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Societal Impact Statement The Jersey Daffodil Project, a secondary school initiative, boosted students' aspirations in science careers. Fieldwork, DNA sequencing and discussions with scientists enriched their learning and aspirations. Surveys revealed a positive shift in students' views towards STEM careers. The project also influenced an entire cohort to pursue biological sciences in 2021. The use of cutting‐edge technology reduced costs and time, showing promise for broader school collaboration. This project not only transforms science education but also inspires students, shaping their futures and fostering a new generation of scientists.

Abstract Objectives This study aimed to investigate the prevalence of dementia among older adults from Florianópolis, in the Southern Region of Brazil. Methods Data were originally drawn from the Epifloripa Aging Cohort Study, a representative and community‐based survey designed to evaluate older people's health. This cross‐sectional study was conducted in two phases: the community‐screening phase, in which the Mini‐Mental State Examination and a multifunctional scale were administered to older subjects and close informants, respectively; and the hospital‐diagnosis phase, when the Cambridge Examination and the National Institute on Aging criteria were used. Adjustment for screening accuracy was made in order to estimate dementia prevalence. Results Of 1184 subjects evaluated in the community, 243 were screened for the diagnosis phase, in which 47 were identified with dementia, resulting in a crude prevalence of 4.5% (95% CI: 3.241–5.758) and an estimated prevalence of 9.2% (95% CI: 7.446–10.954). Dementia was associated with older ages, lower education levels, and the presence of stroke. Mild alcohol use (in comparison with no alcohol use), community‐group practice, internet use and a higher level of physical activity, rather than education, decreased the odds ratio for dementia. Education was directly associated with these lifestyle habits. Conclusions Prevalence was lower than that in previous studies in the country, and multivariate analysis reinforced the importance of lifestyle in preventing cognitive disorders in the older population.

Abstract Large predator attacks on humans often provoke calls for animal population reduction, assuming it will reduce such incidents. Whilst this seems logical, there is currently little evidence supporting a consistent link between large predator density and attacks on humans. Here, we assessed whether large predator density is linked to the frequency of attacks on humans using estuarine crocodile (Crocodylus porosus) data in the Northern Territory (NT), Australia. Over the past 50 years, the estuarine crocodile population in the NT has grown from a few thousand to over 100,000 non‐hatchling individuals. Crocodile and human population densities have been closely monitored throughout this period, allowing the frequency of attacks on humans to be assessed over a wide range of densities for both populations. Our analysis showed an increase in the frequency of attacks on humans as the crocodile population recovered from very low levels in the 1970s. However, the attack rates stabilised around 2009, despite crocodile density and the human population continuing to increase. Based on the relationship between crocodile density and human‐attack frequency, scenario modelling suggested that the crocodile population would need to be culled to a critically endangered level (e.g. 90% population reduction) to reduce attacks on humans from 2.16 to 1.16 attacks per year. We conclude that whilst crocodile density significantly influences crocodile attack rates at low crocodile population sizes, this relationship becomes weaker as the density increases. For estuarine crocodiles in the NT, a plateauing of attack risk occurred once crocodile density attained ~2 crocodiles per km of river, and we argue that this was because high crocodile densities instigated management (e.g. removal of bold animals, exclusion zones) and education initiates by the government (e.g. ‘Be crocwise’ campaign) that subsequently evoked a change in human behaviour around waterways and stabilised the attack rate. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Invasive alien species are considered a major contributor to biodiversity loss. Yet, many are favoured for particular ecosystem services that they provide. This is often so in urban environments experiencing rapid environmental and social change and land transformation. Public support is viewed as critical for invasive alien species prevention and management. Furthermore, it is assumed that local citizens are more likely to be willing and ready to engage if they are informed about the costs and benefits associated with invasive alien species. However, the use of, and attitudes towards, invasive alien species in urban areas is poorly understood, especially regarding urban gardens under private ownership and control. This lack of understanding is likely to compromise potential management interventions. Here, we report on a survey of 240 people across 12 small towns in the Eastern Cape province of South Africa to determine their knowledge and perceptions regarding woody invasive alien plants (IAPs), their willingness to engage in control and how these vary in relation to respondent attributes. The findings indicated that respondents have low levels of knowledge about woody IAPs despite 84% of them having at least one woody IAP species in their garden. Nineteen different woody IAPs were noted across the sample of 240 households. A wide range of ecosystem services and disservices from woody IAPs were mentioned. Because of the benefits provided, or the effort required to remove them, only 56% of respondents were willing to have the woody IAPs removed from their gardens, with most considering it the responsibility of government agencies to do so. There was a positive association between the levels of education, income, and the impression that woody IAPs pose a problem and being aware of the term, but not willingness to remove them. Synthesis and implications. These results reveal the complex relationship that urban citizens have with IAPs in garden settings, and for authorities to consider appropriate and targeted awareness campaigns if control strategies are to be successful. Read the free Plain Language Summary for this article on the Journal blog.

Abstract The extent to which coding skills are taught within ecology and evolution curricula remains largely unquantified. While coding, and especially R, proficiency is increasingly demanded in academic and professional contexts, many students encounter coding for the first time as postgraduates, presenting a steep learning curve alongside learning advanced statistics. With the emergence of large language models (LLMs), questions arise regarding the relevance of teaching coding when many of these tasks can now be automated. Here, we explore students' experiences with using LLMs for coding, highlighting both benefits and limitations. Through qualitative analysis of student perspectives, we identify several advantages of using LLMs for coding tasks, including enhanced search capabilities, provision of starting points and clear instructions, and troubleshooting support. However, limitations such as a lack of responsiveness to feedback and the prerequisite of extensive prior knowledge pose challenges to the effectiveness of student use of LLMs for coding at a beginner level. Concerns also arise regarding future access to LLMs, potentially exacerbating inequities in education. Despite the potential of LLMs, we argue for the continued importance of teaching coding skills alongside their integration with LLM support. Tutor‐supported learning is essential for building foundational knowledge, facilitating comprehension of LLM outputs and fostering students' confidence in their abilities. Moreover, reliance solely on LLMs risks hindering deep learning and comprehension, thereby undermining the educational process. Our experiences underscore the significance of maintaining a balanced approach, leveraging LLMs as supplementary tools rather than substitutes for coding education in ecology and evolution courses.

Abstract Background Though laparoscopic gastrectomy (LG) has become the gold standard for gastric cancer treatment according to the Japanese treatment guidelines, its learning curve remains steep. Decreasing numbers of surgeons and transitions in the work environment have changed LG training recently. We analyzed LG training over the last decade to identify factors affecting the learning curve. Study Design Laparoscopic distal and pylorus‐preserving gastrectomies conducted between 2010 and 2020 were included. We assessed learning curves based on the standard operation time (SOT) defined by analysis of covariance. Then we divided the trainees into two groups based on the length of the learning curve and examined the factors affecting the learning curve with linear regression analysis. Results Among 2335 LGs, 960 cases treated by 27 trainees and 1301 cases treated by six attending surgeons were analyzed. The operation time was prolonged (p = 0.009) and postoperative morbidity rates were lower (p = 0.0003) for cases treated by trainees. Trainees experienced 38 (range, 9–81) cases as scopists and nine (range, 0–41) cases as first assistants to the first operator. The learning curve was approximately 30 cases. The SOT was calculated based on gender, body mass index, tumor location, reconstruction, and lymph node dissection. Trainees who had shorter learning curves had more experience (51–100 cases) with any laparoscopic surgery before LG training than the others (11–50 cases, p = 0.017). Conclusion Sufficient experience with laparoscopic surgery before starting LG training might contribute to the efficiency of LG training and shorten the learning curve.

Societal Impact Statement Plant biology is an essential discipline for addressing global challenges from food security to climate change. In order to achieve this, we need to educate plant biologists who can contribute to research, enterprise, policy, public engagement and beyond. This article explores the potential of competency‐based education, which emphasises what students can do rather than what we know. A flexible and adaptable model of competency based plant biology education is presented, along with practical suggestions and examples. This provides a framework through which we can educate plant biologists equipped to address major scientific and societal challenges of the future. Summary Plant biology is an essential discipline for addressing global challenges from food security to climate change. In order to achieve this we need to educate plant biologists who can contribute to research, enterprise, policy, public engagement and beyond. In this article, I explore some of the issues and challenges facing plant biology education from authentic research driven curricula to the impact of AI. In order to effectively educate the plant biologists of the future I propose moving to a competency based approach to education. Competency based education emphasises what students can do rather than what they know. I present a three‐domain competency model for plant biology, structured around (i) knowledge and information literacy (ii) disciplinary and professional experience and (iii) self‐awareness and personal development as three interdependent aspects of competency. I accompany this with twelve proposed competencies for plant biologists. The model is flexible, robust and adaptable to specific local requirements and future demands of plant biology education. In reimagining plant biology education in this way we can present our discipline as exciting and relevant to students, and equip them with the capabilities required to contribute to plant biology activity from research to public policy.

