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

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

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

Background: Dysphagia is a highly prevalent condition and affects a wide range of cohorts. A common compensatory strategy to manage dysphagia is diet modification. However, this technique is often associated with poor patient quality of life and adverse long‐term effects. Carbonated liquids have shown promise as an alternative compensatory strategy for the management of dysphagia. Aims: To examine the effect of genetic taste status and intensity of carbonation on swallowing and palatability in a healthy young adult population. To examine the palatability of carbonated liquids over time. Methods & Procedures: A total of 35 healthy young adults were recruited for this prospective, quantitative cohort study. They each drank 150 ml of still water (SW), lightly carbonated water (LCW) and highly carbonated water (HCW). Swallow function, palatability and genetic taste status were assessed using the timed water swallow test, the hedonic general labelled magnitude scale and participant ratings of the bitterness of propylthiouracil strips, respectively. Participants were divided into groups of supertasters, moderate tasters and non‐tasters. Outcomes & Results: A significant difference was found between SW and HCW on three tests of swallow function. Average time per swallow increased (p = 0.03), average swallow velocity decreased (p = 0.001) and average volume per swallow decreased (p = 0.017) on HCW compared with SW. HCW had a greater impact on swallow function than LCW. A significant mean difference in palatability ratings was found across intensity levels of carbonated fluids (p = 0.002), specifically between SW and HCW (p = 0.001). HCW was less palatable than SW. The palatability of carbonated liquids, investigated within a subgroup of five participants, did not decrease after a 24‐h period during which participants only drank carbonated liquids (p = 0.102). A significant difference was found between supertasters' (n = 9) (mean = 13.33) and non‐tasters' (n = 20) (mean = –24.5) palatability ratings of HCW (p = 0.03). Despite differences in swallow function between SW and HCW, no differences were detected between supertasters' and non‐tasters' swallow function on SW, LCW or HCW. Conclusions & Implications: Carbonated liquids have the ability to alter swallow function in a healthy young adult population; however, liquids must be highly carbonated in order to have an effect. Additionally, highly carbonated liquids are less palatable than SW, but the palatability of carbonated liquids does not decrease over time. Furthermore, supertasters find HCW more palatable than non‐tasters. These findings suggest that carbonated liquids alter swallowing in a healthy population. Further research in a clinical population is needed to better understand the potential role of sensory stimulation as a dysphagia intervention. What this paper adds: What is already known on the subject: Several studies have found that carbonated liquids have the ability to alter swallow function in both healthy and clinical populations. However, there is a lack of evidence around the optimum intensity of CO2 in carbonated liquids and the palatability of carbonated liquids as well as the palatability of carbonated fluids over time. What this paper adds to existing knowledge: The findings from this study suggest that carbonated liquids can alter swallow function in a healthy young adult population, but liquids must be highly carbonated in order to have an effect. HCW is less palatable than SW, but the palatability of carbonated liquids does not decrease over time. Additionally, supertasters find HCW more palatable than non‐supertasters (non‐tasters). What are the potential or actual clinical implications of this work?: The findings from this study suggest that carbonated liquids may be suitable for use as a sensory stimulation technique for people with dysphagia, as their palatability does not decrease over time; however, further research in a clinical population is needed in order to determine this. Additionally, intensity of stimulus is an important factor to consider during dysphagia evaluation to identify what intensity is required to optimize swallowing. [ABSTRACT FROM AUTHOR]

