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Background: Investigating emotion sequence patterns in the posts of discussion forums in massive open online courses (MOOCs) holds a vital role in shaping online interactions and impacting learning achievement. While the majority of research focuses on the relationship between emotions and interactions in MOOC forum discussions, research on identifying the crucial difference in emotion sequence patterns among different interaction groups remains in its infancy. Objectives: This research utilizes deep learning and sequential pattern mining to investigate whether there are differences in emotion sequence patterns across different groups of learners who exhibit various types of interactions in online discussion forums. Methods: Data from a comprehensive array of sources, including log files, discussion texts and scores from 498 learners in online discussion forums, were collected for this study. The agglomerative hierarchical algorithm is used to classify learners into groups with different levels of interactions. Additionally, we implement and evaluate multiple deep learning models for detecting different emotions from online discussions. Relevant emotion sequence patterns were identified using sequence pattern analysis and the identified emotion sequence patterns were compared across different groups with different levels of interactions. Results and Conclusions: Using an agglomerative hierarchical algorithm, we classified learners into three distinct groups characterized by different levels of interactions: high, average and low level. Leveraging the bi‐directional long short‐term memory model for emotion detection yielded the highest predictive performance, with an impressive F‐measure of 94.01%, a recall rate of 93.83% and an accuracy score of 95.01%. The results also revealed that learners in the low‐level interaction group experienced more emotion transition from boredom to frustration than the other two groups. Therefore, the aggregation of students into groups and the utilization of their MOOC log data offer educators the capability to provide adaptive emotional feedback, customize assessments and offer more personalized attention as needed. Lay Description: What is currently known about the subject matter: Emotions are dynamic over time when learners experience cognitive disequilibrium/equilibrium.Online interactions are critical components, which influence learners' emotional state, cognitive processes and learning achievement.It is not clear what are differences in emotion sequence patterns across the groups with different interaction types. What the paper adds: An agglomerative hierarchical algorithm was implemented to cluster learners into three groups by analysing behavioural data.We explore possibilities for automated classification of emotions using deep learning approaches.Learners in the low‐level interaction group experienced more emotion transition from boredom to frustration. Implications for practitioners: A considerable amount of effort should be expended to identify and respond to learners who experience boredom and frustration emotions.Designing interventions or scaffolding to facilitate learners' interaction and promote favourable emotions.Educators could provide more personalized support based on learners' online interaction cluster. [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]

Background: Mindfulness practices enhance executive function skills and academic achievement, spurring interest in integrating mindfulness interventions into education. Embedding mindfulness practice into a digital math game may provide a low‐cost, scalable way to induce mindfulness and boost game‐based learning, yet this approach remains unexplored. Objectives: We investigated the learning benefits of integrating mindfulness exercises in a digital math learning game and examined how students' trait mindfulness might moderate the outcomes. Methods: Two classroom studies were conducted with 404 5th and 6th grade students from six public schools in the U.S. (nStudy 1 = 227, nStudy 2 = 177). The two randomized controlled experiments assigned students to one of the three conditions: passive control (playing the digital learning game Decimal Point), story‐enriched active control, or mindfulness‐enriched condition. Trait mindfulness, learning gains, and in‐game problem‐solving (including problem‐solving duration, error count and correctness after reminder) were assessed. Study 2 included a manipulation check to better understand the effects of the mindfulness intervention. Results: Findings showed no significant differences in learning gains, problem‐solving duration or error count among the conditions. Students' trait mindfulness did not moderate these outcomes. Mindfulness reminders in the mindfulness‐enriched game led to more correct answers after errors than jokes in the story‐enriched game. Study 2 revealed that we failed to induce higher state mindfulness through the mindfulness inductions. Conclusions: Mindfulness prompts could be especially beneficial for students experiencing frustration during gameplay, warranting more exploration for digital game‐based instruction. We highlight barriers and future directions for fostering mindfulness through computer‐based instruction in classrooms. Lay Description: What is currently known about this topic?: Researchers focus on digital games as productive learning environments for math, with potential for higher learning gains compared with traditional methods. However, results are mixed, and not all games lead to improved math outcomes.Executive function (EF) skills are crucial for math learning, and mindfulness‐based interventions show promise in enhancing EF skills in school‐aged students.Embedding mindfulness practice into a digital math game may provide a low‐cost, scalable way to induce mindfulness and, in turn, boost EF skills and game‐based learning, yet this approach remains unexplored What does this paper add?: This paper presents the results of two randomized control trials investigating the feasibility and benefits of incorporating mindfulness exercises into a digital math game designed for middle school students. Benefits are compared to those of a story‐enriched and regular version of the same digital math learning game.The paper also explores variations in the effects of the mindfulness‐enriched game based on students' initial trait mindfulness levels.We observe that listening to mindfulness inductions at the beginning of game sessions do not induce mindfulness, and therefore does not benefit math learning.We find that mindfulness prompts received after recurrent errors can be beneficial for students' problem solving. Implications of study findings for practitioners: Our study provides important information on how digital learning game designers should attempt to induce mindfulness in a digital game to promote learning.Digital learning game designers should consider incorporating mindfulness exercises into their games strategically. Presenting mindfulness inductions in audio format at the beginning of game sessions may not induce mindfulness or benefit math learning. Instead, designers should focus on integrating mindfulness prompts at moments when students encounter frustration within the learning game.Beyond embedding audio mindfulness exercises in the game, learning designers should also consider alternative technological and game features to induce mindfulness within a learning game. [ABSTRACT FROM AUTHOR]

Background: Learner profiles detected from digital trace data are typically triangulated with survey data to explain those profiles based on learners' internal conditions (e.g., motivation). However, survey data are often analysed with limited consideration of the interconnected nature of learners' internal conditions. Objectives: Aiming to enable a thorough understanding of trace‐based learner profiles, this paper presents and evaluates a comprehensive approach to analysis of learners' self‐reports, which extends conventional statistical methods with psychological networks analysis. Methods: The study context is a massive open online course (MOOC) aimed at promoting physical activity (PA) for health. Learners' (N = 497) perceptions related to PA, as well as their self‐efficacy and intentions to increase the level of PA were collected before and after the MOOC, while their interactions with the course were logged as digital traces. Learner profiles derived from trace data were further examined and interpreted through a combined use of conventional statistical methods and psychological networks analysis. Results and Conclusions: The inclusion of psychological networks in the analysis of learners' self‐reports collected before the start of the MOOC offers better understanding of trace‐based learner profiles, compared to the conventional statistical analysis only. Likewise, the combined use of conventional statistical methods and psychological networks in the analysis of learners' self‐reports before and after the MOOC provided more comprehensive insights about changes in the constructs measured in each learner profile. Major Takeaways: The combined use of conventional statistical methods and psychological networks presented in this paper sets a path for a comprehensive analysis of survey data. The insights it offers complement the information about learner profiles derived from trace data, thus allowing for a more thorough understanding of learners' course engagement than any individual method or data source would allow. Lay Description: What is already known about this topic: Researchers have made extensive use of data from online learning platforms—often referred to as learning trace data—to understand how learners engage in online learning activities.Surveys are often used to gather information about learners' motivation, perceptions, and other internal factors, to complement the insight gleaned from learning traces and thus create a more complete picture of the learning behaviour.When analysing survey data, the focus is usually on individual factors without considering how different factors are connected and affect one another.Psychological networks analysis is a novel analytic approach to studying complex phenomena both in psychology and education. What this paper adds: The paper uses psychological networks as a method for examining mutual relations among learners' internal factors (e.g., motivation, perceptions) measured through self‐reports before and after a course.By combining conventional statistical analysis of self‐reports with psychological networks analysis, the paper develops a comprehensive picture of learners' internal factors measured through self‐reports, one that accounts for both individual and interconnected nature of those factors.This comprehensive approach to information extraction from surveys allows for better understanding of trace‐based learner profiles, that is, profiles mined from data about learners' interaction with online learning activities. Implications for practice and/or policy: The presented method paves a way for a comprehensive analysis of the data collected from learners through surveys.It helps us gain a better understanding of learners' engagement with online learning activities.It can advance the evaluation of digital educational programs that aim to encourage changes in health‐related behaviour. [ABSTRACT FROM AUTHOR]

Background: Research on cognitive effects of educational games in general shows promising results. However, there are large variations in learning outcomes between individual educational games. Research on the design process and different design elements of educational games has led to some interesting directions, but some design aspects remain unclear. Objectives: We examined how an educational game designed on the basis of intrinsic integration theory, based on a strong alignment between game and learning goals, supports the learning of Newtonian mechanics. Methods: This study applied a mixed‐methods approach (N = 223). A pre‐ and post‐test design was used to examine possible learning and transfer effects fostered by playing the educational game, Newton's Race. To examine how players played the game, log data for each player were digitally recorded during gameplay. Results and Conclusions: Our findings demonstrated a significant positive learning effect of Newton's Race (p = 0.003, d = 0.201). This can be explained through the acquired log data. Log data show that players' gameplay mostly matched expected learning during the game, with physically correct game settings occurring more and more as gameplay progressed. The ability to transfer learned knowledge to other situations was shown to be limited to situations closely resembling the game environment. Implications: Similarly, designed intrinsically integrated games on different (physics) subjects could also foster learning in a relative short time. To foster transfer to other situations we propose embedding the game within other instructional activities. Lay Description: What is already known about this topic?: Research on cognitive effects of educational games in general shows promising results.There are large variations in learning outcomes between individual educational games.Some design aspects remain unclear on the design process and different design elements of educational games.Attempting to integrate learning with gameplay, without affecting the enjoyability of the game, is not easily achieved. What this paper adds?: The current study fits within the research body that emphasizes the importance of aligning gameplay with learning in educational games (i.e., intrinsic integration).Evidence for intrinsic integration as a key element in the design process, found by examining players' log data.A better understanding of how an intrinsically integrated game supports the learning of Newtonian mechanics. Implications for practice and/or policy: Similarly, designed intrinsically integrated games on different (physics) subjects could also foster learning in a relative short time.To foster transfer to other situations we propose embedding the game within other instructional activities. [ABSTRACT FROM AUTHOR]