Abstract Introduction Diagnostic radiography students experience challenges during clinical placements, which have the potential to impact students' emotional wellbeing. This study aimed to explore radiography students' perception of the newly developed podcast series as a wellbeing support tool. Methods A mixed methods study was conducted analysing data from listeners, including usage data from the podcast host site, surveys, and focus groups. Usage data was analysed descriptively. A bespoke survey, using a 5‐point Likert scale and fixed‐response questions was analysed descriptively. Two focus groups consisting of ten participants in total were conducted and data was analysed using thematic analysis. Results There were 1201 downloads of the ‘Breathe‐in Radiography Podcast’ series across 20 countries and 17 platforms during the study period. A total of 66 complete survey responses demonstrated an overall positive perception of the podcast series. Five main themes were identified from the focus groups: integrated with other activities, accessed when experiencing emotional challenges, relatability to peers, impact on behaviour and mindset, and future podcast content. Conclusions This study demonstrated students' positive perceptions of a podcast for support during clinical placement. Further studies are needed to maximise the benefits of podcasting to radiography students and to establish a direct effect of podcasts on student wellbeing.

Abstract Podcasts refer to episodes of audio content that are readily available on streaming applications on smartphones or computers. This paper reports on the development of the ‘Breathe In Radiography Podcast’ series for radiography students and provides suggestions for evaluation. Podcast development followed a structured framework, including identification of podcast topics and expert guests, content development, audio recording, episode upload to host site and distribution. Using a framework was useful to guide development and ensure consistency across podcast episodes. Evaluation through podcast usage data, surveys and focus groups provides a comprehensive strategy to explore radiography students' perception of the newly developed podcast series.

Abstract Background The incidence of skin cancer is rapidly increasing, leading to a growing amount of general practitioner (GP) consultations of patients with suspected skin lesions. It is essential that GPs have good training skills to differentiate between benign and malignant skin lesions. Dermoscopy in addition to clinical examination can help them to develop these skills. Objectives In this article, we examine the effect of a 2‐day training course in dermoscopy among Dutch GPs. Methods The educational intervention was designed as blended learning and consisted of a 2‐day training course on dermoscopy, clinical features, and management of patients with suspected skin lesions in primary care. Before the training course, all participants were required to take a test (T0). This test was repeatedly administered at the end of the second course day (T1) and within 6 months after completion of the course (T2). Outcomes were the specificity and sensitivity of recognizing skin lesions and the changes between the test moments. Results In total, 400 GPs participated in the training course. At T1, the specificity for detecting benign lesions was higher than at T0 (0.91 vs. 0.75). This specificity remains at the same level at T2, 6 months after the course (0.91 p

Background Balance, Eye, Face, Arm, Speech, Time (BE FAST) was proposed to increase the public's ability to recognize more signs of stroke by adding balance (B) and eyesight changes (E) to the stroke acronym FAST (Face, Arm, Speech, Time). Previous prospective studies suggested these additions did not result in increased stroke detection. Methods and Results A randomized, assessor blinded prospective pilot study assessed retention of BE FAST and FAST. The 174 participants were randomized to 1 of 2 education arms, educated similarly visually and auditorily, and retention was tested at 3 time points. Mnemonic recall was similar at 30 days (79.5% versus 69.8%, P=0.104). Significantly lower retention was seen in the BE FAST group's ability to recall all symptoms at 3 to 5 minutes (75% versus 30.2%, P

Background Discrimination may contribute to sleep health disparities among women, yet limited research has investigated the association between discrimination and insomnia with short sleep. Methods and Results Among a racially and ethnically diverse sample of women (N=25 920; mean age, 72.2±6.1 years), we investigated the relationship of discrimination with insomnia symptoms and sleep duration. Poisson models with robust variance were fit to examine discrimination with insomnia, sleep duration (short 9 hours versus recommended 7–9 hours), and insomnia short sleep phenotype adjusted for covariates. Insomnia symptoms, short and long sleep, and high discrimination were reported by 53%, 11%, 15%, and 40% of women, respectively. Women reporting high versus low discrimination were more likely to report insomnia, short sleep, and insomnia short sleep phenotype (insomnia: adjusted prevalence ratio, 1.15 [95% CI, 1.13–1.18]; short sleep: adjusted prevalence ratio, 1.24 [95% CI, 1.16–1.34]; insomnia short sleep phenotype: adjusted prevalence ratio, 1.45 [95% CI, 1.31–1.61]). In exploratory analyses, the association between discrimination and insomnia symptoms was present among Asian and White women, whereas the association between discrimination and sleep duration was among Hispanic (long sleep) and White (short sleep) women. Further, the association between discrimination and insomnia symptoms was more pronounced among those with less than a bachelor's degree, whereas women with a bachelor's degree or higher were less vulnerable to the association between discrimination and long sleep. Conclusions Discrimination was associated with insomnia and short sleep, a more severe phenotype for adverse cardiovascular health. Discrimination may be a target for reducing sleep problems among older women.

Abstract Objective A prospective, multicenter, randomized study evaluated the efficacy of major depressive disorder (MDD) patients after 2–3 months of acute treatment based on the dual factors of education and age. Methods This study classified the included patients into four groups using two classification parameters: age (≤45 years, vs. >45 years) and education years (≤12 vs. >12). We analyzed age, gender, marital status, personal income, depression onset history, medication use, and follow‐up across various groups. We evaluated residual somatic symptoms and social functioning in depression patients was conducted using the 16‐item Quick Inventory of Depressive Symptomatology Self‐report (QIDS‐SR16), the Patient Health Questionnaire‐15 (PHQ15), and the Sheehan Disability Scale (SDS). Results In China, 16 hospitals, 553 depression patients, and 428 fulfilled the inclusion criteria. Baseline patient data revealed significant differences among the different age groups in gender, marital status, income, first onset age, physical illness, combination of antipsychotics, and benzodiazepines use (all p .05) were found in residual somatic symptoms and social functioning parameters between different education levels (≤12 years vs. >12 years) at baseline, 3 months, and 6 months, based on total scores on the scale. Repeated measures mixed model indicates that the QIDS‐SR16 assessment indicates statistical differences among various marital statuses, income levels, medical histories, and antipsychotic medication use (p 45 years old, those ≤45 years old often exhibit more residual depression, somatic symptoms, and severe social functional impairment; patients' education levels less influence this trend.

Abstract Aim To explore Finnish paramedics' perceptions of work‐related performance expectations in relation to work experience, and understand how organizational socialization contributes to understanding paramedics' performance expectations. Design A qualitative design with a deductive‐inductive approach utilizing a social constructivist framework. The organizational socialization framework by Wanberg was used as the theoretical basis. Methods Data were collected between May and August 2023, using group and individual interviews of newly graduated (n = 9) and experienced paramedics (n = 13). Participants were recruited via social media channels. Data were first analyzed deductively, according to constructs of the organizational socialization framework (role clarity, task mastery, and social acceptance), then inductively, using codes not utilized in the deductive phase. Data Sources Interviewed Finnish paramedics (N = 22), both newly graduated paramedics (n = 9) and experienced paramedics (n = 13). The interviews were performed remotely and then transcribed into text. Results Our findings showed comparable performance expectations between newly graduated and experienced paramedics, mismatches in role clarity of paramedic work, challenges in both learning and upholding professional competence, and difficulties of social acceptance into the paramedic community. There were variations in how expectations were perceived between groups, indicating that experience might partly affect how paramedics identify and manage performance expectations. The organizational socialization framework enables the contextualization of these performance expectations. Conclusions and Implications Paramedic work involves challenges to upholding clinical competence, aligning to a professional role, and social integration into the professional community. Our research contributes to understanding how paramedics perceive these challenges as performance expectations in different stages of their careers and how they could be managed utilizing a framework for organizational socialization. The socialization of paramedics into the workforce needs to account for these performance expectations, especially considering the changing paradigm of paramedic work, role, and societal expectations. Patient or Public Contribution No Patient or Public Contribution.

ABSTRACT This paper uses household panel data from the Thai Socio‐Economic Surveys of 2012 and 2017 to examine the effects of parental health shocks on child education and labour. Three measures of parental health are analysed: chronic illness, hospitalisation, and functional health status. The results show that the parentʼs illness decreases school enrolment and leads to fewer years of education completed. Boys are less likely to have attended school if any parent was chronically ill or had any health problems. Parentsʼ chronic illness increases the probability of entering the labour force for youths aged 15 and over; however, only maternal illness increases their time spent at work. Additionally, parental illness significantly increases household health expenditures, but there is a significant decline in education expenditures. The results suggest that targeted government support to low‐income families affected by major illnesses of parents could help them to maintain their children in school.