Background: Speech intelligibility is a global indicator of the severity of a speech problem. It is a measure that has been used frequently in research and clinical assessment of speech. Previous studies have shown that factors, such as measurement method and listener experience, can influence speech intelligibility scores. However, these factors of speech intelligibility assessment have not yet been investigated in people with Down syndrome (DS). Aims: To compare the speech intelligibility scores in speakers with DS measured using two methods: orthographic transcription and visual analogue scale (VAS), by two groups of listeners, experienced listeners and naïve listeners. Also, to examine the relationship across the four sets of speech intelligibility scores by means of correlational analysis. Methods & Procedures: A total of 30 adolescents and adults with DS read or repeated 12 sentences from a standardized test of intelligibility for adults with dysarthria. Each sentence was saved as a separate sound file and the 360 sentences were divided to form eight sets of stimuli. A total of 32 adults (16 experienced and 16 naïve) served as listeners of speech intelligibility. Each listener heard a single set of sentences and independently estimated the level of intelligibility for each sentence using a VAS in one task and wrote down the words perceived (i.e., orthographic transcription) in another task. The order of the two tasks was counterbalanced across listeners and the tasks were completed at least 1 week apart. Outcomes & Results: Repeated‐measures analysis of variance (ANOVA), confirmed by mixed‐methods analysis, showed that the scores obtained using orthographic transcription were significantly higher than those obtained using VAS; and the experienced listeners' scores were significantly higher than the naïve listeners' scores. Spearman rank correlation analysis showed that the four sets of scores across all conditions were strongly positively correlated with each other. Conclusions & Implications: Listeners, both experienced and naïve, may udge speech in DS differently when using orthographic transcription versus VAS as the method of measurement. In addition, experienced listeners can judge speech intelligibility differently compared with listeners who are less exposed to unclear speech, which may not represent 'real‐world' functional communicative ability. Speech and language therapists should be aware of the effect of these factors when measuring intelligibility scores and direct comparison of scores obtained using different procedures and by different groups of listeners is not recommended. What this paper addsWhat is already known on the subjectPrevious research on other clinical groups (e.g., Parkinson's disease) has shown that speech intelligibility scores can vary across different measurement methods and when judged by listeners with different experience. However, these factors have not yet been investigated in people with DS.What this paper adds to existing knowledgeSimilar to the findings reported for other clinical groups, using an impressionistic measurement method, such as VAS, can result in different speech intelligibility scores compared with scores obtained from orthographic transcription in speakers with DS. Furthermore, experienced listeners can perceive intelligibility as better compared with naïve (untrained) listeners for this group.What are the potential or actual clinical implications of this work?When measuring speech intelligibility, speech and language therapists should be aware that scores obtained using orthographic transcription can be higher than those obtained using VAS. They should also be aware that their increased exposure to hearing atypical speech may cause them to judge the speech difficulty as less severe and lead to an inaccurate representation of speech performance. Speech and language therapists should consider these factors when interpreting assessment results and especially when using intelligibility measures for treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. Aims: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. Methods and Procedures: In total, 43 UK families of 2–4‐year‐olds were recruited to the study, half of whom completed an 8‐week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait‐list controls. Results and Outcomes: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait‐list controls. Conclusions and Implications: We conclude that pre‐verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. What This Paper Adds: What is already known on the subject: Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds: This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work?: Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need. [ABSTRACT FROM AUTHOR]

Fractional counting of citations can improve on ranking of multidisciplinary research units (such as universities) by normalizing the differences among fields of science in terms of differences in citation behavior. Furthermore, normalization in terms of citing papers abolishes the unsolved questions in scientometrics about the delineation of fields of science in terms of journals and normalization when comparing among different (sets of) journals. Using publication and citation data of seven Korean research universities, we demonstrate the advantages and the differences in the rankings, explain the possible statistics, and suggest ways to visualize the differences in (citing) audiences in terms of a network. [ABSTRACT FROM AUTHOR]