Background: With the growing integration of technology in education, the adoption of blended learning (b‐learning) has gained attention. B‐learning combines traditional classroom teaching with online components, holding potential to enhance student outcomes and educational efficiency. Yet, current research predominantly concentrates on higher education institutions in urban areas, creating a void in understanding its impact on K‐12 education, particularly in rural settings. Objectives: This qualitative study aims to propose recommendations for successful implementation of blended learning in rural K‐12 areas by addressing the key stakeholders influencing its adoption and identifying the main factors affecting its success. Methods: We performed a content analysis of grey literature documents detailing the implementation of b‐learning in K‐12 education. Additionally, interviews with crucial stakeholders such as teachers, principals, and experts in rural schools in South America provide insights into the challenges and prospects of b‐learning adoption in these contexts. Results and Conclusions: The study identifies pivotal stakeholders for effective b‐learning implementation, outlining their roles and addressing challenges inherent in rural settings. Recommendations for enhancing b‐learning's implementation in developing countries are also proposed. The research underscores the significance of involving diverse stakeholders such as governmental bodies, school leaders, educators, students, and families to ensure a holistic and efficient approach to blended learning. Lay Description: What is currently known about this topic: Blended Learning Definition and Benefits: Blended learning combines face‐to‐face and online instruction, enhancing student engagement and personalization by providing diverse learning pathways.Growth in K‐12 Implementation: Blended learning gained traction in K‐12 education, boosting academic outcomes, driven by recognition of learner diversity and potential in meeting students' needs.Contextual Challenges: Implementation challenges arise in low‐income households and rural areas, including limited access to technology and internet connectivity, impacting student engagement and success. What does this paper add: Focusing on Rural Dynamics: This study helps to fill a gap by investigating blended learning in rural K‐12 settings, spotlighting key players and success drivers in these unique contexts.Recommendations from Various Sources: By combining interviews and grey literature, this research generates comprehensive, practical recommendations grounded in both empirical insights and real‐world perspectives.Insights into Rural Hurdles: This paper extends the discussion on blended learning by addressing specific rural barriers, proposing family involvement, private sector partnerships for training, and tailored pedagogical strategies. Implications for practice or policy: Leadership and Collaboration: Effective school leadership and collaboration with local governments are pivotal for fruitful blended learning implementation, ensuring defined roles, responsibility, and accountability.Adaptable Curriculum Design: An adaptable, centralized curriculum aligns with recommendations, fostering efficient tracking of student progress and enabling customized learning.Engagement‐Centric Pedagogies: Recommendations spotlight interactive, student‐centered teaching methods, tailored to diverse student needs, nurturing active participation and elevated learning outcomes. [ABSTRACT FROM AUTHOR]

Background: Painting is the foundational expression across all art forms and is one of the key creative practices for fostering students' aesthetic ability and creativity within fine arts courses. Collaborative painting in the form of socially shared regulation of learning (SSRL) can be recognized as an effective strategy for enhancing creativity in both individual and group work. However, the absence of contextual experiences and collaborative spaces poses challenges for students in cultivating their creativity in painting. Objectives: The present study explores students' creativity, socially shared regulation (SSR) and positive painting behaviours using an SSRL‐based collaborative painting approach in the metaverse (Meta‐CP). Methods: Via a quasi‐experimental design, a total of 40 Chinese students in fifth grade were recruited and were randomly divided into an experimental group and a control group, with 20 students utilizing the Meta‐CP approach, while the remaining 20 students followed the conventional SSRL‐based paper‐and‐brush collaborative painting (C‐CP) approach. The Meta‐CP approach not only offers an authentic painting context and a collaborative space but also facilitates the collaborative process through the SSRL framework. The data collection included students' creative tendency, painting works and painting process. Results and Conclusions: The Meta‐CP approach effectively enhances students' creativity concerning adventure, curiosity and imagination, as well as results in the creation of more distinctive and logical artistic works. Furthermore, the approach significantly improved the quality of students' SSR. Additionally, students utilizing the Meta‐CP approach displayed more positive painting behaviours compared with those employing the C‐CP approach. Lay Description: What is already known about this topic:Collaborative painting is an effective strategy for enhancing creativity.Socially shared regulation of learning (SSRL) fosters collaborative learning.Students in collaborative painting may lack a contextual and synchronized painting space.The metaverse benefits in terms of contextual experiences and collaborative spaces. What this paper adds:Using an SSRL‐based collaborative painting approach in the metaverse (Meta‐CP) is effective in improving students' creativity.The Meta‐CP approach has the potential to improve students' quality of socially shared regulation (SSR), and positive painting behaviours. Implications for practice and/or policy:The metaverse provides an immersive synchronized painting space for art education to stimulate students' creative potential.The metaverse with proper learning strategies (e.g., SSRL) provides an effective collaborative learning environment for creation. [ABSTRACT FROM AUTHOR]

Background: With the rapid proliferation of online education, it is incumbent upon teachers to find ways to provide online students with science laboratory experiences. Existing research on online labs focuses heavily on computer‐supported inquiry learning environments, such as virtual laboratories and remote laboratories. There are limited studies on kitchen labs or home labs. Objectives: This study investigated the effectiveness of home labs using lab kits from two perspectives: students' perceptions and experiences of labs conducted in a home environment, as well as whether home labs help with students' knowledge acquisition. Methods: This study employed lab quizzes to assess students' performance and lab reports to evaluate students' ability to interpret the lab results accurately in the authentic home lab contexts. Surveys and semi‐structured interviews were used to collect students' perceptions and experience data regarding these hands‐on experiments at home. Results and Conclusions: We found that students' perceptions of home labs are similar to that of face‐to‐face labs, but they generally perceive home labs to be less complex. Students' performances on lab quizzes and lab reports indicate that the majority of them were able to apply the key scientific concepts to accurately interpret lab results in authentic home lab contexts. Students perceived that home labs provide flexibility and help in connecting learning to the real world. However, they also face challenges such as unexpected results and ambiguity during the process. Implications: Based on the key findings from this study and our reflections, four practice guidelines were provided for teaching hands‐on experiments online. Lay Description: What is already known about this topic: Science‐laboratory activities play a critical role in science education. The lack of best practices for teaching science laboratory activities online has become one of the most significant barriers to online education.Existing online labs research focuses heavily on computer‐supported inquiry learning environments, such as virtual laboratories and remote laboratories. There are limited studies on kitchen labs or home labs and some research has mainly an exploratory nature. What this paper adds: The value of authentic hands‐on learning experience is more than the acquisition of laboratory design skills, but also the acquisition of problem‐solving skills in real‐world.This study reported findings of the evaluation of hands‐on home laboratory activities in an online science course from both students' perception and their knowledge acquisition perspectives.This study also explored the benefits and challenges students faced in home labs. Implication for practice and/or policy: Practical guidance and implications for teaching and learning science online using laboratory activities were provided by sharing our experience and lessons learned through the whole process.We recommend that practitioners incorporate more scaffolding and peer collaboration opportunities as well as key concept reflection as teaching strategies to improve the effectiveness of home lab activities. [ABSTRACT FROM AUTHOR]

The employment of two‐sample hypothesis testing in examining random graphs has been a prevalent approach in diverse fields such as social sciences, neuroscience, and genetics. We advance a spectral‐based two‐sample hypothesis testing methodology to test the latent position random graphs. We propose two distinct asymptotic normal statistics, each optimally designed for two different models—the elementary Erdős–Rényi model and the more complex latent position random graph model. For the latter, the spectral embedding of the adjacency matrix was utilized to estimate the test statistic. The proposed method exhibited superior efficacy as it accomplished higher power than the conventional method of mean estimation. To validate our hypothesis testing procedure, we applied it to empirical biological data to discern structural variances in gene co‐expression networks between COVID‐19 patients and individuals who remained unaffected by the disease. [ABSTRACT FROM AUTHOR]

Background: There is a lack of randomized controlled trials of behavioral interventions and process‐level research related to alcohol reduction among patients with chronic liver disease (e.g., hepatitis C viral (HCV) infection). We conducted a process‐level, secondary analysis of the Hepatitis C‐Alcohol Reduction Treatment (HepART) trial to investigate the association between change in psychological processes posited by the Integrated Behavioral Model (IBM) and change in World Health Organization (WHO) drinking risk levels. Methods: Patients with HCV who consume alcohol were recruited from hepatology clinics and received provider‐delivered SBIRT (Screening, Brief Intervention, Referral to Treatment) or SBIRT+ 6 months of co‐located alcohol counseling. Treatment arms were combined for this analysis because no between‐group differences were found. At baseline and 6 months, the timeline followback method was used to determine alcohol risk levels according to the 2000 WHO risk categories (based on average grams of alcohol per day). Changes in alcohol consumption and WHO risk levels were quantified and regressed on change in individual psychological processes (e.g., readiness, self‐efficacy, motives, attitudes, and strategies) from baseline to 6 months. Results: At the baseline assessment, 162 participants were classified as abstinent (5%), low (47%), moderate (16%), high (19%), or very high (13%) WHO risk levels. At 6 months, 38% remained at the same risk level and 48% decreased by at least one level. In univariate analyses, changes in 7 of 12 psychological processes were associated with change in risk levels. Adjusted multivariate analyses demonstrated that change in four processes were significantly associated with change in risk levels, including SOCRATES Taking Steps, Ambivalence, and Recognition scores and alcohol reduction strategies. Conclusions: These findings demonstrate significant reductions in quantitative indices of alcohol consumption following opportunistic alcohol interventions in patients with HCV. However, results provided mixed support for associations between change in IBM psychological processes and alcohol consumption. [ABSTRACT FROM AUTHOR]