Abstract Background Breastfeeding has immediate and long‐term benefits for both mother and child, but many mothers feel unprepared for the challenges of early breastfeeding. The first letter mnemonic, close, head free, nose to nipllie, in‐line, sustainable (CHINS) was developed as a tool to help practitioners remember retain and recall the principles of positioning for effective breastfeeding and a UK‐wide evaluation shows it is used widely within the UK breastfeeding workforce. This study sought to understand the extent to which breastfeeding mothers were aware of CHINS and their experience of using it to support their breastfeeding. Methods An exploratory qualitative research design was used to describe and interpret the findings of individual interviews with 11 breastfeeding mothers from across the United Kingdom who were recruited via a digital flier shared via social media and breastfeeding networks. The interviews were analysed thematically. Results Awareness and perception of CHINS, Timing of introduction to CHINS, and Sharing CHINS were the key themes to emerge, with an overarching core theme—The Right Advice at the Right Time. All the participants in the study were aware of CHINS and found it particularly helpful during the early stages of breastfeeding. Some participants reported that others, including fathers and peers, were aware of CHINS and had used it to support breastfeeding mothers. The participants felt support for breastfeeding was variable and that it was important to ensure that the right advice was given at the right time. Conclusion This study included a small number of breastfeeding mothers from across the United Kingdom and whilst there were high levels of awareness and perceived value of CHINS, a larger study would be warranted to explore the value of CHINS in more depth as well as to understand the role of CHINS in the wider education of peers and significant others, including fathers.

Abstract Children's interest in nature is crucial for their understanding and appreciation of the natural environment, as well as for their mental health and biodiversity conservation efforts. To foster this interest, it is important to establish a theoretical framework and explore practical applications. Given the current trend of children spending more time with screens and less time in nature, school gardens offer potential solutions. This study aimed to investigate the effectiveness of a 4‐month teaching programme conducted in a school garden to promote children's individual interest in nature. 24 Grade‐4 students participated in weekly 40‐min activities, which were divided into three treatments: natural observation with assigned tasks, natural observation with open‐ended tasks and inquiry‐based activities. Participants maintained individual portfolios consisting of questionnaires, nature journals, observation descriptions and interviews. Qualitative and quantitative data were analysed to categorize children into three types: those with initiated interest, those with enhanced interest and those with no significant change. Thematic analysis was used to identify factors influencing children's interest in nature based on qualitative data. The results showed that 17 out of 24 children were classified as either ‘interest‐initiated’ or ‘interest‐enhanced’, indicating a generally positive outcome. The school garden provided a novel and safe environment that empowered children to learn and explore autonomously. Teacher scaffolding further supported their curiosity towards the garden's organisms, potentially leading to the development of their individual interests in nature. This study emphasizes the positive impact of involving children in garden‐based activities in primary schools. Implementing a diverse school garden with informative labels and explanation boards, along with teacher support, represents a promising approach to cultivating children's interest in nature. We recommend implementing mini botanical gardens and club activities in schools to bridge formal and informal education. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Introduction Foetal MRI scans can induce feelings of fear, concern and anxiety in pregnant patients. The aim of this research was to determine if providing patients with an information leaflet reduced maternal anxiety regarding foetal MRI. Methods A prospective, three‐arm comparative pilot study was performed in the MRI department of a quaternary public hospital in Brisbane, Australia. Three groups of 30 participants (total 90 participants) received differing levels of information about foetal MRI: Group A – no foetal‐MRI specific information (current practice at the site); Group B – a basic information leaflet; Group C – a comprehensive information leaflet. All participants completed a survey that explored their pre‐scan anxiety immediately after their MRI scan. Results Over 50% of participants in each group felt anxious before the MRI. Participants expressed anxiety towards the general process of the MRI, the outcome or results of the scan, and the safety of the modality. The basic and comprehensive leaflets were both efficacious in reducing anxiety for the majority of participants. Conclusions Whilst not all patients express anxiety regarding MRI scans, emotional distress surrounding the entire process is prevalent. Providing patients with comprehensive information about what the MRI scan entails (including the scan environment and duration, positioning, breath‐holding requirements, and foetal safety) reduces anxiety for most patients. These findings can be used to determine ways in which reduction of anxiety improves the patient experience.

Abstract Aim The aim of this study was to verify the clinical feasibility of tele‐proctoring using our ultra‐low latency communication system with shared internet access. Methods Connections between two multiple remote locations at various distances were established through the TELEPRO® tele‐proctoring system. The server records the latency between the two locations for tele‐proctoring using the annotations. Questionnaires were administered to the surgeons, assistants, and medical staff. Respondents rated the quickness and quality of communication in terms of latency and disturbances in the audio, video, and usefulness of the live telestrations with annotation. Results Seven hospitals tele‐proctored with Sapporo Medical University between January 2021 and September 2022. The median latency of annotation between the two locations ranged from 24.5 to 48.5 ms. No major technological problems occurred, such as streaming interruption, loss of video or audio, poor resolution. The video encoding time was 10 ms, and its decoding time was 0.8 ms. The total latency positively correlated with the distance between two locations (R = 0.55, p

Abstract Background We have previously pioneered arts‐based training to enhance clinical skills in senior and resident dermatologists. However, the utility of music to support the development of dermatological skills such as listening, observation, description and communication is unexplored. Objectives We hypothesised that music literacy training (MLT) would enhance the clinical dermatology skills of newly qualified doctors and could be effectively delivered in a single‐session virtual format. Methods Our training comprised a 2.5‐h course held in October 2021 on the virtual meeting platform Zoom. The course was led by a music educator and included sessions which placed particular emphasis on listening to music, discriminating auditory cues to interpret imagery and meaning, and describe this to others. Participants explored concepts such as pitch, melody, pace, rhythm, dynamics and timbre by working collaboratively, independently and in small break‐out groups. All participants documented their learning journey through pre‐ and post‐course reflective essays and the training was evaluated by a pre‐ and post‐course dermatology clinical assessment. Results Music served as a catalyst for reflection and discussion, supporting significant improvement key clinical skills such as listening, clinical observation and description in newly qualified doctors. Participants reported increased confidence communicating with others and found the course structure enjoyable and fun. Conclusions Combined qualitative and quantitative evidence highlights the benefit of MLT in developing key clinical skills in newly qualified doctors which is effective when delivered in a single‐session, virtual format.

Abstract Aim To explore enablers and barriers to the creation of an oral health training for care workers at specialized centres for children with disabilities in Ouagadougou. Design This was a formative study informed by the Theoretical Domains Framework using qualitative methods. Methods Qualitative observations and 14 semi‐structured interviews were conducted with care workers from six specialized centres for disability. Results Carer workers emphasized that a successful oral health training must account for available resources and competencies in each specific centre. Part of the training must be dedicated to oral hygiene targeted for people with disabilities and provide knowledge about risk factor management. Care workers must be empowered through the training with practical skills and tools to manage regular toothbrushing and identify oral health needs of their dependents. Conclusion This study gathered valuable and unique perspectives about the roles of care workers of children with disabilities in Ouagadougou and underscores the need for improving access to oral health and care services for children with disabilities in low‐resourced settings. Implications for Patient Care Teams planning oral health promotion activities in low resourced settings for vulnerable population groups can benefit from the methodology and results of this research for ensuring their interventions are appropriate and relevant. Impact This is a unique field study conducted in a scarcely researched area of caregiving practices for children with disabilities in a low‐income country, Burkina Faso. Results from the disability centre observations and interviews with local caregivers are of great value to any team planning health projects in similar low‐resourced settings. Psychiatric and mental health nursing practices are highly context‐dependent, thus using proposed qualitative methods can help to ensure that planned interventions are appropriate and relevant. Patient or Public Contribution There was no patient contribution in this study.

Abstract Aim This study aimed to explore the perception of nursing students regarding their engagement in digital learning environments. Design At one of universities in Saudi Arabia, a qualitative descriptive study design was used among nursing students from various academic levels. Methods Data were collected using focus group discussions among a sample of 23 participants. Data were analysed using thematic analysis. The COREQ Standards for Reporting Qualitative Research were used to report this study. Results While sharing their perceptions the nursing students reflected on the behavioural and cognitive aspects of engagement, yet they did not include emotional aspects of engagement in their conceptualization. However, the results showed that, while they reflected on their experiences they tended to reflect on emotional aspects of engagement. According to the study's results, self‐paced studying, reflective exercises, and interaction with audiovisual and dynamic content all encourage the activation of past knowledge in online learning. The learning modality also was found to be a safe and convenient approach among the participating students. Digital learning presents as a promising educational approach that extends beyond the pandemic yet, efforts should be put in place to facilitate the optimal student engagement to meet learning outcomes. Further research is needed to measure its impact on engagement and other pertinent indicators objectively.