Background: A total of 68% of pre‐school children with cleft palate have speech problems requiring speech therapy. There is a lack of access to regular targeted therapy. Parent training leads to positive outcomes in early communication skills in cleft palate and non‐cleft speech disorders. Connected health has been used to address inadequate access to therapy, providing intervention to those who would not otherwise receive therapy. Aims: To evaluate the speech, activity and participation outcomes of Parent Led, Therapist Supervised, Articulation Therapy (PLAT) compared with routine speech therapy intervention in parent–child dyads. Methods & Procedures: A total of 44 children, aged 2.9–7.5 years, were included in a two‐centre, two‐phase randomized controlled trial. Informed consent and assent were obtained. Participants and speech and language therapists (SLTs) were unblinded to the groups. Parents, in the parent‐trained group (n = 23), attended 2 days' training, received a detailed speech therapy programme, and undertook intervention over 12 weeks supported by the cleft specialist SLT using FaceTime and one face‐to‐face session. In the control arm (n = 21), parent–child dyads received six therapy sessions over 12 weeks with a research SLT, comparable with usual care. Speech recordings were undertaken pre‐ and post‐intervention. Percent consonant correct (PCC) was analysed by external SLTs blinded to the time and group. Activity and participation were measured using the Intelligibility in Context Scale (ICS) and Focus on Outcomes for Children Under Six (FOCUS) questionnaire. Outcomes & Results: There was no evidence of an interaction between Time and Group or an overall statistical difference between groups for PCC scores. There was a statistically significant difference over time for both groups (words: p < 0.002; confidence interval (CI) = 9.38–16.27; d = 0.57; sentences: p < 0.002; CI = 16.04–25.97; d = 0.23). Effect sizes were medium for words and small for sentences. For intelligibility and participation, there was no evidence of an interaction between Time and Group or an overall statistical difference between groups. A statistically significant difference over time was found for intelligibility (F = 29.97, d.f. = 1, 42, p < 0.001, 95 % CI = 1.45–3.15 d = 0.46) and for participation (F = 14.19, d.f. = 1, 41, p < 0.001 95% CI = 7.63–25.03; d = 0.36) with FOCUS results indicating clinically meaningful (parent‐led group) and significant (control group) change in participation. Conclusions & Implications: PLAT can be as effective as routine care in changing speech, activity and participation outcomes for children with cleft palate, when supported by a specialist cleft SLT using connected health. What this paper addsWhat is already known on this subjectOver 50% of children with cleft palate require speech therapy. However, there is a lack of timely, accessible speech therapy services in the UK and Ireland. Previous studies have shown that parents can deliver therapy effectively, and that connected health can support the delivery of speech therapy. This study aims to provide evidence that parent‐led therapy with the supervision of a specialist cleft therapist using FaceTime is effective.What this paper adds to existing knowledgeThis randomized controlled trial indicates that parents can be trained to deliver therapy for children with cleft palate speech disorders, under the supervision of an SLT. This approach results in improved speech, activity and participation outcomes similar to routine care.What are the potential or actual clinical implications of this work?This study indicates that both parent‐led articulation therapy and routine care showed meaningful gains in speech, activity and participation, and that parent‐led articulation therapy when supported by a cleft SLT using connected health could be an additional service delivery model for children with cleft palate speech disorders. [ABSTRACT FROM AUTHOR]

Retrieval practice promotes retention more than restudying (i.e., the testing effect) and is applied to many educational settings. However, little research has investigated means to enhance this effect in educational settings. Theoretical accounts assume retrieval practice to be the most effective whenever retrieval is difficult but successful. Therefore, we developed a novel retrieval practice procedure, which adapts to learners' abilities and can be applied irrespective of learning content. This adaptive procedure aims to make retrieval gradually easier whenever students provide an incorrect answer. In a field experiment, students read book chapters as part of a weekly university course. In three consecutive weeks, they then practiced reading assignments by (a) adaptive testing, (b) non‐adaptive testing and (c) restudy. In Week 4, a surprise criterial test took place. Restudy outperformed both testing conditions, whereas adaptive testing performed equally well as non‐adaptive testing. However, exploratory analyses revealed that with increasing retention intervals, the superiority of restudy disappeared. Furthermore, whenever participants fully read the assignments and retention intervals increased, adaptive testing outperformed non‐adaptive testing. In sum, adaptive retrieval practice did not prove to be generally superior, but retention interval and students' preparation for class might be conditions rendering adaptive retrieval useful in educational settings. Lay Description: What is already known about this topic: Testing is a commonly used technique to assess progress in computer‐assisted learning environmentsStudents often benefit from the testing effect, that is practicing retrieval of information (testing) from memory benefits long‐term retention compared to restudyingCurrently, empirical evidence how to enhance the benefits of this technique in educational contexts is scarce What this paper adds: We propose a new approach to increase the benefit of the testing effect: For each question in retrieval practice the individual ability to retrieve this information from memory is consideredTo do so, cue informativeness of retrieval cues adapts to the individual ability level and thus makes the tests cognitively effortful but solvableThis adaptive approach is put to test in a higher education context and by using multiple‐choice questionsIn sum, adaptive retrieval practice did not prove to be generally superior to non‐adaptive retrieval practice or restudy However, retention interval and students' preparation for class might be conditions rendering adaptive retrieval useful in educational settings Implications for practice and/or policy: Findings can be implemented in educational contexts when multiple‐choice questions are used to enhance learningLearning can be optimized in computer‐assisted learning environments that allow adaptive testingWe advise adaptive retrieval only when students are well prepared for practice and when time between practice and final assessment exceeds two weeks [ABSTRACT FROM AUTHOR]