Background: Alcohol‐associated cardiomyopathy (ACM) is a cardiac muscle disease characterized by inflammation and oxidative stress. Thromboxane‐prostanoid receptor (TP‐R) plays an important role in the pathogenesis of cardiovascular disease. Herein, we hypothesize that TP‐R mediates alcohol‐induced early cardiac injury. Methods: Eight‐week‐old male C57BL/6 wild‐type mice were fed a chronic ethanol (ET) or control diet (CON) for 10 days followed by a single binge of ethanol or maltose‐dextrin through oral gavage. A cohort of ethanol‐fed mice received SQ 29,548 (SQ), a TP‐R antagonist. RNA sequencing, real‐time PCR, and western blot analysis were performed on left ventricle to investigate alterations in genes and/or proteins mediating oxidative stress, inflammation, and cardiac remodeling. Sirius Red staining was performed to measure myocardial fibrosis. Results: RNA‐sequencing analysis of myocardium from CON and ET groups identified 142 genes that were significantly altered between the two groups. In particular, the gene expression of thioredoxin‐interacting protein (TXNIP), a component of NLR family pyrin domain containing 3 (NLRP3) signaling, which mediates oxidative stress and inflammatory response, was upregulated in response to ethanol exposure. The myocardial protein levels of TP‐R and thromboxane A2 synthase were increased upon alcohol exposure. Ethanol increased the levels of 4‐hydroxynonenal, a marker of oxidative stress, with a concomitant increase in the protein levels of TXNIP and NLRP3, and administration of SQ attenuated these effects. Additionally, ethanol increased the protein levels of pro‐inflammatory mediators, including tumor necrosis factor alpha and the NLRP3 downstream product, secretory interleukin 1 beta, and SQ blunted these effects. Finally, the Sirius red staining of the myocardium revealed an increase in collagen deposition in ethanol‐fed mice which was attenuated by TP‐R antagonism. Conclusion: This study demonstrates that ethanol promotes the NLRP3 signaling pathway within the myocardium, leading to a pro‐inflammatory milieu that potentially initiates early myocardial remodeling, and TP‐R antagonism attenuates this effect. [ABSTRACT FROM AUTHOR]

Background: Although the World Health Organization recommends visible and clear warning labels about the risks of alcohol consumption on containers and advertising, many of the currently used labels are too small to be visible. This study investigated the brain activity (using fMRI) and alcohol consumption intentions of French young men exposed to two warning formats displayed on alcoholic beverage advertisements: a small Text‐only Alcohol Warning (TAW) currently used in many countries, and a larger text‐and‐picture alcohol warning (PAW). Methods: Seventy‐four eligible 18–25‐year‐old male drinkers completed a face‐to‐face individual visit with a physician expert in addiction medicine. This was followed by the fMRI session during which they viewed 288 stimuli [96 alcohol advertisements with TAWs, the same 96 advertisements with PAWs, and 96 water advertisements (controls)] for 3 s each. If the advertisement made participants want ("yes")/do not want ("no") to consume the product, they pressed the corresponding button (self‐report responses). The number of "yes" responses was compared between advertisement types with a paired sample t‐test. Whole‐brain and region‐of‐interest (ROI) analyses of the fMRI data were performed. Results: Whole‐brain BOLD fMRI highlighted contrasting effects of PAWs and TAWs. Compared with TAWs, PAWs elicited more activation in the precuneus, angular gyrus, occipital, frontal and temporal areas, and less activation in the nucleus accumbens, ventral tegmental areas, and putamen areas (regions of the reward circuit). The ROI analysis confirmed less activation in the reward circuit (left and right ventral tegmental areas, left and right nucleus accumbens) when viewing PAWs than TAWs. Analysis of the self‐report responses indicated that the desire to consume the advertised alcohol product was lower when PAWs were viewed (compared with TAWs) (T = 8.18, p < 10−11). Conclusions: This is the first fMRI study to assess the effect of different alcohol warning formats. Our findings show that compared with TAWs, stronger PAWs in advertisements elicited less activity in key regions of the reward system. This suggests that the effects may influence the desire to consume alcohol products (self‐report response analysis). These results could help policymakers who are interested in developing more effective labeling measures that target young people. [ABSTRACT FROM AUTHOR]

Background: The Positive Drinking Consequences Questionnaire (PDCQ) was developed to measure positive consequences of alcohol use endorsed by college drinkers. Efforts to assess positive drinking consequences experienced by adolescents have been much more limited. The aim of the present study was to advance the psychometric testing and evaluation of the factor structure of the PDCQ in adolescents. Methods: The current sample consisted of 173 adolescents at T1 (mean age = 15 years, range = 13–17; 61% female) who reported alcohol use in the past 12 months. Data were collected at two time points over a 12‐month interval in the United States. Confirmatory factor analyses, internal consistency, test–retest reliability, and discriminant, concurrent, predictive, and incremental validity were tested. Results: Our analyses supported four factors of positive alcohol‐related consequences: sociability, liquid courage, sexual enhancement, and tension reduction. Internal consistency was moderate to high (α = 0.78–0.94, ω = 0.86–0.91 at T1; α = 0.59–0.93, ω = 0.85–0.93 at T2). Test–retest reliability was fair to good (ICC = 0.46–0.55). The PDCQ total and subscale factor scores demonstrated discriminant validity from negative alcohol expectancy. PDCQ total and subscale factor scores were positively associated with current alcohol consumption (ρs = 0.19–0.50 at T1; ρs = 0.17–0.46 at T2), indicating concurrent validity. Predictive validity analyses showed that the overall PDCQ scale score and the sociability subscale positively predicted maximum drinks 1 year later (ρs = 0.18–0.22). However, the sexual enhancement subscale was negatively predictive of typical drinking frequency 1 year later. Finally, the PDCQ showed incremental validity for concurrent alcohol consumption beyond that for alcohol expectancies and drinking motives. Conclusion: The present findings support for the reliability and validity of PDCQ for use in adolescents where it may have utility as an assessment tool for characterizing various aspects of positive drinking. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol spectrum disorder (FASD) is one of the leading causes of neurodevelopmental disorder for which there is a pressing need for an effective treatment. Recent studies have investigated the essential nutrient choline as a postnatal treatment option. Supplementation with choline has produced improvements in behavioral tasks related to learning and memory and reverted changes in methylation signature following third‐trimester equivalent ethanol exposure. We examined whether there are related improvements in hippocampal synaptic plasticity in vivo. Methods: Sprague–Dawley offspring were administered binge‐levels of ethanol from postnatal day (PND) 4 to 9, then treated with choline chloride (100 mg/kg/day) from PND 10 to 30. In vivo electrophysiology was performed on male and female offspring from PND 55 to 70. Long‐term potentiation (LTP) was induced in the medial perforant pathway of the dentate gyrus using a theta‐burst stimulation (TBS) protocol, and field‐evoked postsynaptic potentials (EPSPs) were evoked for 60 min following the conditioning stimulus. Results: Developmental ethanol exposure caused long‐lasting deficits in LTP of the slope of the evoked responses and in the amplitude of the population spike potentiation. Neither deficit was rescued by postnatal choline supplementation. Conclusions: In contrast to our prior findings that choline can improve hippocampal plasticity (Nutrients, 2022, 14, 2004), here we found that deficits in hippocampal synaptic plasticity due to developmental ethanol exposure persisted into adulthood despite adolescent choline supplementation. Future research should examine more subtle changes in synaptic plasticity to identify synaptic changes that mirror behavioral improvements. [ABSTRACT FROM AUTHOR]

Objective: To identify the technology and connectivity issues in rural and remote general practices, and the factors independently associated with these issues that negatively impact staff's capability to perform their job. Methods: An annual cross‐sectional survey of rural and remote general practice managers. Dependent variables included demographic data, practice size, geographic location, connection type and frequency of connectivity issues. Descriptive statistics are presented, and bivariate logistic regression was undertaken to determine factors independently associated with connectivity issues that negatively impact staff's capability to perform their job. Participants: One hundred sixty‐eight general practice managers from rural and remote New South Wales. Results: The majority of respondents (87%, n = 146) indicated that technology and connectivity issues had impacted staff's capability to perform their job. Internet problems were the most frequently reported issue (36%, n = 61). In bivariate analysis, practices that had a total clinical staff headcount between 5 and 7 (OR 0.27; 95% CI 0.10–0.67; p = 0.005) or between 8 and 11 (OR 0.39; 95% CI 0.16–0.95; p = 0.038) were significantly less likely to report technology and connectivity issues that negatively impact staff's capability to perform their job, compared with practices with a total clinical headcount of less than five. Conclusions: Technology and connectivity issues persist in rural and remote general practices. This is the first study to demonstrate that technology and connectivity issues impact on rural staff's capability to perform their job. Furthermore, smaller practices face more technology and connectivity issues that negatively impact staff's capability to do their job than larger practices. Further research is required to find solutions to address these challenges. [ABSTRACT FROM AUTHOR]