Abstract Objective Treatment of obesity has been transformed by the recent approval of incretin‐based therapies for weight loss (e.g., glucagon‐like peptide 1 agonist semaglutide), but little is known about patient perspectives on these medications. Methods Between December 2023 and March 2024, healthcare patients from an academic medical center in the Southeast United States with Body Mass Index ≥30 kg/m2 completed a cross‐sectional online survey on attitudes toward incretin‐based medications. Results Compared to patients with a bachelor's degree, those without a degree were less likely to be aware of incretin‐based pharmacotherapies (96% vs. 78%) and to have discussed pharmacotherapies with a doctor (43% vs. 27%) but had greater interest in using these pharmacotherapies (4.3 vs. 4.7). These pharmacotherapy‐related variables did not differ significantly according to gender, race, or financial security. Concerns about side effects, long‐term health risks, and potential for weight regain were highly endorsed and were associated with lower interest in using incretin‐based therapies and with some demographic factors. Patients reported high interest in lifestyle programs designed for individuals taking anti‐obesity medications. Conclusion Demographic considerations, notably education level, should be factored into the strategy to promote equitable utilization of incretin‐based therapies, particularly as their accessibility expands.

Abstract Objective Safe home tracheostomy care requires engagement and troubleshooting by patients, who may turn to online, AI‐generated information sources. This study assessed the quality of ChatGPT responses to such queries. Methods In this cross‐sectional study, ChatGPT was prompted with 10 hypothetical tracheostomy care questions in three domains (complication management, self‐care advice, and lifestyle adjustment). Responses were graded by four otolaryngologists for appropriateness, accuracy, and overall score. The readability of responses was evaluated using the Flesch Reading Ease (FRE) and Flesch–Kincaid Reading Grade Level (FKRGL). Descriptive statistics and ANOVA testing were performed with statistical significance set to p

Abstract Background and Aims The recent integration of artificial intelligence (AI) across education, research, and clinical healthcare has led to a growing interest in AI training for healthcare students. This scoping review seeks to delve into existing literature, aiming to evaluate the perceptions and attitudes, of health science students toward the implementation of AI in their field. Methods This review followed the methodological guidance offered by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis extension for Scoping Reviews (PRISMA‐ScR). A systematic search was conducted in the databases Medline, Emcare, and Scopus. Studies using both quantitative and qualitative methodologies were eligible if they explored the perceptions or attitudes of health science students in relation to AI. Relevant data from eligible articles was extracted and analyzed using narrative synthesis. Results Ten studies were included. Articles reported on the primary outcomes of perceptions (i.e., thoughts, ideas, satisfaction, etc.) and attitudes (i.e., beliefs, tendencies, etc.). Disciplines included nursing, diagnostic radiography, pharmacy, midwifery, occupational therapy, physiotherapy, and speech pathology were featured. Overall, students felt positively about the potential benefits AI would have on their future work. Students' interest and willingness to learn about AI was also favorable. Studies evaluating attitudes found positive correlations between attitudes toward AI, AI utilization, and intention to use AI. Negative perceptions related to threats of job security, and a lack of realism associated with AI software. Conclusion Overall, evidence from this review indicates that health science students' worldwide hold positive perceptions toward AI. Educators should focus on instilling positive attitudes toward AI, given correlations between AI exposure and intention to adopt AI.

Abstract End users of single‐use plastics can help minimize their contribution to plastic pollution via mindful purchasing and waste management. These behaviors can be impacted via behavior change interventions in various key sectors of society. This review set out to summarize recent (2015–2023) peer‐reviewed evidence on interventions aimed at changing the plastic consumption, recycling, and/or littering behaviors of individuals across four sectors: business and retail, tourism and leisure, schools and education, and communities. Systematic literature searches were conducted across multiple databases and resulted in the inclusion of 92 intervention studies. Information on intervention strategy and effectiveness was extracted, and the studies were assessed for risk of bias. Intervention descriptions and outcomes were coded into five intervention categories (informational, contextual, prompts, social, and personal strategies) and synthesized qualitatively to inform future practice in an accessible manner. Although nearly half of the reviewed studies were assessed as having moderate‐to‐high risk of bias (e.g., lacked reliability assessment of outcome measures), limiting confidence in the documented findings, the review concludes that different strategies work in different sectors. For example, informational strategies showed mostly promising results in most sectors, but had mixed effectiveness in the education sector, while contextual modifications were effective across sectors.

Abstract Purpose This study aimed to evaluate the effects and interactions of training level and different joints on the outcomes of cadaveric arthroscopic training courses for orthopaedic residents. Methods This prospective study enrolled 16 orthopaedic residents who voluntarily participated in a cadaveric training programme involving the shoulder, elbow, wrist, knee and ankle joints. Outcomes were quantitatively assessed using task‐specific checklists and the Arthroscopic Surgery Skill Evaluation Tool. Two‐way analysis of variance (ANOVA) was conducted to determine the significance of the interactions between joint and years of training. Results Resident scores significantly increased after the dedicated lectures in all five joints (p = 0.003 for the shoulder module, p

Abstract Background and Aims Traditional apprenticeship‐based surgical training presents with challenges, especially in acute scenarios. Simulation provides the current standard of facilitating surgical training in a low‐risk environment but is restricted by limited accessibility and high costs. Virtual reality (VR) offers immersive three‐dimensional computer‐generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin‐based simulation. We hypothesised that VR would be as effective as mannequin‐based simulation in performance outcomes. Methods This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin‐based simulation. Participants completed questionnaires and a 15‐min pneumothorax scenario. Quantitative metrics included overall score, time‐to‐critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants' likes and dislikes of their allocated simulation modality. Results VR participants scored significantly higher than mannequin‐based simulation participants in overall scores (74.30% (SD ± 5.08%) vs. 59.75% (SD ± 10.14) (p = 0.04)), and technical skills aspects (77.20% (SD ± 8.01%) vs. 65.00% (SD ± 8.21%) (p = 0.01)). Mannequin‐based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time‐to‐completion (p = 0.06). ABS scores increased for both study groups, though was only significant for VR participants (p ≤ 0.01). VR participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication‐learning compared to mannequin‐based simulation. Conclusion Both VR and mannequin‐based simulation training are effective in training junior doctors in acute surgical scenarios but present different educational benefits. Future research should recruit a larger sample size for a full comparative randomised controlled trial.

Abstract Aims To (a) compare student nurses' health status and levels of ergonomics knowledge and awareness to those of first‐year nursing staff and (b) investigate the association between nurses' ergonomic compliance and health status with their educational preparedness. Design This cohort study compared ergonomics awareness and knowledge, and health status of nurses when they were students and after their first‐year working in medical facilities. Methods In total, 133 4th‐year student nurses completed a survey; 45 of them completed a second survey after working 1 year in a medical facility. Their health status was compared over time using repeated‐measures ANOVA. Correlation tests were used to analyse associations between ergonomics knowledge and awareness, health status, demographic variables and educational preparedness. Results Respondents in both surveys displayed weak knowledge of ergonomic principles significantly associated with increased pain intensity and educational preparedness. Patient contribution Ergonomics training should be expanded during nursing studies and first‐year training to prevent long‐term health disorders.

Abstract Aim This study adopted the qualitative research method, aiming to explore the learning experience of nursing graduate professional curricula in China from the perspective of students and provided a basis for the continuous improvement of nursing graduate training. Design A qualitative study. Methods A purposive sampling method was employed to conduct semi‐structured in‐depth interviews with 14 nursing master's students enrolled in professional curricula from September 03, 2021, to December 8, 2022. The Colaizzi seven‐step analysis method was utilized for data analysis, summarization and extraction. Results Four themes emerged from the study findings: (i) The study of professional curricula is the cornerstone of scientific research work, but it is relatively boring; (ii) The teaching methods and assessment methods of postgraduate education need to be diversified; (iii) The postgraduate education needs to increase the study time of specialized courses and highlight the specialty characteristics; (iv) the study of professional curricula can enhance the comprehensive ability of postgraduate students. Conclusion The study of professional curricula for post‐graduate nursing students plays an important role in the development of post‐graduate research and can statistically significant improve their comprehensive ability, but there are some problems such as boring courses, single teaching assessment methods and insufficient time. In the future teaching reform, it is necessary to highlight the specialty characteristics of nursing scientific research, optimize curriculum education and improve students' scientific research knowledge and thinking. Patient and Public Contributions We thank all participants for their valuable input throughout the study.