Background: Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people's health expectations and potentially behaviour during the COVID‐19 pandemic. Objectives: Data were collected through an international survey (N = 6485) exploring people's thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Methods: Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile. Findings: Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P <.001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID‐19‐related infection or symptoms) when thinking about the next year. Discussion: This is one of the first ever studies to report compelling comparative biases in UK adults' thinking about COVID‐19. [ABSTRACT FROM AUTHOR]

Background Alcohol-related blackouts ( ARBs) are reported by ~50% of drinkers. While much is known about the prevalence of ARBs in young adults and their cross-sectional correlates, there are few prospective studies regarding their trajectories over time during mid-adolescence. This paper reports latent trajectory classes of ARBs between age 15 and 19, along with predictors of those patterns. Methods Latent class growth analysis ( LCGA) was used to evaluate the pattern of occurrence of ARBs across 4 time points for 1,402 drinking adolescents from the Avon Longitudinal Study of Parents and Children ( ALSPAC). Multinomial regression analyses evaluated age-15 demography, substance-related items, externalizing characteristics, and estimated peer substance use as predictors of latent class membership. Results ARBs were reported at age 15 in 30% and at age 19 in 74% of these subjects. Four latent trajectory classes were identified: Class 1 (5.1%) reported no blackouts; for Class 2 (29.5%), ARBs rapidly increased with age; for Class 3 (44.9%), blackouts slowly increased; and for Class 4 (20.5%), ARBs were consistently reported. Using Class 2 (rapid increasers) as the reference, predictors of class membership included female sex, higher drinking quantities, smoking, externalizing characteristics, and estimated peer substance involvement (pseudo R2 = 0.22). Conclusions ARBs were common and repetitive in these young subjects, and predictors of their trajectories over time involved multiple domains representing diverse characteristics. [ABSTRACT FROM AUTHOR]

Background/aim Engagement in desired occupations can promote health and wellbeing in older adults. Assessments of engagement often measure frequency, amount or importance of specific activities. This study aimed to develop a scale to measure older adults' evaluation of the extent to which their everyday activities are contributing to their health and wellness. Methods Eighteen items, each scored with a seven-point rating scale, were initially developed by content experts, covering perceptions of how daily activities contribute to physical and mental health, as well as satisfaction and activity participation in the last six months. Rasch analysis methods were used to refine the scale using the pencil and paper responses of 460 community-living older adults. Results Initial Rasch analysis indicated three unlabelled rating scale categories were seldom used, reducing measurement precision. Five items were conceptually different by misfit statistics and principal component analysis. Subsequently, those items were removed and the number of rating scale steps reduced to 4. The remaining 13-item, 4-step scale, termed the Activity Significance Personal Evaluation ( ASPEn), formed a unidimensional hierarchy with good fit statistics and targeting. Person separation reliability (2.7) and internal consistency (.91) indicated the tool is appropriate for individual person measurement. Relative validity indicated equivalence between Rasch measures and total raw scores. Conclusions ASPEn is a brief, easily administered assessment of older adults' perception of the contribution of everyday activities to personal health and wellness. ASPEn may facilitate occupational therapy practice by enabling clinicians to assess change in meaning of an older adult's activity over time. [ABSTRACT FROM AUTHOR]

Aims: School‐based humanistic counselling (SBHC) is a common psychological intervention for young people, particularly in the UK. However, studies have tended to suffer from high attrition rates, such that effects may have been over‐estimated. This paper describes a low budget ‘star topology’ practice research network (PRN) outcome evaluation of SBHC in a sample where attrition rates were minimised. Design: A practice‐based longitudinal study in a small PRN compared levels of psychological distress at first and last session from session‐by‐session data. Multilevel regression modelling was used to identify predictors of outcomes. Methods: Eight counsellors working across 11 schools agreed to use session‐by‐session self‐rating on the Young Person's CORE (YP‐CORE) yielding data from 256 young people aged 11 to 17. Predictors of outcomes were analysed using multilevel regression analysis. Results: Mean levels of distress on the YP‐CORE reduced from 18.29 (SD = 7.32) at baseline to 9.10 (SD = 6.19) at endpoint, giving a baseline to endpoint effect size of 1.26 (95% CI = 1.06–1.46). Lower levels of psychological distress at endpoint were associated with male clients, younger age groups, greater rates of attendance at counselling, and bereavement as a presenting problem. Conclusions: This ‘star topology’ PRN focused on a single study and demonstrated that such a system can provide relatively low cost, high quality data. The data showed that SBHC is associated with large reductions in psychological distress, and that this cannot be attributed to the high attrition rates of previous datasets. [ABSTRACT FROM AUTHOR]