Introduction: The adoption of remote healthcare methods has been accelerated by the COVID‐19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID‐19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups. Methods: This was a mixed‐methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis. Findings: Survey responses were received from 292 staff and 1069 patients and carers. Twenty‐three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p < 0.001) and had more difficulty in understanding information (p = 0.005). Health status (p = 0.004), ethnicity (p < 0.001), gender (p < 0.001) and employment (p = 0.007) were associated with differential engagement with monitoring, and minority ethnic groups reported more difficulty understanding service information (p = 0.001). Qualitative data found illness severity to be an important factor in the support required, and patients' living situation and social network affected whether they found the service reassuring. Conclusion: Addressing health disparities must be a key focus in the design and delivery of remote care. Services should be tailored to match the needs of their local population, encourage access through collaboration and referral pathways with other services and monitor their inclusiveness. Involving patients and staff in service design can illuminate the diversity of patients' needs and experiences of care. Patient or Public Contribution: The study team met with service user and public members of the BRACE PPI group and patient representatives from RSET in a series of workshops. Workshops informed study design, data collection tools, data interpretation and dissemination activities. Study documents (such as consent forms, topic guides, surveys and information sheets) were reviewed by PPI members; patient surveys and interview guides were piloted, and members also commented on the manuscript. [ABSTRACT FROM AUTHOR]

Background: The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages. Methods: This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two‐round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator. Results: The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults. Conclusions: This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults. Patient or Public Contribution: Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings. [ABSTRACT FROM AUTHOR]

To accurately and timely evaluate the long‐term performance of cables in cable‐stayed bridges, an automatic perception technology scheme by on‐line monitoring of cable vibrations is proposed for the fatigue damage evaluation of in‐service cables. In the fatigue‐stress amplitude of cables, the stress produced by tension changes caused by external actions like traffic, wind, and temperature is the main component. When cables vibrate significantly, the stress caused by changes in cable vibration‐induced additional stress should not be neglected. Besides axial stress, bending stress is also significant in cable fatigue damage analysis. To make cable fatigue life prediction closer to real engineering scenarios, this factor should be considered. First, based on the cable dynamic stiffness theory, a method is proposed for the automatic gathering of the actual full‐stress time history of a cable by on‐line vibration monitoring. Furthermore, based on Miner's linear fatigue damage accumulation theory, an automatic fatigue life assessment method is proposed and applied to the vibration monitoring data of cables on an operational bridge. The results indicate that the proposed technology realizes automatic on‐line monitoring of cable forces and fatigue assessment of cables. Through statistical analysis of cable fatigue stress amplitude, it was determined that in cable‐stayed bridges, compared to long cables, short cables are more sensitive to external variable loads, typically experiencing larger and more frequent tension changes, and are more prone to fatigue. Therefore, short cables should be given more attention when analyzing cable fatigue in cable‐stayed bridges. [ABSTRACT FROM AUTHOR]

Objectives: South Asia (SA) and Southeast Asia (SEA) are geographically close; however, discrepancies in oral cancer (OC) epidemiology exist between the two regions. Socioeconomic disparities may influence the OC burden. The aim of this study was to assess the epidemiology of OC and its relationship with the Inequality Adjusted Human Development Index (IHDI) and its components in SA and SEA. Methods: Cancer data for this ecological study was obtained from GLOBOCAN 2020, while the IHDI was obtained from the Human Development Report 2020. Based on data availability, 14 SA and SEA countries were chosen. Poisson log‐weighted regression models were employed to examine IHDI and its components in relation to incidence and mortality. Univariate linear regression models were utilized to determine the association between the mortality‐to‐incidence ratio (MIR) and the IHDI. Results: Mortality and MIR of OC were negatively correlated with all sub‐indices of the IHDI, including education, health and income. However, incidence and mortality of OC were influenced by region and sex. Conclusions: Higher IHDI countries tended to have lower MIR. SA and males showed higher incidence and mortality. Reducing intra‐country inequalities in development may be a pragmatic approach to enhancing the OC burden and prognosis. [ABSTRACT FROM AUTHOR]

Aim s : Community‐ and school‐based lifestyle interventions are an efficient method of preventing type 2 diabetes in vulnerable populations. Many participants, however, fail to complete the necessary follow‐ups. We investigated factors affecting the continuous participation in follow‐up evaluations during the Feel4Diabetes‐study, a multilevel intervention programme implemented across Europe. Methods: Socioeconomic, sociodemographic and clinical factors were assessed for 2702 participants within six participating countries: Bulgaria and Hungary (low‐to‐middle‐income countries, LMIC), Belgium and Finland (high‐income countries, HIC) and Greece and Spain (high‐income countries under austerity measures, HICAM). Results: Statistically significant differences were detected with respect to sex, control group, education level, employment status, BMI and blood pressure measurements (systolic and diastolic blood pressure). Post hoc analysis revealed significant differences within socioeconomic regions. Higher levels of education were associated with significantly lower attrition in HIC (p < 0.05) and HICAM (p < 0.001), higher employment status was associated with lower attrition in HICAM (p < 0.001) and being female was associated with lower attrition in LMIC (p < 0.001). Surprisingly, the intervention group exhibited higher‐than‐expected attrition in HIC (p < 0.001) and HICAM (p = 0.003), and lower attrition in LMIC (p = 0.007). When tested together in the same multivariable predictive model, all sociodemographic and socioeconomic variables along with higher BMI retained their statistical significance, while systolic and diastolic blood pressure failed to remain significant. Conclusions: Key socioeconomic and sociodemographic factors along with BMI play a significant role in determining continuous participation in follow‐up evaluations during school‐ and community‐based intervention programmes. [ABSTRACT FROM AUTHOR]

Introduction: Reporting of hypoglycaemia and its impact in clinical studies is often retrospective and subject to recall bias. We developed the Hypo‐METRICS app to measure the daily physical, psychological, and social impact of hypoglycaemia in adults with type 1 and insulin‐treated type 2 diabetes in real‐time using ecological momentary assessment (EMA). To help assess its utility, we aimed to determine Hypo‐METRICS app completion rates and factors associated with completion. Methods: Adults with diabetes recruited into the Hypo‐METRICS study were given validated patient‐reported outcome measures (PROMs) at baseline. Over 10 weeks, they wore a blinded continuous glucose monitor (CGM), and were asked to complete three daily EMAs about hypoglycaemia and aspects of daily functioning, and two weekly sleep and productivity PROMs on the bespoke Hypo‐METRICS app. We conducted linear regression to determine factors associated with app engagement, assessed by EMA and PROM completion rates and CGM metrics. Results: In 602 participants (55% men; 54% type 2 diabetes; median(IQR) age 56 (45–66) years; diabetes duration 19 (11–27) years; HbA1c 57 (51–65) mmol/mol), median(IQR) overall app completion rate was 91 (84–96)%, ranging from 90 (81–96)%, 89 (80–94)% and 94(87–97)% for morning, afternoon and evening check‐ins, respectively. Older age, routine CGM use, greater time below 3.0 mmol/L, and active sensor time were positively associated with app completion. Discussion: High app completion across all app domains and participant characteristics indicates the Hypo‐METRICS app is an acceptable research tool for collecting detailed data on hypoglycaemia frequency and impact in real‐time. [ABSTRACT FROM AUTHOR]

Background: Psychosocial function of Chinese temporomandibular disorders (TMD) pain patients and the correlation with somatosensory function has not been sufficiently studied. Objective: The study aims at assessing the psychosocial function of Chinese TMD pain patients by visualisation method and evaluating the correlations with somatosensory function quantitatively. Methods: The Symptom Checklist 90 (SCL‐90) questionnaire and standardised quantitative sensory testing (QST) were administered to 70 Chinese TMD pain patients and age‐ and gender‐matched healthy controls (HCs). Of these, 40 TMD arthralgia patients received QST before and after medication. Psychosocial and somatosensory parameters were transformed into standardised scores. Differences within groups were assessed through t tests. Correlations between psychosocial and somatosensory profiles were explored through correlation analyses with Bonferroni correction for multiple comparisons. Results: 100% of the Chinese TMD pain patients exhibited psychosocial distress in contrast to HCs. Anger and hostility showed negative correlation with the thermal nonnociceptive parameter (thermal sensory limen, p =.002) and nociceptive parameters (cold pain threshold and pain pressure threshold, p<.001). Correlation analysis indicated that cold detection threshold was negatively correlated with somatization and mechanical pain sensitivity had a negative correlation with anger and hostility through medical treatment (p <.001). Conclusions: Visual psychosocial profiles provided an easy overview of psychosocial function in Chinese TMD pain patients. Anger and hostility was associated with increased thermal nonnociceptive and nociceptive sensitivity to stimuli. Psychosocial distress might be negatively associated with TMD treatment response which indicated a possible need for psychological intervention during treatment. [ABSTRACT FROM AUTHOR]