Abstract Review Rationale and Context Many intervention studies of summer programmes examine their impact on employment and education outcomes, however there is growing interest in their effect on young people's offending outcomes. Evidence on summer employment programmes shows promise on this but has not yet been synthesised. This report fills this evidence gap through a systematic review and meta‐analysis, covering summer education and summer employment programmes as their contexts and mechanisms are often similar. Research Objective The objective is to provide evidence on the extent to which summer programmes impact the outcomes of disadvantaged or ‘at risk’ young people. Methods The review employs mixed methods: we synthesise quantitative information estimating the impact of summer programme allocation/participation across the outcome domains through meta‐analysis using the random‐effects model; and we synthesise qualitative information relating to contexts, features, mechanisms and implementation issues through thematic synthesis. Literature searches were largely conducted in January 2023. Databases searched include: Scopus; PsychInfo; ERIC; the YFF‐EGM; EEF's and TASO's toolkits; RAND's summer programmes evidence review; key academic journals; and Google Scholar. The review employed PICOSS eligibility criteria: the population was disadvantaged or ‘at risk’ young people aged 10–25; interventions were either summer education or employment programmes; a valid comparison group that did not experience a summer programme was required; studies had to estimate the summer programme's impact on violence and offending, education, employment, socio‐emotional and/or health outcomes; eligible study designs were experimental and quasi‐experimental; eligible settings were high‐income countries. Other eligibility criteria included publication in English, between 2012 and 2022. Process/qualitative evaluations associated with eligible impact studies or of UK‐based interventions were also included; the latter given the interests of the sponsors. We used standard methodological procedures expected by The Campbell Collaboration. The search identified 68 eligible studies; with 41 eligible for meta‐analysis. Forty‐nine studies evaluated 36 summer education programmes, and 19 studies evaluated six summer employment programmes. The number of participants within these studies ranged from less than 100 to nearly 300,000. The PICOSS criteria affects the external applicability of the body of evidence – allowances made regarding study design to prioritise evidence on UK‐based interventions limits our ability to assess impact for some interventions. The risk of bias assessment categorised approximately 75% of the impact evaluations as low quality, due to attrition, losses to follow up, interventions having low take‐up rates, or where allocation might introduce selection bias. As such, intention‐to‐treat analyses are prioritised. The quality assessment rated 93% of qualitative studies as low quality often due to not employing rigorous qualitative methodologies. These results highlight the need to improve the evidence. Results and Conclusions Quantitative synthesis The quantitative synthesis examined impact estimates across 34 outcomes, through meta‐analysis (22) or in narrative form (12). We summarise below the findings where meta‐analysis was possible, along with the researchers' judgement of the security of the findings (high, moderate or low). This was based on the number and study‐design quality of studies evaluating the outcome; the consistency of findings; the similarity in specific outcome measures used; and any other specific issues which might affect our confidence in the summary findings. Below we summarise the findings from the meta‐analyses conducted to assess the impact of allocation to/participation in summer education and employment programmes (findings in relation to other outcomes are also discussed in the main body, but due to the low number of studies evaluating these, meta‐analysis was not performed). We only cover the pooled results for the two programme types where there are not clear differences in findings between summer education and summer employment programmes, so as to avoid potentially attributing any impact to both summer programme types when this is not the case. We list the outcome measure, the average effect size type (i.e., whether a standardised mean difference (SMD) or log odds ratio), which programme type the finding is in relation to and then the average effect size along with its 95% confidence interval and the interpretation of the finding, that is, whether there appears to be a significant impact and in which direction (positive or negative, clarifying instances where a negative impact is beneficial). In some instances there may be a discrepancy between the 95% confidence interval and whether we determine there to be a significant impact, which will be due to the specifics of the process for constructing the effect sizes used in the meta‐analysis. We then list the I2 statistic and the p‐value from the homogeneity test as indications of the presence of heterogeneity. As the sample size used in the analysis are often small and the homogeneity test is known to be under‐powered with small sample sizes, it may not detect statistically significant heterogeneity when it is in fact present. As such, a 90% confidence level threshold should generally be used when interpreting this with regard to the meta‐analyses below. The presence of effect size heterogeneity affects the extent to which the average effects size is applicable to all interventions of that summer programme type. We also provide an assessment of the relative confidence we have in the generalisability of the overall finding (low, moderate or high) – some of the overall findings are based on a small sample of studies, the studies evaluating the outcome may be of low quality, there may be wide variation in findings among the studies evaluating the outcome, or there may be specific aspects of the impact estimates included or the effect sizes constructed that affect the generalisability of the headline finding. These issues are detailed in full in the main body of the review. – Engagement with/participation in/enjoyment of education (SMD): ∘ Summer education programmes: +0.12 (+0.03, +0.20); positive impact; I2 = 48.76%, p = 0.10; moderate confidence. – Secondary education attendance (SMD): ∘ Summer education programmes: +0.26 (+0.08, +0.44); positive impact; I2 = N/A; p = N/A; low confidence. ∘ Summer employment programmes: +0.02 (−0.03, +0.07); no impact; I2 = 69.98%; p = 0.03; low confidence. – Passing tests (log OR): ∘ Summer education programmes: +0.41 (−0.13, +0.96); no impact; I2 = 95.05%; p = 0.00; low confidence. ∘ Summer employment programmes: +0.02 (+0.00, +0.04); positive impact; I2 = 0.01%; p = 0.33; low confidence. – Reading test scores (SMD): ∘ Summer education programmes: +0.01 (−0.04, +0.05); no impact; I2 = 0.40%; p = 0.48; high confidence. – English test scores (SMD): ∘ Summer education programmes: +0.07 (+0.00, +0.13); positive impact; I2 = 27.17%; p = 0.33; moderate confidence. ∘ Summer employment programmes: −0.03 (−0.05, −0.01); negative impact; I2 = 0.00%; p = 0.76; low confidence. – Mathematics test scores (SMD): ∘ All summer programmes: +0.09 (−0.06, +0.25); no impact; I2 = 94.53%; p = 0.00; high confidence. ∘ Summer education programmes: +0.14 (−0.09, +0.36); no impact; I2 = 94.15%; p = 0.00; moderate confidence. ∘ Summer employment programmes: +0.00 (−0.04, +0.05); no impact; I2 = 0.04%; p = 0.92; moderate confidence. – Overall test scores (SMD): ∘ Summer employment programmes: −0.01 (−0.08, +0.05); no impact; I2 = 32.39%; p = 0.20; high confidence. – All test scores (SMD): ∘ Summer education programmes: +0.14 (+0.00, +0.27); positive impact; I2 = 91.07%; p = 0.00; moderate confidence. ∘ Summer employment programmes: −0.01 (−0.04, +0.01); no impact; I2 = 0.06%; p = 0.73; high confidence. – Negative behavioural outcomes (log OR): ∘ Summer education programmes: −1.55 (−3.14, +0.03); negative impact; I2 = N/A; p = N/A; low confidence. ∘ Summer employment programmes: −0.07 (−0.33, +0.18); no impact; I2 = 88.17%; p = 0.00; moderate confidence. – Progression to HE (log OR): ∘ All summer programmes: +0.24 (−0.04, +0.52); no impact; I2 = 97.37%; p = 0.00; low confidence. ∘ Summer education programmes: +0.32 (−0.12, +0.76); no impact; I2 = 96.58%; p = 0.00; low confidence. ∘ Summer employment programmes: +0.10 (−0.07, +0.26); no impact; I2 = 76.61%; p = 0.02; moderate confidence. – Complete HE (log OR): ∘ Summer education programmes: +0.38 (+0.15, +0.62); positive impact; I2 = 52.52%; p = 0.06; high confidence. ∘ Summer employment programmes: +0.07 (−0.19, +0.33); no impact; I2 = 70.54%; p = 0.07; moderate confidence. – Entry to employment, short‐term (log OR): ∘ Summer employment programmes: −0.19 (−0.45, +0.08); no impact; I2 = 87.81%; p = 0.00; low confidence. ∘ Entry to employment, full period (log OR) ∘ Summer employment programmes: −0.15 (−0.35, +0.05); no impact; I2 = 78.88%; p = 0.00; low confidence. – Likelihood of having a criminal justice outcome (log OR): ∘ Summer employment programmes: −0.05 (−0.15, +0.05); no impact; I2 = 0.00%; p = 0.76; low confidence. – Likelihood of having a drug‐related criminal justice outcome (log OR): ∘ Summer employment programmes: +0.16 (−0.57, +0.89); no impact; I2 = 65.97%; p = 0.09; low confidence. – Likelihood of having a violence‐related criminal justice outcome (log OR): ∘ Summer employment programmes: +0.03 (−0.02, +0.08); no impact; I2 = 0.00%; p = 0.22; moderate confidence. – Likelihood of having a property‐related criminal justice outcome (log OR): ∘ Summer employment programmes: +0.09 (−0.17, +0.34); no impact; I2 = 45.01%; p = 0.18; low confidence. – Number of criminal justice outcomes, during programme (SMD): ∘ Summer employment programmes: −0.01 (−0.03, +0.00); no impact; I2 = 2.17%; p = 0.31; low confidence. – Number of criminal justice outcomes, post‐programme (SMD): ∘ Summer employment programmes: −0.01 (−0.03, +0.00); no impact; I2 = 23.57%; p = 0.37; low confidence. – Number of drug‐related criminal justice outcomes, post‐programme (SMD): ∘ Summer employment programmes: −0.01 (−0.06, +0.06); no impact; I2 = 55.19%; p = 0.14; moderate confidence. – Number of violence‐related criminal justice outcomes, post‐programme (SMD): ∘ Summer employment programmes: −0.02 (−0.08, +0.03); no impact; I2 = 44.48%; p = 0.18; low confidence. – Number of property‐related criminal justice outcomes, post‐programme (SMD): ∘ Summer employment programmes: −0.02 (−0.10, +0.05); no impact; I2 = 64.93%; p = 0.09; low confidence. We re‐express instances of significant impact by programme type where we have moderate or high confidence in the security of findings by translating this to a form used by one of the studies, to aid understanding of the findings. Allocation to a summer education programme results in approximately 60% of individuals moving from never reading for fun to doing so once or twice a month (engagement in/participation in/enjoyment of education), and an increase in the English Grade Point Average of 0.08. Participation in a summer education programme results in an increase in overall Grade Point Average of 0.14 and increases the likelihood of completing higher education by 1.5 times. Signs are positive for the effectiveness of summer education programmes in achieving some of the education outcomes considered (particularly on test scores (when pooled across types), completion of higher education and STEM‐related higher education outcomes), but the evidence on which overall findings are based is often weak. Summer employment programmes appear to have a limited impact on employment outcomes, if anything, a negative impact on the likelihood of entering employment outside of employment related to the programme. The evidence base for impacts of summer employment programmes on young people's violence and offending type outcomes is currently limited – where impact is detected this largely results in substantial reductions in criminal justice outcomes, but the variation in findings across and within studies affects our ability to make any overarching assertions with confidence. In understanding the effectiveness of summer programmes, the order of outcomes also requires consideration – entries into education from a summer employment programme might be beneficial if this leads towards better quality employment in the future and a reduced propensity of criminal justice outcomes. Qualitative Synthesis Various shared features among different summer education programmes emerged from the review, allowing us to cluster specific types of these interventions which then aided the structuring of the thematic synthesis. The three distinct clusters for summer education programmes were: catch‐up programmes addressing attainment gaps, raising aspirations programmes inspiring young people to pursue the next stage of their education or career, and transition support programmes facilitating smooth transitions between educational levels. Depending on their aim, summer education programme tend to provide a combination of: additional instruction on core subjects (e.g., English, mathematics); academic classes including to enhance specialist subject knowledge (e.g., STEM‐related); homework help; coaching and mentoring; arts and recreation electives; and social and enrichment activities. Summer employment programmes provide paid work placements or subsidised jobs typically in entry‐level roles mostly in the third and public sectors, with some summer employment programmes also providing placements in the private sector. They usually include components of pre‐work training and employability skills, coaching and mentoring. There are a number of mechanisms which act as facilitators or barriers to engagement in summer programmes. These include tailoring the summer programme to each young person and individualised attention; the presence of well‐prepared staff who provide effective academic/workplace and socio‐emotional support; incentives of a monetary (e.g., stipends and wages) or non‐monetary (e.g., free transport and meals) nature; recruitment strategies, which are effective at identifying, targeting and engaging participants who can most benefit from the intervention; partnerships, with key actors who can help facilitate referrals and recruitment, such as schools, community action and workforce development agencies; format, including providing social activities and opportunities to support the formation of connections with peers; integration into the workplace, through pre‐placement engagement, such as through orientation days, pre‐work skills training, job fairs, and interactions with employers ahead of the beginning of the summer programme; and skill acquisition, such as improvements in social skills. In terms of the causal processes which lead from engagement in a summer programme to outcomes, these include: skill acquisition, including academic, social, emotional, and life skills; positive relationships with peers, including with older students as mentors in summer education programmes; personalised and positive relationships with staff; location, including accessibility and creating familiar environments; creating connections between the summer education programme and the students' learning at home to maintain continuity and reinforce learning; and providing purposeful and meaningful work through summer employment programmes (potentially facilitated through the provision of financial and/or non‐financial incentives), which makes participants more likely to see the importance of education in achieving their life goals and this leads to raised aspirations. It is important to note that no single element of a summer programme can be identified as generating the causal process for impact, and impact results rather from a combination of elements. Finally, we investigated strengths and weaknesses in summer programmes at both the design and implementation stages. In summer education programmes, design strengths include interactive and alternative learning modes; iterative and progressive content building; incorporating confidence building activities; careful lesson planning; and teacher support which is tailored to each student. Design weaknesses include insufficient funding or poor funding governance (e.g., delays to funding); limited reach of the target population; and inadequate allocation of teacher and pupil groups (i.e., misalignment between the education stage of the pupils and the content taught by staff). Implementation strengths include clear programme delivery guidance and good governance; high quality academic instruction; mentoring support; and strong partnerships. Implementation weaknesses include insufficient planning and lead in time; recruitment challenges; and variability in teaching quality. In summer employment programmes, design strengths include use of employer orientation materials and supervisor handbooks; careful consideration of programme staff roles; a wide range of job opportunities; and building a network of engaged employers. Design weaknesses are uncertainty over funding and budget agreements; variation in delivery and quality of training between providers; challenges in recruitment of employers; and caseload size and management. Implementation strengths include effective job matching; supportive relationships with supervisors; pre‐work training; and mitigating attrition (e.g., striving to increase take up of the intervention among the treatment group). Implementation weaknesses are insufficient monitors for the number of participants, and challenges around employer availability.