Background The Physical Activity Questionnaire for Children and Adolescents ( PAQ- C/- A) provides general estimates of physical activity levels. Following recent expert recommendations for using the PAQ for population surveillance, the aim of this paper was twofold: first, to describe normative PAQ data for English youth; and second, to determine a criterion-referenced PAQ-score cut-off point. Methods Participants ( n = 7226, 53% boys, 10-15 years) completed an anglicized version of the PAQ. Peak oxygen uptake ( VO2peak) was predicted from PACER lap count according to latest FITNESSGRAM standards and categorized into 'at-risk' and 'no-risk' for metabolic syndrome. R OC curves were drawn for each age-sex group to identify PAQ scores, which categorized youth into 'sufficiently active' versus 'low-active' groups, using cardiorespiratory fitness as the criterion-referenced standard. Results PAQ scores were higher in boys than in girls and declined with age. Mean PAQ score was a significant, albeit relatively weak (area under the curve < 0.7) discriminator between 'at-risk' and 'no-risk.' PAQ scores of ≥2.9 for boys and ≥2.7 for girls were identified as cut-off points, although it may be more appropriate to use lower, age-specific PAQ scores for girls of 13, 14 and 15 years (2.6, 2.4, 2.3, respectively). Conclusion The normative and criterion-referenced PAQ values may be used to standardize and categorize PAQ scores in future youth population studies. [ABSTRACT FROM AUTHOR]

The objective of the paper is to explore bottom-up auditory and top-down cognitive processing abilities as part of long-term outcome assessment of preterm birth. Fifty-five adolescents (age 13-15) born with very low birth weight ( VLBW) were compared to 80 matched controls born to term, using three consonant-vowel dichotic listening ( DL) instruction conditions (non-forced, forced-right and forced-left). DL scores were correlated with cortical gray matter thickness derived from T1-weighted structural MRI volumes using FreeSurfer to examine group differences also in the neural correlates of higher cognitive processes. While showing normal bottom-up processing, VLBW adolescents displayed impaired top-down controlled conflict processing related to significant cortical thickness differences in left superior temporal gryus and anterior cingulate cortex. Preterm birth with VLBW induces fundamental changes in brain function and structure posing a risk for long-term neurocognitive impairments. Deficits emerge in situations of increasing cognitive conflict and can be related to measures of executive functions as well as morphology. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mississippi (MS) Delta adults and youth report obesity rates far exceeding those of the state and nation. State law requires in-school physical activity and nutrition practices to address childhood obesity but does not require evaluation of outcomes, specifically the impact on weight-related outcomes. This paper offers 3 things: (1) describes the weight status of elementary school-age children in the MS Delta; (2) explains the importance of including waist-to-height ratio (WHtR) values when reporting body mass index (BMI); and (3) provides impetus for policy that requires weight-related health risk, as measured by WHtR, to be assessed regularly as a means to evaluate school health policy. METHODS: We took anthropometric measures in a cross-sectional investigation of 1136 children from 11 public elementary schools in the MS Delta. Measures included BMI, waist circumference (WC) and WHtR. RESULTS: The prevalence of overweight and obesity (BMI ≥85th percentile) was 47.1% (18.3% overweight and 28.8% obese). In this sample, 59.9% and 42.0% were 'at risk' for weight-related chronic disease based on WC (≥75th percentile) and WHtR (>0.5), respectively. The differences in these proportions were statistically significant. The predominantly black districts reported higher on all of the weight-related measures. CONCLUSIONS: Investigators recommend the assessment of health policy include measures of health risk in addition to BMI, namely WHtR as it accounts for growth in both WC and height over age. Furthermore, WHtR is a more accurate indicator of fat distribution and health risk than WC alone. [ABSTRACT FROM AUTHOR]