Background: Tooth loss has been associated with cognitive decline, but the underlying mechanisms involving speech and psychosocial impairment remain unclear. Objectives: To investigate the impact of tooth loss‐related speech and psychosocial impairment on cognitive function in Hong Kong's older population. Methods: Seventy‐six Cantonese‐speaking participants between the ages of 51–92 were classified into three groups: patients with complete dentures (CD), partially edentulous patients with less than 10 occluding tooth pairs (OU <10), and at least 10 occluding tooth pairs (OU ≥10). Cognitive function was assessed using the Montreal Cognitive Assessment Hong Kong Version, One‐minute Verbal Fluency Task and Hayling Sentence Completion Test. Objective and subjective speech assessments were carried out using artificial intelligence speech recognition algorithm and a self‐designed speech questionnaire. The impact of tooth loss on psychosocial condition was evaluated by the Reading the Mind in the Eyes Test and a self‐designed questionnaire. Statistical analyses (one‐way ANOVA, ANCOVA, Kruskal–Wallis test, Spearman correlation test) were performed. Results: Tooth loss was significantly associated with lower cognitive function (p =.008), speech accuracy (p =.018) and verbal fluency (p =.001). Correlations were found between cognitive function and speech accuracy (p <.0001). No significant difference in tooth loss‐related psychosocial impact was found between the three groups. Conclusion: While warranting larger sample sizes, this pilot study highlights the need for further research on the role of speech in the association between tooth loss and cognitive function. The potential cognitive impact of tooth retention, together with its known biological and proprioceptive benefits, supports the preservation of the natural dentition. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to conceptualise Temporomandibular disorder (TMD) symptom burden and severity and explored their interrelationships with somatic symptoms and psychological distress. Methods: Participants were recruited from a local polytechnic. The quintessential five TMD symptoms (5Ts) of the Diagnostic Criteria for TMDs (DC/TMD) were appraised and extended to evaluate the duration, frequency, intensity and interference of discrete TMD symptoms. Global TMD severity (GS) was computed by totaling the points for all TMD symptoms and dimensions. TMD (TS) and somatic symptom (SS) burden were assessed based on the Somatic Symptoms Scale‐8, while psychological distress was measured with the Depression, Anxiety and Stress Scales‐21. Statistical analyses were performed using Kruskal–Wallis/Dunn tests and Spearman's correlation (α =.05). Result: Of the 366 eligible participants (mean age 19.1 ± 2.3 years), 51.4% were 5Ts‐negative and 48.6% were 5Ts‐positive. Among the 5Ts‐positive individuals, 25.3%/64.0% were 'bothered a little' whereas 4.5%/10.7% were 'bothered a lot' by TMD pain/headache. Correspondingly, 32.6%/12.4%/5.1% were 'bothered a little' while 2.8%/2.8%/1.1% were 'bothered a lot' by TMJ sounds/closed/open locking. TS burden was moderate‐to‐strongly correlated to aggregate symptom duration, frequency, intensity, interference, GS and SS burden (rs =.50–.88). While TS burden and GS were weakly associated with psychological distress (rs =.18–.36), SS burden was moderately related to depression, anxiety and stress (rs =.47–.53). Conclusions: TS burden can serve as a proxy for global TMD severity and may be more meaningful than the mere presence of TMD symptoms in clinical and research settings. [ABSTRACT FROM AUTHOR]

Background: Hyposalivation is a highly prevalent condition in old persons. Objectives: The aim of this study was to assess a novel tool for the diagnosis of hyposalivation using a sugar cube and to compare its reliability to other validated test methods. Methods: Five tests were performed: unstimulated salivary flow test by draining method (USFT), oral moisture device Mucus® (MCS), sugar cube test (SCT), stimulated salivary flow test by chewing gum (CG) and Saxon test (SX). The sugar cube test consisted in measuring the time needed to disintegrate a standard‐sized sugar cube N°4 (5.6 g) placed beneath the tongue. Bivariate correlation analyses were performed. ROC curve analysis and the Youden Index were used to determine the cut‐off value. Sensitivity and specificity were calculated according to the determined cut‐off point. Results: A total of 121 participants were recruited, with an average age of 49.8 ± 18.2 years. The USFT was best correlated with the SCT. No correlation was found between SCT and the stimulated saliva tests (CG, SX) as well as the MCS test. According to the Youden index, 140 s is appropriate to diagnose hyposalivation. Sensitivity of.64 and specificity of.91 were found for SCT using USFT as gold standard. The mean subjective evaluation score of the SCT was 3.1 ± 1, significantly higher than USFT 2.6 ± 1.1 (p <.05). Conclusions: The sugar cube test proved to be a useful method for assessing unstimulated salivation, reducing test execution time and causing less participant discomfort than the gold standard unstimulated salivary flow test. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in the development of objective methods for assessing lip‐closing function in children. Objective: To obtain normative data for healthy children in the developmental stages of lip closure function, we quantitatively evaluated oral movements associated with lip closure in children and adults using a composite sensor (CS). Methods: Twenty‐five normal children (11 boys, 14 girls) aged 8.8 ± 1.6 years and 25 young adults (13 men, 12 women) aged 27.4 ± 3.9 years were asked to perform test movements, maximal lip closure and swallowing of 3 mL of water. Lip‐closing pressure (LP), intraoral baro‐pressure (IP) and electromyographic (EMG) activity of the upper orbicularis oris muscle were simultaneously recorded using the CS. Results: EMG activity of the upper orbicularis oris muscle during closure was significantly greater in adults than in children. There were significant positive correlations between integral values of LP and EMG for closure in adults (r =.527, p =.008) but not in children, and significant positive correlations between integral values of LP and IP for swallowing in children (r =.508, p =.010) but not in adults. Conclusions: The CS may provide an effective tool for evaluating lip function in children acquiring oral function. For the combination of maxillary orbicularis oculus contraction and formation of intraoral negative pressure, EMG activity of the upper orbicularis oris muscle involvement in LP and IP involvement in LP may differ between children and adults. [ABSTRACT FROM AUTHOR]

Background: It can be challenging to perform a second task at the same time as swallowing. Objective(s): The study aimed to investigate the effect of visual, auditory and motor dual‐tasking on swallowing and chewing function in healthy young adults. Method: Right‐handed healthy adults without any psychological and cognitive problems were included in the study. Swallowing was evaluated based on the dysphagia limit in different liquid textures such as water and nectar consistencies, and chewing was evaluated by the Test of Masticating and Swallowing Solids. For the second task, visual and auditory performance was assessed using reaction time, and the motor performance was assessed using a bilateral tapping task. Assessments were performed in two steps: baseline and dual‐task. For baseline, all evaluation methods were applied individually. After completing the baseline assessment, dual‐task assessment were carried out the following day. For dual‐task assessment, the swallowing and chewing tasks were performed simultaneously with visual, auditory and motor tasks. Results: Results showed a significant decrease in dysphagia limit in the nectar consistency, and significant increase in chewing time, visual reaction time and tapping rate (right–left) when compared to baseline and dual‐task conditions (χ2(3) = 9.61, p =.02; χ2(3) = 9.02, p =.02; χ2(3) = 28.09, p <.001; χ2(3) = 28.97, p <.001; χ2(3) = 21.56, p <.001, respectively). However, there were no differences in dysphagia limit in the water and auditory reaction time compared to baseline and dual‐task conditions (χ2(3) = 3.18, p =.36; χ2(3) = 2.56, p =.50, respectively). Conclusion: Results shedding light on how simultaneous dual tasks can influence swallowing and chewing. Dual‐tasking cause a decrease in both swallowing/chewing and the visual/motor performances. These results may provide valuable information for designing interventions or strategies aimed at improving or maintaining optimal swallowing and chewing during in various populations during daily life. [ABSTRACT FROM AUTHOR]

Background: Extrinsic factors for erosive tooth wear (ETW) have been widely reported, but the intrinsic factors for wear remain unclear. Objectives: The aim of this study was to evaluate the factors associated with the prevalence of ETW in patients with reflux oesophagitis (RO). To prevent severe ETW with RO, factors associated with severity of ETW were also evaluated. Methods: A total of 270 patients with RO were recruited. A modified tooth wear index was used to evaluate the prevalence and severity of ETW. Salivary secretion and buffering capacity were assessed prior to endoscopy. Subjects were asked to complete a medical condition and oral self‐care questionnaire. Univariate and multivariate analyses were employed to identify factors collectively associated with the prevalence and severity of ETW. Results: A total of 212 cases were categorized as patients with ETW (148 with mild ETW and 64 with severe ETW). Multivariate analyses indicated that saliva secretion, severity of RO and proton pump inhibitor (PPI) resistance were associated with the prevalence of ETW, whereas age, BMI and severity of RO were associated with the severity of ETW. The odds ratio of saliva secretion and BMI were less than 1, meaning that higher saliva secretion resulted in a lower prevalence of ETW and lower BMI was associated with severe ETW. Conclusion: Saliva secretion, severity of RO and PPI resistance were associated with the prevalence of ETW, whereas age, BMI and severity of RO were associated with the severity of ETW. Lower saliva secretion and BMI were significant factors for ETW. [ABSTRACT FROM AUTHOR]