Abstract Background Investment in mobile devices to support primary or elementary education is increasing and must be informed by robust evidence to demonstrate impact. This systematic review of randomised controlled trials sought to identify the overall impact of mobile devices to support literacy and numeracy outcomes in mainstream primary classrooms. Objectives The aim of this systematic review was to understand how mobile devices are used in primary/elementary education around the world, and in particular, determine how activities undertaken using mobile devices in the primary classroom might impact literacy and numeracy attainment for the pupils involved. Within this context, mobile devices are defined as tablets (including iPads and other branded devices), smartphones (usually those with a touchscreen interface and internet connectivity) and handheld games consoles (again usually with touchscreen and internet‐enabled). The interventions of interest were those aimed at improving literacy and/or numeracy for children aged 4–12 within the primary/elementary school (or equivalent) classroom. Specifically, the review aimed to answer the following research questions: ‐ What is the effect of mobile device integration in the primary school classroom on children's literacy and numeracy outcomes? ‐ Are there specific devices which are more effective in supporting literacy and numeracy? (Tablets, smartphones, or handheld games consoles) ‐ Are there specific classroom integration activities which moderate effectiveness in supporting literacy and numeracy? ‐ Are there specific groups of children for whom mobile devices are more effective in supporting literacy and numeracy? (Across age group and gender). ‐ Do the benefits of mobile devices for learning last for any time beyond the study? ‐ What is the quality of available evidence on the use of mobile devices in primary/elementary education, and where is further research needed in this regard? An Expert Advisory Group supported the review process at key stages to ensure relevance to current practice. Search Methods The search strategy was designed to retrieve both published and unpublished literature, and incorporated relevant journal and other databases with a focus on education and social sciences. Robust electronic database searches were undertaken (12 databases, including APA PsychInfo, Web of Science, ERIC, British Education Index and others, and relevant government and other websites), as well as a hand‐search of relevant journals and conference proceedings. Contact was also made with prominent authors in the field to identify any ongoing or unpublished research. All searches and author contact took place between October and November 2020. The review team acknowledges that new studies will likely have emerged since and are not captured at this time. A further update to the review in the future is important and would build on the evidence reflected here. Selection Criteria The review included children within mainstream primary/elementary/kindergarten education settings in any country (aged 4–12), and interventions or activities initiated within the primary school classroom (or global equivalent) that used mobile devices (including tablets, smartphones, or hand‐held gaming devices) to intentionally support literacy or numeracy learning. In terms of study design, only Randomised Controlled Trials were included in the review. Data Collection and Analysis A total of 668 references were identified through a robust search strategy including published and unpublished literature. Following duplicate screening, 18 relevant studies, including 11,126 participants, 14 unique interventions, and 46 relevant outcome measures were synthesised using Robust Variance Estimation and a random effects meta‐analysis model. Risk of Bias assessment was undertaken by three reviewers using the ROB2 tool to assess the quality of studies, with 13 studies rated as having some concerns, and 5 as having high risk of bias. Qualitative data was also extracted and analysed in relation to the types of interventions included to allow a comparison of the key elements of each. Main Results A positive, statistically significant combined effect was found (Cohen's d = 0.24, CI 0.0707 to 0.409, p

Abstract Background Rhinitis encompasses diverse forms. Each form has distinct pathophysiology and clinical manifestations and may be influenced by differential risk factors. The association between socioeconomic status (SES) and different forms of rhinitis remains poorly understood. Our aim was to examine SES variations in allergic rhinitis, chronic rhinitis, and chronic rhinosinusitis in adults. Methods Based on a 2016 postal questionnaire survey within the West Sweden Asthma Study, we analyzed data from 36,213 subjects aged 16–75 years. The measures of SES were levels of education and occupation. Adjusted logistic regression was used to examine associations between SES and the rhinitis outcomes. Results Attaining a secondary school and tertiary education, compared to a primary school, were associated with increased risk of allergic rhinitis (secondary OR 1.33, 95% CI 1.22–1.45; tertiary 1.54, 1.41–1.69) and chronic rhinitis (secondary 1.18, 1.08–1.29; tertiary 1.17, 1.06–1.28). The influence of occupation was consistent with respect to allergic rhinitis. For instance, compared to the lowest occupational skill level, the highest level (OR 1.24, 95% CI 1.04–1.48) and the lower high occupation levels (1.24, 1.04–1.49) were associated with an increased risk of allergic rhinitis. No significant link was found between education and chronic rhinosinusitis or between occupation levels and risk of either chronic rhinitis or chronic rhinosinusitis. Conclusion Individuals with higher education and those at higher occupational levels may be at higher risk of having different forms of rhinitis than those at lower education and occupation levels. Assessment of rhinitis burden via SES can be one strategy to develop preventive strategies.