The aims of this paper are two-fold: (i) to examine the impact of audience individualism and collectivism orientation on the judgment of strategic self-presentations and (ii) to test whether audience individualism and collectivism orientation would affect the importance of likeability and competence in determining social outcomes. In two studies, participants evaluated modest and boastful presentations in an achievement context. It was found that the more collectivistic the audience was, the more likely the modest presenter was to be rated as likable, competent, and deserving of a desirable social outcome. In contrast, the more individualistic the audience was, the more likely the boastful presenter was to be rated as likeable, competent, and deserving of a desirable social outcome. The importance of likeability and competence in predicting the final social outcome was moderated by audience individualism and collectivism orientation. Likeability was more important in deciding the social outcome for those who were more collectivistic than for those who were less so (Study 1). Competence was more important in determining the social outcome for those who were more individualistic (Study 2). These studies build a potential theoretical bridge between social influence and social perception/social judgment literature. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose The purpose of this paper was to determine if the Six-minute Walk Test (6MWT) was a reliable exercise test for patients referred to cardiac rehabilitation when up to three tests were performed and to determine if test scores differed according to between-test time interval. Methods Thirty adults aged 63 ± 7.9 years referred to cardiac rehabilitation participated in a repeated measures reliability trial. Participants completed three 6MWTs within a one-week period. Participants were randomly allocated to one of three groups: on the first day, Group A completed three walks, Group B completed two walks and Group C completed one walk. Relative reliability was expressed in a ratio (ICC2,1), and absolute reliability was expressed in metres (95% confidence intervals) for group and individuals. Results The 6MWT demonstrated a high level of relative reliability (intraclass correlation coefficients [ICC] = 0.94) across the three walks. There was no statistically significant difference between the test scores of the three groups. However, there was an increase in distance walked from the first to the second to the third 6MWT. Absolute reliability indicated that a change of at least 44 m would be required to be interpreted as true change in a group, and at least 95 m to be interpreted as true change in an individual with 95% confidence. Conclusion Three 6MWTs completed in relatively short timeframes were not sufficient for reliable results as there was an increase in the distance walked, and relatively large increases in distances would be required to be interpreted as change. It did not make any difference whether the tests were all completed on one day or over one week. This study highlighted problems that may arise when relying on reliability coefficients alone to interpret reliability. These results suggest that the 6MWT may not have sufficient reliability to be a suitable test to evaluate exercise tolerance in patients referred to cardiac rehabilitation. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Lucena C, López JM, Abalos C, Robles V, Pulgar R. Statistical errors in microleakage studies in operative dentistry. A survey of the literature 2001-2009. Eur J Oral Sci 2011; 119: 504-510. © 2011 Eur J Oral Sci The aim of this study was to assess the literature on microleakage of direct restorations in operative dentistry indexed in the ISI Web of Science, in order to assess the robustness of the statistical methodology used. Our database included 226 scientific papers (published between 2001 and 2009 in 22 journals) from the journal citation report categories 'Dentistry, Oral Surgery and Medicine' and 'Materials Science, Biomaterials'. We reviewed all articles to find potential mistakes that are commonly made at different stages in the scientific research process. Microleakage was assessed quantitatively in 50 (22.2%) studies and qualitatively in 176 (77.8%) studies. In all studies reviewed the statistical methods used were appropriate for the category attributed to the outcome variable, but in 13% of the total, the chi-square test or parametric methods were inappropriately used afterwards. When the appropriate statistical methods were applied in studies that had originally employed inappropriate methods to analyse their data, and in which the authors provided raw data, an alteration of the conclusions was necessary in 15.4% of these re-analysed studies. This survey also showed that the statistical methodology applied varies considerably for similar experimental designs. This could have an effect on statistical results; hence, a more standardized methodology should be implemented. [ABSTRACT FROM AUTHOR]