Parenting a child with anorexia nervosa (AN) is highly stressful, and the struggles around eating have a large impact on family functioning. Parents get involved in conflicts with their child and/or accommodate to the eating disorder symptoms. Non‐violent resistance (NVR) offers an additional treatment option for these families. NVR aims at helping parents effectively deal with their child's (self‐)destructive behaviour and their own helplessness, by non‐violent and non‐escalating means. In our pilot, we examined whether NVR was helpful in reducing stress and improve parent–child interaction. In six parents, it was found that parenting stress was significantly reduced at post‐assessment and at 3‐month follow‐up. For parent–child interaction, a non‐significant trend was found for improvement. Change in body mass index of the adolescents was not associated with the decrease in parenting stress. Although preliminary, the results of this pilot suggest that NVR can be a feasible treatment alternative for families of adolescents with AN. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the association between hyperuricemia and arrhythmia recurrence after catheter ablation for paroxysmal atrial fibrillation (AF) is scarce. We investigated whether hyperuricemia predicts arrhythmia recurrence after catheter ablation for paroxysmal AF and the relationship between hyperuricemia and alcohol consumption in AF recurrence. Methods: Patients who underwent catheter ablation for paroxysmal AF were divided into the hyperuricemia (index serum uric acid [UA] >7.0 mg/dL; n = 114) and control (UA ≤7.0 mg/dL; n = 609) groups and were followed for a median of 24 (12–48) months after ablation. Results: The hyperuricemia group had more patients with an alcohol intake of ≥20 g/day (33.3% vs. 22.7%, p =.017) and a lower incidence of AF‐free survival (p =.019). Similarly, those with an alcohol intake of ≥20 g/day had a lower incidence of AF‐free survival than other patients. Multivariate Cox regression analysis revealed the following independent predictors of AF recurrence (adjusted hazard ratio, 95% confidence interval): hyperuricemia (1.64, 1.12–2.40), female gender (1.91, 1.36–2.67), brain natriuretic peptide level >100 pg/mL (1.59, 1.14–2.22), and alcohol consumption ≥20 g/day (1.49, 1.03–2.15) (all p <.05). In addition, causal mediation analysis revealed that alcohol consumption of ≥20 g/day directly affected AF recurrence, independent of hyperuricemia. Conclusions: Patients with hyperuricemia may be at a high risk of arrhythmia recurrence after catheter ablation for paroxysmal AF. Although high alcohol consumption may contribute to increased UA levels, the presence of hyperuricemia may independently predict AF recurrence. [ABSTRACT FROM AUTHOR]

Background: Laser balloon (LB) pulmonary vein isolation (PVI) is an established ablation technique for atrial fibrillation (AF). We report long‐term follow‐up and procedural data of LB‐PVI and we compare the first and second LB generation. Methods: Patients undergoing LB ablation with first‐ (LB1) or second‐generation LB (LB2) for AF were retrospectively enrolled and divided into two groups. Procedural endpoint was complete PVI. Clinical success was defined as no recurrence of AF/atrial tachycardia after a 90 days blanking period. Results: 538 patients were included (age 66 ± 10 years, 58% paroxysmal AF), 427 in LB1 and 111 in LB2. 2079 PVs were targeted and 2073 (99.7%) were successfully isolated; 2027 (97.5%) using solely the LB. Additional touch‐up ablation was limited (46 PVs; 2.2%) with no difference between the groups. Procedural (LB1: 120 ± 33 minutes vs. LB2: 99 ± 22 min; p <.001) and fluoroscopy time (LB1: 11.2 ± 5 min vs. LB2: 8.5 ± 3 min; p <.001) were shorter with LB2. The complication rate was 8.9% (LB1: 10.1% vs. LB2: 4.5%; p =.067) with most complications resulting from the access site (21/48). Overall freedom from AF after 1‐year was 73.7% (paroxysmal AF: 76.9%; persistent AF: 69.3%; p <.001) with no difference between the groups (LB1: 73.4% vs. LB2: 74.7%; p =.491). Conclusion: LB showed a high efficacy and acceptable safety, with numerically lower complication rates with the second‐generation LB. Procedure and fluoroscopy times were shorter with LB2. Overall, 73.7% of patients were free from AF at 1‐year, with comparable results among both generations. [ABSTRACT FROM AUTHOR]

Background: There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala‐AF represents the largest prospective AF cohort study from the Indian subcontinent. Objectives: To compare 12‐month outcomes between rate and rhythm control strategies. Methods: Patients aged ≥18 years with non‐transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all‐cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression. Results: A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; p =.955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; p =.848). Independent predictors of the primary composite outcome were older age (aOR 1.01; p =.013), BMI <18 (aOR 1.51; p =.025), permanent AF (aOR 0.78; p =.010), HFpEF (aOR 1.40; p =.023), HFrEF (aOR 1.39; p =.004), chronic kidney disease (aOR 1.36; p <.001), and prior thromboembolism (aOR 1.31; p =.014). Conclusion: In the Kerala‐AF registry, 12‐month outcomes did not differ between rate and rhythm control cohorts. [ABSTRACT FROM AUTHOR]

Aims: To analyse the bibliometric data of nursing journals covering general fields, specializations, skills and practices and investigate the influence of selection factors on the one‐year improved SCImago journal rank (SJR). Design: A bibliometric analysis. Methods: The study sample included academic journals in the field of nursing indexed in the Scopus and SJR database using data from 2020 to 2022. Quantile regression were performed that investigated the influence factors over the one‐year improved SJR when variables were found to be non‐normally distributed, characterized by extremely high kurtosis. Results: Results from 539 nursing journals retrieved from the Scopus and SCImago databases revealed that citation index remains the main factor that positively affects differences in SJR, while citable articles only affect the early stages of quantile regression. In addition, an excessively high number of research articles may negatively affect SJR, and the influence of self‐citations can initially be positive but become negative the following year. Citations continue to be the dominant factor, while the rapid growth in the number of articles and self‐citations must be addressed with caution. No Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate personal preparedness among patients on haemodialysis (HD) and to examine the relationship among sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours during natural disaster incidents. Design: A cross‐sectional survey was conducted. Methods: A convenience sampling method was used. A total of 446 participants from six areas of Sichuan province completed the online questionnaire study from February 27 to March 13, 2022. Sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours were measured. Descriptive statistics were used to analyse sociodemographic characteristics and attitudes toward disaster preparedness. The relationship among sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours were assessed using ordinal regression. Statistical significance was defined as p < 0.05. Results: A total of 446 participants completed the survey. Of these, 42.15% (N = 188) were poorly prepared, 26.23% (N = 117) were moderately prepared and 31.61% (N = 141) were highly prepared. Ordinal regression showed that knowing about disaster preparedness (Odds Ratio (OR) = 1.691, 95% Confidence Interval (CI) = 1.081–2.644, p = 0.021), participating in disaster evacuation exercises (OR = 2.519, 95% CI = 1.595–3.977, p < 0.001) and learning about disaster preparedness (OR = 2.421, 95% CI = 1.542–3.802, p < 0.001) were associated with high preparedness. Compared to patients with a university degree or higher, patients with a junior high school education or lower (OR = 3.491, 95% CI = 1.760–6.925, p < 0.001) and senior high school degree (OR = 2.052, 95% CI = 1.038–4.057, p = 0.039) were associated with high preparedness. Patients who felt very confident and could deal with all their needs (OR = 3.878, 95% CI = 2.904–7.181, p < 0.001) or patients who felt confident and could meet some of their needs (OR = 1.949, 95% CI = 1.124–3.379, p = 0.017) had higher preparedness than those who felt less confident and were not well prepared to take care of their needs. Patient or Public Contribution: After obtaining each participant's consent, they filled out the online questionnaire using their own or a relative's cell phone while undergoing HD. Implication for Practice: It is essential that patients should be educated not only on medical specialty topics, but also on general disaster preparedness. Medical institutions should improve and reinforce preparation training among targeted populations. The low level of preparedness is partly due to the lack of participation of patients in disaster preparedness programs. Dialysis center managers should be urged to implement such programs at their centers. [ABSTRACT FROM AUTHOR]

Aim: To explore the correlations between examination tolerance and anxiety, knowledge needs and examination cooperation in sedation‐free gastroscopy examinees. Design: Cross‐sectional survey using convenience sampling. Methods: A total of 170 healthy adults who underwent sedation‐free gastroenteroscopy were asked to complete a visual analogue scale (VAS) to rate their examination tolerance, the state anxiety questionnaire (S‐AI), a newly designed knowledge needs questionnaire and a cooperation questionnaire. Results: The VAS score was 4.47 ± 1.96, the state anxiety score was 39.46 ± 9.81, the total score for knowledge needs was 44.89 ± 11.02, and the average cooperation score was 2.47 ± 0.38. The VAS score during the examination positively correlated with the pretest state anxiety score and pretest knowledge needs score and negatively correlated with the examination cooperation score. The results of multiple linear regression analysis showed that after undergoing the examination for the first time, anxiety, body position and swallowing control were the main factors influencing the examination tolerance of sedation‐free gastroscopy examinees. Patient or Public Contribution: We would like to thank the staff and patients of the participating hospital for their assistance and cooperation in performing the current study. [ABSTRACT FROM AUTHOR]

Aim: Limited available studies compare the core competence performance of students undertaking their practicum at different level‐of‐care practicum sites. This study aimed to (1) compare the gaps between the perception of importance for competence and the perceived performance of nursing students at practicum sites involving different level‐of‐care and (2) identify low competencies that must be prioritized for improvement at different sites during the fundamental nursing practicum. Design: Cross‐sectional design. Methods: A total of 659 students who had passed their fundamental nursing practicum within 1 month from six nursing colleges in Taiwan were recruited. The students completed the 25‐item Core Competence in Fundamental Nursing Practicum Scale, wherein both the importance and performance level of each item are indicated. One‐way analysis of variance along with the Scheffe post hoc test and importance–performance analysis were used to explore the gaps between the perception of importance for competence and the perceived performance and to identify weak competencies that must be prioritized for improvement, respectively. Results: Compared with nursing students practicing in district hospitals (predominantly caring for chronically ill patients), nursing students practicing in medical centres (predominantly caring for patients with severe and critical conditions) had larger gaps in total scores and the application of nursing processes. Students in medical centres also had larger gaps in professional attitude than their counterparts in long‐term care facilities. Importance–performance analysis identified a common shortfall in communication skills among nursing students for all level‐of‐care practicum sites. Students at long‐term facilities had the highest number of weak competencies that required improvement. The results of this study can guide instructors in designing curricular activities focused on the weaker core competencies of the students at a practicum site for each level of care. Patient or Public Contribution: No patient or public contributions. [ABSTRACT FROM AUTHOR]