Abstract Most countries have declared one or more animal or plant species to be among their national symbols, termed here national biodiversity symbols. National biodiversity symbols are the species formally or informally recognised by societies and countries as having meaning to one or more of national identity, values and unity. It has been proposed previously that national biodiversity symbols can be used as flagship species to advance habitat conservation in their respective countries. However, this assumes that the symbols are well‐known and revered by the citizens of the country concerned. We examined this assumption via direct interviews with 382 urban residents in four towns in South Africa, which is a mega‐biodiversity country with five national biodiversity symbols (a national tree, flower, animal, bird and fish). We found that less than 3% of the urban respondents could name all five species, ranging from 6% for the national tree to 40% for both the national flower and national animal. Knowledge of other national symbols (flag and anthem) were equally low. The number of national biodiversity symbols known increased with income and education level of respondents. Despite limited knowledge of which species were the national biodiversity symbols, almost two‐thirds of respondents felt that having national biodiversity symbols was important for promoting national identity. These findings show that from a heritage perspective a great deal more awareness needs to be developed in South Africa around the national biodiversity symbols. From a conservation perspective, it indicates that the national biodiversity symbols are unlikely, at this stage at least, to be useful as flagship species for habitat conservation programmes. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Background With the aging of heart failure (HF) patients, collaboration between medical and nursing care facilities is essential for HF care. The aims of this study were: (1) to identify the factors that affect willingness of nursing care staffs to cooperate with HF care; (2) to test whether the internet video education is useful in improving their willingness to collaborate. Methods A web‐based questionnaire was e‐mailed to 417 registered medical corporations that operated nursing care facilities in the prefecture where the authors work. Medical and care staff working at each facility were asked their willingness to cooperate with HF care and their problems about collaboration. Machine learning analysis was used to assess the factors associated with unwillingness to cooperate. After watching a 6‐min YouTube video explaining HF and community collaboration, we reaffirmed their willingness to cooperate. Results We received responses from 76 medical and care staff members. Before watching the video, 32.9% of participants stated that they were unwilling to cooperate with HF care. Machine learning analysis showed that job types, perceived problems of collaboration, and low opportunities to learn about HF were associated with unwillingness to cooperation. After watching the video, we observed an increase from 67.1% to 80.3% (p

Abstract Aim Nursing competencies are crucial indicators for providing quality and safe care. The lack of international agreement in this field has caused problems in the generalization and application of findings. The purpose of this review is to identify the core competencies necessary for undergraduate nursing students to enter nursing work. Data Sources We conducted a structured search using Scopus, MEDLINE (PubMed), Science Direct, CINAHL, Web of Science, and Google Scholar. Review Methods We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute, supported by the PAGER framework, and guided by the PRISMA‐ScR Checklist. Inclusion criteria included full‐text articles in English, quantitative and qualitative research related to competencies for undergraduate students or newly graduated nurses, competency assessment, and tool development from 1970 to 2022. We excluded articles related to specific nursing roles, specific contexts, Master's and Ph.D. curricula, hospital work environment competencies, and editorial. Results Out of 15,875 articles, we selected 43 studies, and data analysis with summative content analysis identified five themes named individualized care, professional nursing process, nursing administration, readiness, and professional development. Conclusion Considering the dynamics of competencies and their change with time, experience, and setting, it is necessary to update, localize, and levelling of the proposed competencies based on the culture of each country. Impact These competencies provide a guide for undergraduate nursing curriculum development and offer a framework for both clinical instruction and the evaluation of nursing students.

Abstract Background With the decline of cognitive function in vascular cognitive impairment, the burden on the family and society will increase. Therefore, early identification of vascular mild cognitive impairment (VaMCI) is crucial. The focus of early identification of VaMCI is on the attention of risk factors. Therefore, this study aimed to investigate the relationship between diabetes and VaMCI among the Chinese, hoping to predict the risk of VaMCI by diabetes and to move the identification of vascular cognitive impairment forward. Methods We collected data from seven clinical centers and nine communities in China. All participants were over 50 years of age and had cognitive complaints. We collected basic information of the participants, and cognitive function was professionally assessed by the Montreal Cognitive Assessment scale. Finally, logistic regression analysis was used to analyze the correlation between each factor and VaMCI. Results A total of 2020 participants were included, including 1140 participants with VaMCI and 880 participants with normal cognition. In univariate logistic regression analysis, age, heavy smoking, and diabetes had a positive correlation with VaMCI. At the same time, being married, high education, and light smoking had a negative correlation with VaMCI. After correction, only diabetes (OR = 1.04, 95% CI: 1.01–1.09, p = 0.05) had a positive correlation with VaMCI, and high education (OR = 0.60, 95% CI:.45–.81, p = 0.001) had a negative correlation with VaMCI. Conclusion In our study, we found that diabetes had a positive correlation with VaMCI, and high education had a negative correlation with VaMCI. Therefore, early identification and timely intervention of diabetes may reduce the risk of VaMCI and achieve early prevention of VaMCI.

Background We examined the association of multilevel social determinants of health with incident apparent treatment‐resistant hypertension (aTRH). Methods and Results We analyzed data from 2774 White and 2257 Black US adults from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study taking antihypertensive medication without aTRH at baseline to estimate the association of social determinants of health with incident aTRH. Selection of social determinants of health was guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Blood pressure (BP) was measured during study visits, and antihypertensive medication classes were identified through a pill bottle review. Incident aTRH was defined as (1) systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease while taking ≥3 classes of antihypertensive medication or (2) taking ≥4 classes of antihypertensive medication regardless of BP level, at the follow‐up visit. Over a median 9.5 years of follow‐up, 15.9% of White and 24.0% of Black adults developed aTRH. A percent of the excess aTRH risk among Black versus White adults was mediated by low education (14.2%), low income (16.0%), not seeing a friend or relative in the past month (8.1%), not having someone to care for them if ill or disabled (7.6%), lack of health insurance (10.6%), living in a disadvantaged neighborhood (18.0%), and living in states with poor public health infrastructure (6.0%). Conclusions Part of the association between race and incident aTRH risk was mediated by social determinants of health.

Abstract Objective The process of resident recruitment is costly, and our surgical residency program expends significant time on the resident selection process while balancing general duties and responsibilities. The aim of our study was to explore the relationship between otolaryngology–head and surgery (OHNS) residents' National Residency Matching Program (NRMP) rank‐list position at our institution and their subsequent residency performance. Study Design Retrospective cohort study. Setting Single site institution. Methods We retrospectively reviewed 7 consecutive resident classes (2011‐2017) at a single tertiary OHNS residency program. We reviewed each resident's absolute rank order in the NRMP matches. Measures of residency performance included overall faculty evaluation during postgraduate year 5 (PGY5), annual in‐service examination scores (scaled score), and the number of manuscripts published in peer‐reviewed journals. Correlations between NRMP rank order and subsequent residency performance were assessed using Spearman's rho correlation coefficients (ρ). Results Twenty‐eight residents entered residency training between 2011 and 2017. The average rank position of the trainees during this study was 9.7 (range: 1‐22). We found no significant correlation between rank order and faculty evaluation during PGY5 (ρ = 0.097, P = .625) or number of publications (ρ = −0.256, P = .189). Additionally, when assessing the association between rank order and annual Otolaryngology Training Examination‐scaled scores, no statistically significant relationship was found between the 2 (P > .05). Conclusion Our results showed that there were no significant correlations between OHNS rank order and various measures of success in residency training, which aligns with existing literature. Further investigation of this relationship should be conducted to ensure the applicability of our findings.

Abstract Aim The aim of this study was to: (1) use cognitive task analysis to describe final year nursing students situation awareness in recognising, responding and escalating care of deteriorating patients in ward settings; and (2) make recommendations for training and practice. Design A mixed methods cognitive task analysis with a convergent triangulation design. Method Data collection involved observations of 33 final year nursing students in simulated deteriorating patient scenarios and retrospective cognitive interviews. A process tracing technique was applied to identify the cues to deterioration participants perceived; how cue perception altered as situational demands increased; the extent that participants made connections between perceived cues and reached a situational understanding; and the factors that influenced and constrained participants situation awareness. Qualitative and quantitative findings are woven together and presented using descriptive statistics, illustrative quotations and timeline extractions. Results The median cue perception was 65.4% and 57.6% in the medical and surgical scenarios, respectively. Perception was negatively influenced by incomplete vital sign monitoring as situations escalated; limited physical assessments; passive scanning behaviours; poor task automaticity; and excessive cognitive demands. Incomplete perception, poor cue integration and underdeveloped mental models influenced situational understanding. Escalation calls did not always accurately reflect situations and a reporting mindset was evident. Clinical exposure to deteriorating patients was described as variable and opportunistic. Reporting Method The study is reported in accordance with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist. Patient or Public Contribution Patients and public were not involved in this research.

