044 older adults enrolled in the Swedish Citizen Panel. We adopted a mixed‐method design to analyse the survey data, including free‐text options (n = 2155) and numerical data. Social isolation was assessed using a score built from the social loneliness items of the UCLA Loneliness Scale. Results: In our population, 21.5% of the older adults were providing informal care and support to their peers. Practical/instrumental help was frequently offered by younger participants (<75 years), men and respondents who were less socially isolated. On a general level, the factors that were positively associated with giving informal care and support to peers were older age, being male, retired, married/living in a relationship, living in an urban area/big city and exhibiting greater isolation. Focusing specifically on social support shows that older participants (>80) and those experiencing less social isolation (score < 24) were more engaged in social activities. Conclusion: This paper is unique in exploring the informal peer‐caregiver's perceptions of isolation. Data were collected during the COVID‐19 pandemic; this highlights the need to recognise informal care and support between older adults and to acknowledge their contributions as an essential component of Swedish civil society, especially during a societal crisis. [ABSTRACT FROM AUTHOR]

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Student engagement within the development of learning analytics services in Higher Education is an important challenge to address. Despite calls for greater inclusion of stakeholders, there still remains only a small number of investigations into students' beliefs and expectations towards learning analytics services. Therefore, this paper presents a descriptive instrument to measure student expectations (ideal and predicted) of learning analytics services. The scales used in the instrument are grounded in a theoretical framework of expectations, specifically ideal and predicted expectations. Items were then generated on the basis of four identified themes (Ethical and Privacy Expectations, Agency Expectations, Intervention Expectations, and Meaningfulness Expectations), which emerged after a review of the learning analytics literature. The results of an exploratory factor analysis and the results from both an exploratory structural equation model and confirmatory factor analysis supported a two‐factor structure best accounted for the data pertaining to ideal and predicted expectations. Factor one refers to Ethical and Privacy Expectations, whilst factor two covers Service Feature Expectations. The 12‐item Student Expectations of Learning Analytics Questionnaire (SELAQ) provides researchers and practitioners with a means of measuring of students' expectations of learning analytics services. Lay Description: What is already known about this topic: Understanding student expectations of learning analytics is an important challenge for higher education institutions to address.Research has measured student beliefs regarding the features and ethical procedures of a learning analytics service. What this paper adds: This study builds on prior work by developing an instrument to measure student expectations of learning analytics services.This study proposes that student expectations of learning analytics can be measured using two subscales: (a) ethical and privacy expectations and (b) service expectations. Implications for practice and/or policy: Higher education institutions should understand what students expect from learning analytics services before any implementations are actioned.Higher education institutions have a validated instrument to gauge and understand student expectations of learning analytics services.Results obtained from the instrument can be used to inform the development of specific learning analytics policies for each higher education institution. [ABSTRACT FROM AUTHOR]

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

Reliability is a measure of how well a product will perform under a certain set of conditions for a specified amount of time especially in the field environments. In this paper, a reliability study of a computer numerical control (CNC) system is described. For this analysis, field failure data from a shop manufacturing factory collected over the course of a year on approximately 20 CNC machine tools during their operating period were analyzed. Based on the field failure data, the two-parameter exponential distribution was found to be applicable to describe the time between failures of the CNC system from among many distributions including Weibull, gamma, two-parameter exponential, normal, and logistic using the chi-squared test. In this paper, we discuss the reliability estimation of the CNC system based on the collected field failure data from a manufacturing factory using the maximum likelihood estimate (MLE) and uniform minimum variance estimate (UMVUE) methods. We also discuss the confidence intervals of the mean residual lifetime and reliability function. The result shows that the UMVUE method can provide much better and more accurate results in estimating the reliability of the CNC system than the MLE. This finding, on the one hand, seems to be obvious because the UMVUE is not only an unbiased estimator but also sufficient statistic with the smallest variance; on the other hand, it is not straightforward to obtain the UMVUE of any complex function, which is the reliability function in this case. This is a very important finding and is very encouraging because it indicates that the reliability analysis of the CNC system based on the UMVUE can be more than compensated by the ability of the complexity of parameter estimation method to better evaluate and predict the reliability of the CNC system. Hence, we believe that it is worth the effort to derive those parameter functions using UMVUE method. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To highlight the experiences and challenges of international medical graduates (IMGs) living and working in rural and remote Tasmania, and how this informs their acculturation and retention in the state. Design: This paper reports the findings from the Tasmanian IMG questionnaire, which was administered both in hardcopy and online format to all known IMGs within the state. A total of 105 questionnaires were returned, representing a response rate of 30.0%. Results: IMGs were from the 30 countries and the majority were under 49 years of age, had migrated in the past 10 years, with over half having worked in the state for less than 2 years. Many IMGs indicated that they were satisfied with their current employment, the medical facilities, the friendliness of their patients and the friendliness of the community where they lived, and would like to stay much longer in Tasmania. Conclusions: Many IMGs have previously lived and worked in rural areas and are reasonably satisfied with their current employment and lifestyle in Tasmania. However, the following factors play an important part in their views and attitudes: employment satisfaction, access to schools, employment for spouse or partner and access to cultural or religious foods and goods. Nevertheless, beyond employment satisfaction, employment itself, coupled with career pathway and training opportunities, were highlighted as contributory factors for leaving Tasmania. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this analysis was to assess the prevalence of clinical features, comorbidities, complications and treatment options in the patients with COVID‐19 and compare incidence of these clinical data in severe and non‐severe patients. Design: Systemic review and Meta‐analysis. Methods: PubMed, Embase, Scopus and Web of Sciences databases were searched to identify relevant papers until 20 July 2020. All studies comparing clinical data of severe and non‐severe patients of COVID‐19 were included. Heterogeneity across included studies was determined using Cochrane's Q test and the I2 statistic. Results were expressed as odds ratio with accompanying 95% confidence intervals. Results: Twelve studies with 3,046 patients were included. The result showed the most prevalent clinical symptoms were fever 88.3%, cough 62.2%, fatigue 39.5% and dyspnoea 31.5%. Further meta‐analysis showed incidence of fever, cough, fatigue and dyspnoea was higher in severe patients. The most prevalent comorbidities were hypertension 22.6%, diabetes 11.5%, cardiovascular disease 10.3% and cancer 2.5%. We found that compared with non‐severe patients, the symptoms, existing comorbidities and complications are prevalent in severe COVID‐19 patients. Future well‐methodologically designed studies from other populations are strongly recommended. [ABSTRACT FROM AUTHOR]