Aim: To determine the occurrence of occupational stress among Palestinian nurses, and their associated sources and risk factors. Design: A cross‐sectional descriptive design. Methods: A total of 250 registered nurses from eight governmental hospitals, using a convenience sampling method. Data collection were conducted using the 30‐items self‐reported Occupational Stress Scale from December 2022 to March 2023. Descriptive statistics, independent sample t‐test, one‐way ANOVA, and multiple linear regression analysis were applied to analysis data. Data analysis included descriptive statistics, independent sample t‐test, one‐way ANOVA, and multiple linear regression analysis. Results: The prevalence of high occupational stress levels was 64.8% (Mean = 3.9 out of 5). The main sources of stress are too much responsibility and work, understaffing, lack of promotion and recognition, inadequate pay, time pressure, and management style. The results regression analysis demonstrated that male nurses with a Masters or PhD degree and those working in fixed shifts experienced higher occupational stress. Moreover, participants who worked overtime hours were more susceptible to stress. Conclusions: The research indicates that occupational stress presents a notable challenge for nurses in the Gaza Strip, Palestine. It suggests that in order to alleviate this stress, decision‐makers in healthcare policy and hospital management should prioritize the execution of strategies aimed at addressing the primary stressors and risk factors identified. Reporting Method: This study adhered to the STROBE guidelines. Public Contribution: A total of 250 registered nurses were taken part in this study by answering a self‐administered study survey. [ABSTRACT FROM AUTHOR]

Aims: To investigate the relationships among communication competence, professional autonomy and clinical reasoning and to identify the factors that influence clinical reasoning competence in oncology nurses. Design: Cross‐sectional descriptive design. Methods: Participants included 147 oncology nurses with more than a year of clinical experience in cancer wards. The Global Interpersonal Communication Competence Scale, Schutzenhofer Professional Autonomy Scale and Nurses Clinical Reasoning Scale (NCRS) were used to collect data. Data were analysed using descriptive statistics, independent t‐test, one‐way ANOVA, Pearson correlation analysis and hierarchical multiple regression analysis. Results: Communication competence (r = 0.59) and professional autonomy (r = 0.46) showed significant positive relationships with clinical reasoning competence. Clinical experience, communication competence, age and professional autonomy were statistically significant predictors and explained 48.6% of clinical reasoning competence. Conclusions: The clinical reasoning competence of oncology nurses increases proportionally with their communication competence and professional autonomy. Therefore, oncology nurses must reinforce their communication competence and professional autonomy to enhance their clinical reasoning competence. Implications for the Profession and/or Patient Care: The reinforcement of communication competence and professional autonomy is necessary for oncology nurses to enhance their clinical reasoning competence. In order to improve nurses' communication competence, practical‐focused communication education programmes must be designed and deployed systematically and periodically. In addition, to increase nurses' professional autonomy, it is necessary to expand their clinical experiences through the regular rotation of working units and to make institutional efforts to retain experienced nurses. Reporting Method: We have adhered to STROBE checklist. Patient or Public Contribution: Participants in the study were recruited online. They were informed of the study's purpose, method and usability and the survey could only be conducted if they consented to participate voluntarily. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the effects of profession‐related films on the professional pride of nursing students. Designs: The study was conducted with a randomised controlled experimental design. Methods: The sample of the study consisted of 102 students enrolled in the first year of the School of Nursing, Zonguldak Bulent Ecevit University in Türkiye in the 2022–2023 academic year. These students were randomly assigned to the experimental (n = 57) and control (n = 45) groups. The experimental group watched two documentaries and a film on YouTube with a one‐week break. Self‐administered online questionnaires were distributed via WhatsApp groups for pretests and posttests. Data were collected with a "Sociodemographic Data Form" and the "Nursing Professional Pride Scale (NPPS)" included in the questionnaire forms prepared on the Google Forms platform. Data were analysed using Spearman's rho, the Mann–Whitney U Test, and the Wilcoxon Signed‐Rank Test. Results: The mean age of the participants was 18.80 ± 0.99 years, 80% of the participants were female, the place where 79.4% had lived for the longest duration in their lives was the city, 85.3% had information about the profession of nursing before they started university (36.8% from the internet, 34.6% from people around them). The experimental group had significantly higher NPPS scores than the control group after the intervention (p = 0.017). There was also a significant increase in the dimensions of professional feeling (p = 0.012) and desire to continue the profession in the experimental group (p = 0.002). Patient or Public Contribution: Patients and public were not involved in this research. [ABSTRACT FROM AUTHOR]

Aim: Internationalization at Home (IaH) strategies play an important role in nursing curricula to enhance nursing students' cultural awareness in the globalized world. The Community of Inquiry (CoI) is a theoretical framework for the optimal design of online learning environments to support critical inquiry and discourse among students and teachers. To optimise nursing students' online cultural awareness learning experiences, it was timely to develop online IaH strategies based on a sound theoretical model. This study aimed to examine the effectiveness of CoI‐guided online IaH strategies on enhancing the cultural awareness of nursing undergraduates who enrolled in a community nursing course. Design: This was an interventional pre‐test post‐test study. Method: One hundred and six nursing undergraduates who enrolled in the course participated in the study. The online IaH strategies were developed focusing on the interactions of teaching presence, cognitive presence and social presence of CoI framework and they were integrated into the course. A previously validated Cultural Awareness Scale was adopted for pre‐post evaluation. Higher scores indicate greater cultural awareness. Results: The results showed that there was a significantly higher total score of cultural awareness of participating students at post‐online IaH strategies. To be effective, aligning CoI‐guided online IaH strategies with course content, pedagogy and assessment was shown to be significant. The inclusion of technological elements in related strategies was also critical to engage student learning. The positive change on the total score of cultural awareness suggested the effectiveness of the deployed strategies. In this ever‐changing educational landscape, it may provide insights to educators regarding considering online IaH strategies with theoretical underpinning for curriculum planning and design. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate cardiac autonomic modulation using short‐term heart rate variability (HRV) and compare it among frailty statuses in older Indian adults. Methods: A total of 210 subjects aged 60 years and above were recruited into three groups: frail (n = 70), pre‐frail (n = 70), and non‐frail (n = 70) from the outpatient department of Geriatric Medicine at a tertiary care hospital in India. Frailty status was assessed using the Rockwood frailty index (FI) criteria. HRV was derived from a 5‐min ECG recording of standard limb leads and assessed using time domain, frequency domain, and nonlinear analysis of cardiac interval variability. Results: The HRV parameters indicative of parasympathetic modulation such as SDNN, SDSD, rMSSD, NN50, pNN50, absolute HF power, and SD1 were significantly lower in frail subjects compared with both pre‐frail and non‐frail subjects (P < 0.05). Absolute LF power and SD2 were also lower in frail subjects compared with pre‐frail and non‐frail subjects (P < 0.05). Measures of sympatho‐vagal balance (LF/HF and SD1/SD2 ratios) did not show statistical significance. The FI demonstrated negative correlations with all HRV parameters. Conclusions: Frail individuals exhibit decreased sympathetic and parasympathetic modulation compared with pre‐frail and non‐frail individuals, although maintaining a balanced sympatho‐vagal state. Furthermore, autonomic modulation declines progressively with increasing frailty. [ABSTRACT FROM AUTHOR]

This randomized controlled trial was conducted to assess the effectiveness of a family‐based and mobile‐assisted lifestyle intervention in reducing weight gain among school‐age children with overweight and obesity. A total of 164 school‐age children with overweight or obesity and their parents were randomized to the treatment intervention (n = 82) or an attention‐control group (n = 82). The treatment intervention included three face‐to‐face education sessions, augmented by monthly text messages sent to parents on their mobile devices. The primary outcome was child BMI‐for‐age z‐score. Secondary outcomes included child BMI, percent body fat, and actigraphy‐assessed sleep as well as parental sleep quality. Outcomes were assessed at baseline, 3, 6, and 12 months after the intervention, with treatment effects analyzed using general linear models for repeated measures. Our results showed that children in the treatment intervention group had significantly lower BMI‐for‐age z score, BMI, and percent body fat than did those in the control group, with an adjusted mean difference of 0.31 units (95% CI: −0.59 to −0.03; p = 0.03), 1.34 kg/m² (95% CI, −2.42 to −0.26; p = 0.01), and 3.12% (95% CI, −5.93 to −0.30; p = 0.03), respectively. No treatment effects were observed for child and parental sleep. Our findings suggest that family‐based and mobile‐assisted lifestyle intervention results in significant and sustained benefits to enhanced weight management for school‐age children with overweight and obesity. Nurses planning and delivering childhood overweight and obesity treatment interventions should consider a family‐based approach with the assistance of mobile devices. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients. Materials and Methods: This randomized controlled split‐mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient's eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure. Results: With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = −0.48, p = 0.01). Conclusions: The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to assess and compare the effect of Morus alba and chlorhexidine gel as an adjunct to scaling and root planing (SRP) in treating stage II periodontitis. Methods: A single‐blind, randomized controlled trial was conducted on 180 patients with stage II periodontitis who received full‐mouth SRP. They were randomly assigned to receive chlorhexidine digluconate (CHX) gel, Morus alba (MA) and placebo gel for Groups A, B and C, respectively, at the baseline, 15 days and 30 days. Plaque index (PI), Gingival index (GI), periodontal pocket depth (PPD) and quantitative analysis (culture) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and 45 days. Analysis of variance was used to compare the significant difference in PI, GI, PPD and microbiological parameters between the three groups after the intervention, followed by post hoc Mann–Whitney U and Tukey's HSD test for clinical and microbiological parameters, respectively. Results: Intergroup comparison of the PI, GI and microbiological parameters between the MA and CHX groups at the end of 45 days did not show a statistically significant difference (p > 0.05), whereas a statistically significant difference was observed for PPD between MA and CHX groups with the mean difference of 0.18 mm (p = 0.002). Conclusion: Morus alba gel was found to be effective in decreasing PPD. However, there was no difference between Morus alba and chlorhexidine gel as an adjunct to SRP in treating stage II periodontitis. [ABSTRACT FROM AUTHOR]