Abstract Background Awareness and understanding of dementia remain limited in ethnically diverse populations in multicultural societies due to culturally inappropriate and inaccessible information. Objective To establish the impact, helpers and hinderers of an online multilingual dementia awareness initiative co‐created with and for English, Arabic and Vietnamese speaking people. Design A case study using mixed methods to assess the impact and implementation of an information session on dementia knowledge. Setting and Participants The study was conducted with English, Arabic and Vietnamese speaking individuals in Canterbury‐Bankstown, Australia. Intervention Studied A dementia alliance co‐created an online multilingual dementia information session, which was delivered synchronously in English, Arabic and Vietnamese by trained facilitators. Main Outcome Measures In‐session group discussions, quizzes and a postsession survey assessed the impact on dementia knowledge. A postimplementation focus group explored the factors that helped and hindered the initiative. Results The online dementia information session successfully supported participants understanding of dementia causes, impacts and care strategies. The initiative was hindered by competing priorities and limited accessibility to target audiences, while it was helped by the support of an established organisation and feedback mechanisms. Discussion Ongoing dementia education and awareness‐raising campaigns that are culturally sensitive are needed in communities to promote dementia literacy and help‐seeking. Conclusions An online multilingual dementia information session can be an effective way to improve dementia literacy and advocate for change in multicultural communities. Patient or Public Contribution English, Arabic and Vietnamese speaking members of the Canterbury Bankstown Dementia Alliance participated in the co‐creation and evaluation of this initiative.

Abstract Background and Aims Provision of physiotherapy services using telehealth has drastically increased since the COVID‐19 pandemic and continues to be utilized in clinical practice suggesting telehealth in physiotherapy will become common practice. Prior research has explored the attitudes of physiotherapists with many years of in‐person clinical experience toward telehealth. However, little is known about the emerging workforce's attitudes. This study aims to explore physiotherapy students' attitudes toward the use of telehealth in clinical practice. Methods A cross‐sectional online survey of physiotherapy students enrolled in the Doctor of Physiotherapy program at Macquarie University between November 2022 and February 2023. Participants rated their level of agreement across 11 statements regarding telehealth use in physiotherapy clinical practice using a 5‐point Likert scale ranging from “strongly disagree” to “strongly agree.” Participants answered two open‐ended questions regarding when they might use telehealth in clinical practice as a physiotherapist and why they believe physiotherapists might be reluctant to use telehealth in clinical practice. Results A total of 118 participants completed the survey (response rate 53%). Overall, most participants believed telehealth would continue being offered post‐Covid‐19 (86%, n = 101), participants would use some form of telehealth in clinical practice (82%, n 96), believe a blended approach would be beneficial for patients (84%, n = 99), and were interested in further training in telehealth (90%, n = 107). We identified six broad themes, including accessibility, subsequent consultations, inability to provide manual therapies, limited training/education, perceived ineffectiveness, and digital literacy of the patient. Conclusion Overall physiotherapy students believe telehealth will continue being offered in clinical practice, form part of contemporary physiotherapy practice, and are interested in further training to upskill in the delivery of care via telehealth. Given the continued use and students' demand for future training, it may be time to reimagine the inclusion of telehealth education and training in the entry‐level physiotherapy curriculum.

Abstract Background Cervical cancer is one of the most common cancers in women worldwide and a cause of high mortality among people. Pap smear screening is an appropriate method to prevent cervical cancer and reduce its mortality. Aim This study aimed to determine the effect of web‐based education based on the Health Belief Model (HBM) on cervical cancer screening behavior in middle‐aged women. Methods and Results This study is a quasi‐experimental interventional research that was conducted on 240 middle‐aged women aged 40–59 years in Isfahan, Iran, in 2022. An online educational intervention based on the constructs of the Health Belief Model was conducted for the intervention group using the Triple‐B platform. The information on the intervention and control groups was collected before, immediately after the intervention, and 2 months later using a valid questionnaire. The gathered Data was analyzed using ANOVA and LSD post‐hoc, independent samples t test, chi‐square, and MANCOVA statistical tests in SPSS 26 software. After the intervention, the mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, self‐efficacy, and internal cues to action in the intervention group increased and the mean score of perceived barriers decreased (p

Abstract Objectives We aimed to assess the impact of in‐person and distance school learning models on children's visits to the emergency department (ED) for psychological or social (“psychosocial”) complaints. Methods We analyzed presentations to one emergency department in a mid‐sized Midwestern city. We used the public school system schedule to determine in‐person and distance learning periods by the grade level. We calculated the incidence of visits to the emergency department during academic years 2018–2019, 2019–2020, and 2020–2021, with particular attention to the time after March 13, 2020, which was the pandemic period. We compared the incidence of visits during in‐person versus distance learning school models. Results A total of 7181 visits occurred during the academic years studied, 17.1% due to psychosocial complaints. The incidence of psychosocial visits to the ED was lower during distance learning than during the pandemic in‐person learning period (given per 1000 student years: 20.5 vs. 24.1, p = 0.14). This difference was statistically significant among middle schoolers (23.3 vs. 46.6, p

Abstract Contemporary students increasingly benefit from non‐hierarchical education, including peer‐led work, which moves beyond more ridged traditional educational structures. Such approaches encourage engagement, two‐way communication, diversity of thought and collaboration. This piece shares the stories and experiences of students with a shared interest in health promotion and lifestyle medicine who took part in a peer‐led, internationally based online student group. The forum aimed to provide a space for students to explore and discuss diverse topics within the health sphere in an attempt to bridge the gap between areas of expertise and education. The group capitalised on the normalisation of remote video meetings following the COVID‐19 pandemic to bring together a small group of diverse students from across the globe on a weekly basis for journal clubs, presentations, debates and guest lectures. Group member feedback was obtained and highlighted key gaps in much traditional education, which the group addressed. These included moving beyond educational and research silos, the importance of preventative health approaches and the need for more judgement‐free and inclusive learning environments. Alignment with the current health landscape and potential for scaling the group format more widely is discussed. The article concludes by emphasising the advantages of this approach in fostering a network of learners prepared to tackle future health challenges.

Abstract Aim This study aims to investigate how Lebanese nursing students perceive the challenges of implementing person‐centered care in clinical settings. Design A qualitative descriptive design was adopted for this study. Methods At one of Lebanon's top universities, a qualitative descriptive study design was used with 18 nursing students from various academic levels. Content analysis was used to generate the results after three focus group discussions. The Consolidated Criteria for Reporting Qualitative Research were used to report this study. Results The content analysis gave rise to four main themes, namely, “overload”, “challenges with education”, “unawareness”, “establishing connection”, and “lack of initiatives related to policy”. The results showed a number of obstacles that Lebanese nursing students believed were in the path of providing person‐centered care. These obstacles included organisational issues like time restraints and an intense workload, as well as interaction difficulties with patients and healthcare teams, and educational issues like insufficient instruction in person‐centered care concepts during nursing programs.

Abstract Background and Aim Myocardial infarction is a common cause of hospitalization, and nutritional behaviors are risk factors in such patients. The present study aimed to determine the effect of education based on the health belief model on nutritional behavior and indices in patients with myocardial infarction. Methods The present experimental study examined patients with myocardial infarction in 2021. Seventy‐two patients with myocardial infarction were randomly divided into intervention and control groups. The intervention group received educational interventions based on the health belief model in four 60‐min sessions for 3 months. The constructs of the health belief model, nutritional behavior, and indices were measured using a valid questionnaire before, 1, and 3 months after the intervention. At the end, the study data was analyzed using SPSS version 22 software. Results There was a significant difference between the two groups in the mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, self‐efficacy, nutritional behaviors, and body mass index after the intervention (p 0.05). Biochemical factors also had a significant difference after the intervention (p

Abstract Background Climate change, health inequalities and obesity are considerable public health challenges of the 21st century. Red and processed meat (RPM) consumption is associated with an increased risk of obesity and with higher climate impact. At the same time, educational inequalities exist not only in RPM consumption and obesity but also in other health behaviours. Thus, we investigated whether educational inequalities exist in the association between RPM consumption and obesity, while also considering health behaviours (physical activity, vegetable, legume and fruit consumption, alcohol consumption and smoking) as potential confounding and effect modifying factors. Methods The FinHealth 2017 Study data, including 4494 participants aged 18–74 years, were used. A validated food frequency questionnaire was employed to determine dietary intake. Height and weight were measured by trained study nurses. Linear and logistic regression models were used. Results Odds of obesity increased along with RPM consumption in women (p