Objective The purpose of this review was to systematically evaluate the effects of an alcohol vehicle solution ( V- Sol) compared with an essential-oils mouthwash ( EOMW) and if available with a water-based control ( WC) on plaque, gingival inflammation parameters and extrinsic tooth staining. Materials and Methods The Pub Med- MEDLINE, Cochrane- CENTRAL and EMBASE databases were searched. Where appropriate, a meta-analysis was performed, and difference of means ( DIFFM) as calculated. Results In total, 971 unique papers were found of which five met the eligibility criteria. The DIFFM of the meta-analysis of four 6-month studies showed that the EOMW provided significantly better plaque control ( DIFFM = 0.39, P < 0.00001) and gingival inflammation reduction as measured by the Löe and Silness Index ( DIFFM = 0.36, P = 0.00001) as compared to the V- Sol. Regarding extrinsic tooth staining, a small but significant difference ( DIFFM = −0.08, P = 0.03) was observed. Conclusion Limited data, but with a low risk of bias, were available to assess the potential benefit of the alcohol-containing V- Sol. 'High'- and 'moderate'-quality data were available for the analysis of plaque and gingivitis, respectively. Within these limitations, EOMW appears to provide a significant oral health benefit during the 6 months of use. The data retrieved for this review suggest that the essential oils produce an effect on plaque and gingivitis that extends beyond the V- Sol. Furthermore, the V- Sol proved to be no different from a WC. [ABSTRACT FROM AUTHOR]

As immersive virtual reality (IVR) systems proliferate in classrooms, it is important to understand how they affect learning outcomes and the underlying affective and cognitive processes that may cause these outcomes. Proponents argue that IVR could improve learning by increasing positive affective and cognitive processing, thereby supporting improved performance on tests of learning outcome, whereas opponents of IVR contend that it could hurt learning by increasing distraction, thereby disrupting cognitive learning processes and leading to poorer learning outcomes. In a media comparison study, students viewed a biology lesson either as an interactive animated journey in IVR or as a slideshow on a desktop monitor. Those who viewed the IVR lesson performed significantly worse on transfer tests, reported higher emotional arousal, reported more extraneous cognitive load and showed less engagement based on EEG measures than those who viewed the slideshow lesson, with or without practice questions added to the lessons. Mediational analyses showed that the lower retention scores for the IVR lesson were related to an increase in self‐reported extraneous cognitive load and emotional arousal. These results support the notion that immersive environments create high affective and cognitive distraction, which leads to poorer learning outcomes than desktop environments. Lay Description: What is already known about the topic: IVR is gaining popularity in classrooms, and it is important to understand its effects on learning.Some theories suggest IVR could help learning because it may increase motivation.Other theories suggest IVR could hurt learning because it causes distraction. What this paper adds: The biology lesson displayed in IVR led to less learning than a PowerPoint lesson.Viewing the IVR lesson caused higher emotional arousal than viewing the PowerPoint lesson.The IVR lesson led to more distraction based on self‐report and EEG measures than the PowerPoint lesson.These results suggest that IVR creates high emotional and cognitive distraction, which leads to less learning. Implications for practice: Using IVR to replace traditional classroom lessons may not yet be useful.However, because students report enjoying IVR, it may be useful to use in addition to conventional lessons.Future research should determine how specific factors of the technology and the learners affect learning outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to see if a more sophisticated ventilator hyperinflation protocol might result in more sputum clearance compared to manual hyperinflation. Background: Hyperinflation has been used to mobilize lung secretions in mechanically ventilated patients in the intensive care unit setting for almost 50 years. In the past decade, rather than using a bag external to the ventilator circuit to deliver hyperinflation (known as "bagging" or "manual hyperinflation"), a new technique has evolved using existing ventilator circuitry (known as "ventilator hyperinflation"). One conservative ventilator hyperinflation protocol has demonstrated equivalence with manual hyperinflation in sputum clearance. Design A randomized crossover study. Method: Patients received manual hyperinflation and ventilator hyperinflation in two randomly ordered treatments on the same day by the same physiotherapist, using a ventilator hyperinflation protocol involving titration of hyperinflation according to airway pressure. Results: Between 2013 and 2018, 48 patients were enrolled in the study. Physiotherapy treatment using ventilator hyperinflation yielded significantly more wet weight sputum (median 2.84 g, IQR 1.81, 4.22) than treatment using manual hyperinflation (median 1.5 g, IQR 0.73, 2.31, P <.001), without significant differences in secondary measures. Conclusions: A more sophisticated approach to the titration of the volume delivered using ventilator hyperinflation relative to the airway pressure resulted in greater wet weight sputum cleared during physiotherapy treatment. Relevance to Clinical Practice: The results presented in this paper demonstrate that the application of ventilator hyperinflation using peak airway pressure rather than tidal volume may be superior in facilitating sputum clearance and improved oxygenation without patient harm. [ABSTRACT FROM AUTHOR]