Introduction: In community settings with limited dental personnel and equipment, and in an era when the aerosol transmission of infectious agents is on the rise, a non‐invasive approach to caries management is critical. To provide information on non‐invasive material selection, the aim of this study was to compare the remineralization effect of commonly used fluoride‐containing materials, adjunctive to the everyday use of fluoride toothpaste (F‐toothpaste), on primary tooth natural dentin caries. Methods: Fifty‐five specimens were randomly divided into five groups: 38% silver diamine fluoride (SDF), 5% fluoride varnish (F‐varnish), glass‐ionomer cement (GIC), deionized water (DW) with F‐toothpaste slurry, and DW as a control group (n = 11). The lesion depth and mineral density were measured before and after bacterial pH‐cycling using micro‐computed tomography. The percentage of mineral density change (%MDchange) was quantified. The dependent t‐test, Wilcoxon‐Signed‐Rank Test, and one way ANOVA with Bonferroni correction were used to analyse the data. Results: SDF application reduced lesion depth from 844.6 to 759.1 μm (p < 0.045) while increasing mineral density from 551.4 to 763.0 mgHA/cm3 (p < 0.003). Only mineral density rose from 600.2 to 678.4 mgHA/cm3 (p < 0.013) when GIC was used. The other groups showed no difference. The highest %MDchange was also found after SDF treatment (49.7%, p < 0.05), whereas GIC (17.2%, p < 0.05) presented a higher percentage than the F‐varnish (2.0%), F‐toothpaste (−1.1%) and no‐treatment groups (−1.4%). Conclusion: In this in vitro study, where the pH of cycling was almost neutral, using SDF as an adjunct to F‐toothpaste resulted in the highest remineralization compared with other remineralizing materials. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the remineralization effect of NaF, NaF with TCP, NaF with CPP‐ACP and NaF with CXP varnishes on newly erupted first permanent molars using laser fluorescence (LF) method. The study was a randomized, double‐blind, controlled trial with four parallel groups. Methods: The study was carried out in 48 high caries‐risk children (DMFS >8), aged 6–7 years with newly erupted permanent first molars (initial lesion with 13 < LF value<30). A total of 140 teeth were divided randomly into four groups (n = 35): G1.Duraphat Varnish containing 5% NaF, G2. Clinpro™ White Varnish containing 5% NaF with TCP, G3.Embrace™ Varnish containing 5% NaF with CXP, G4. MI Varnish containing 5% NaF with CPP‐ACP. All dental treatments of the patients were completed before the varnish application. The varnishes were applied to the targeted teeth at baseline, 1 and 3 months. Patients were called for follow‐up appointments at 1, 3 and 6 months, and LF scanning was used to monitor mineralization changes. Data were analysed statistically by Wilcoxon signed‐rank and Mann–Whitney U‐tests. Results: In total, 40 children (122 teeth) completed the trial. At the end of 6 months, the amount of reduction in LF values (indicating remineralization) are as follows: NaF with CXP(6.87 ± 4.32) < NaF with TCP(7.36 ± 7.05) < NaF(7.40 ± 7.03) < NaF with CPP‐ACP(8.33 ± 4.90). All of the varnishes resulted in significant decrease in LF measurements and there was no significant difference between control (NaF alone) group and other groups. Only MI varnish had a significantly greater remineralization effect than Embrace™ Varnish (p < 0.05). Conclusion: As a non‐invasive approach, CPP‐ACP, TCP and CXP containing NaF varnishes have the potential to remineralize initial caries lesions on permanent first molars in high caries‐risk children. [ABSTRACT FROM AUTHOR]

Introduction: Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. Methods: We performed a cluster‐randomized, stepped‐wedge study to explore the effect of the the implementation of a new nursing evidence‐based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47‐item questionnaire with a score range of 0–100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. Results: At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL‐dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. Conclusion: Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence‐based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL‐dependent patients. [ABSTRACT FROM AUTHOR]

Objectives: Chlorhexidine (CHX)‐based products are the most effective chemical agents used in plaque control and oral disinfection. One of their side effects is tooth and restoration staining. For this reason, CHX products with anti‐discolouration systems (ADS) have been developed. The aim of this in vitro study was to compare different CHX‐based products (gel and mouthwash) with or without ADS in composite colour modification. Methods: Two hundred specimens were created, 100 of which were made of packable composite and 100 of flowable composite. After 24 h, colour coordinates (L*, a*, b*, C*, h°) were recorded using a spectrophotometer (T0). Then, all samples were subjected to a CHX/tea staining model and immersed in human saliva for 2 min. Composite specimens were divided in 10 groups (N = 20). Control groups (PC, FC) were soaked in distilled water and test groups (PG, PGads, FG, FGads, PM, PMads, FM and FMads) were immersed in CHX‐based solutions or brushed with CHX gel. Then the cycle was repeated 6 times, and colour differences (ΔEab and ΔE00) were finally calculated. Results: Through flowable composites, FC and FG showed the highest colour differences, respectively ΔEab = 3.48 ± 1.0, ΔE00 = 2.24 ± 0.6 and ΔEab = 2.95 ± 1.3, ΔE00 = 1.53 ± 0.6. In the composite groups instead, PM and PMads showed the highest colour differences, respectively ΔEab = 2.78 ± 1.3, ΔE00 = 1.94 ± 0.8 and ΔEab = 2.71 ± 1.4, ΔE00 = 1.84 ± 0.9. Conclusions: CHX‐containing products are able to cause stains on restorative composite materials. Discolouration is more likely to occur in flowable composites than packable composites, and ADS‐containing products cause fewer pigmentations than CHX products without ADS. Packable composites showed more staining after mouthwash treatment, whereas flowable composites underwent higher discolouration after treatment with gels. [ABSTRACT FROM AUTHOR]

Background: In patients with periodontal disease, various symptoms are observed along with inflammation. The impact of local and systemic inflammation on periodontal tissue is well‐known; however, the impact of periodontal disease on the individual's quality of life is unclear. This study aimed to assess oral health‐related and general health‐related quality of life in patients undergoing maintenance treatment following treatment for periodontitis (RP‐CPH), patients with gingivitis (G) and patients with Stage I periodontitis (SI‐P) and to compare this with individuals with clinical periodontal health (IP‐CPH). Method: This study was comprised of cross‐sectional periodontal assessment along with questionnaires. Oral health‐related quality of life and general health‐related quality of life were assessed using, respectively, the Oral Health Impact Profile‐14 (OHIP‐14) and Short‐Form‐36 (SF‐36) questionnaires. Study participants were classified according to the classification of periodontal and peri‐implant diseases and conditions established by the 2017 World Workshop. Results: The OHIP‐14 total scores for the 166 study participants (age range: 22–57) of the G (11.61 ± 3.21) and SI‐P (13.03 ± 3.47) groups were significantly higher than the OHIP‐14 total scores of the IP‐CPH (1.09 ± 1.58) and RP‐CPH (2.95 ± 2.58) groups. SF‐36 scores were found to be significantly lower in the SI‐P group in all subgroups compared to the G and IP‐CPH groups. Conclusions: A correlation was found between early‐stage periodontal disease and low levels of OHRQoL and GHRQoL. The health of periodontal tissues may have a positive effect on the quality of life. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the impact of the uninstructed use of a toothpaste containing herbal ayurvedic ingredients on parameters of gingival health in a cohort of periodontal aftercare patients affected by gingival inflammation compared to the use of a standard, non‐herbal toothpaste. Materials and Methods: The monocentric, randomized, double‐blinded, two‐arm parallel‐group intervention was performed in a cohort of 88 periodontal aftercare patients with clinical signs of gingival inflammation. At baseline, bleeding on probing (BoP), gingival index (GI) and Quigley–Hein plaque index (QHI) were recorded. Subsequently, the study patients were randomly provided with a herbal ayurvedic toothpaste (n = 44) or a conventional, non‐ayurvedic control toothpaste (n = 44) and without additional oral hygiene training instructed to use it 2× daily for the next 28 days. On day 28, BoP, GI and QHI were recorded again. Results: At baseline, there were no significant differences between both groups. On day 28, mean GI and BoP scores were significantly lower (p < 0.001) compared to baseline in both groups. Differences between the groups could not be verified. Mean QHI scores did not change significantly between day 0 and day 28 in both groups. Conclusions: The impact of uninstructed toothbrushing with an ayurvedic toothpaste on the manifestation of gingival inflammation in periodontal aftercare patients is not significantly different to the use of a conventional, non‐herbal toothpaste. [ABSTRACT FROM AUTHOR]