This study compared higher education dental undergraduate student performance in online assessments with performance in traditional paper-based tests and investigated students' perceptions of the fairness and acceptability of online tests, and showed performance to be comparable. The project design involved two parallel cross-over trials, one in Year 3 ( n = 132) of the dental curriculum, one in Year 5 ( n = 134). A total of 266 students undertook related tests of the same knowledge base in both online and traditional paper formats. Order of presentation of the test form was randomized. One hundred and thirty-two students in Year 3 additionally completed questions concerning their perceptions of the acceptability and fairness of the online examination process. Focus group discussions were held with groups of students ( n = 30) from both Year 3 and 5 to explore their perceptions of the online format. The online tests were created using the commercial software package MaxExam (Bristol, UK). The results were analysed using repeated measures analysis of variance (ANOVA) with the order of presentation being entered as a variable in the analysis. The results of the study showed that for both Years 3 and 5 students there was a high degree of consistency in performance between the two versions of the tests, although a minority of students performed better in the online version of the test. Over 70% of students rated the online test as acceptable, and 90% felt that the online format did not disadvantage them even in a 'high-stakes' situation. From these results, we conclude that online assessment does not confer any disadvantage to students. Students perceive such assessment to be both fair and acceptable, and to have some advantages over the traditional paper-based methods of assessment. [ABSTRACT FROM AUTHOR]

Background: The probability of pregnancy after in vitro fertilisation (IVF) declines with age in parallel with a reduction in the ovarian reserve. However, there is considerable variation in the ovarian reserve in women of advanced reproductive age; so to give such women accurate advice about the prospects of treatment success, factors other than age must be considered. Anti-Müllerian hormone (AMH) has been shown to be a good indicator of ovarian reserve, and its utility is explored in this paper. Aims: To determine the utility of AMH serum levels for prediction of ovarian response to gonadotropin stimulation and outcome in IVF in women of advanced reproductive age. Methods: The material consists of 127 women with a median age of 42 years (range 39-46) having had their first cycle of IVF/intracytoplasmic sperm injection (ICSI) treatment from November 2006 to December 2008. During this period, a total of 772 oocyte retrievals and 715 embryo transfers were performed at the clinic (median age 36.4 years). AMH was analysed with the Beckman Coulter DSL ELISA. Agonist and antagonist protocols were used and monitored by ultrasound and oestradiol; embryo transfer was performed on day 2, 3 or 5 of culture. Results: The lower the AMH, the higher the risk of cycle cancellation, low oocyte yield and treatment failure. Women with a serum AMH above 8.6 pmol/L had a good chance of achieving live birth after IVF/ICSI treatment. Conclusions: Anti-Müllerian hormone is useful for identifying a good prognosis group in women of advanced reproductive age. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 510-516 Oral health-related quality of life in older Swedish people with pain problems Objectives: The aim of the present paper was to explore the oral health-related quality of life in old Swedish people with pain problems, with special reference to demography, socio-economic factors, health, and general health-related quality of life. Method: Individuals ≥80 years (n = 186) who earlier reported pain problems answered two multi-item instruments on oral health-related quality of life (Oral Health Impact Profile, OHIP-14) and general health-related quality of life (Short Form Health Survey, SF-12), respectively. Socio-demographic and health questions were also inquired. Results: Both the oral and general health-related quality of life were rated very low. Two thirds (67.2%) reported at least one of the aspects in the OHIP-14 fairly often, very often or all the time. The mean additive score of the OHIP-14 was 14.6 (SD 10.5). The mean value of the physical component scale (PCS) of SF-12 was 25.9 (SD 6.2) and of the mental component scale (MCS) 44.1 (SD 11.5). The OHIP-14 was consistently and significantly correlated with self-rated general and oral health, chewing ability and MCS. The associations between self-rated general and oral health in relation to the OHIP-14 were independent of possible confounders: OR 3.63 (95% CI 1.58-8.32) and OR 2.68 (95% CI 1.44-4.99), respectively. Conclusion: Old people with pain problems experienced very low oral and general health-related quality of life. Personnel caring for the oldest with pain problems should be aware that oral health problems can contribute to a low quality of life and that oral care should be included in the general care. [ABSTRACT FROM AUTHOR]

The association between poverty and intellectual disability (ID) has been well documented. However, little is known about persons with ID who face circumstances of extreme poverty, such as homelessness. This paper describes the situation of persons with ID who were or are homeless in Montreal and are currently receiving services from a team dedicated to homeless persons. (1) To describe the characteristics, history and current situation of these persons; and (2) to report within-group differences as a function of gender and current residential status. The data were collected from files using an anonymous chart summary. Descriptive statistics on the whole sample ( n = 68) and inferential statistics on cross-tabulations by gender and residential status were performed. Persons with ID exhibited several related problems. Some of these persons, primarily women, experienced relatively short periods of homelessness and their situations stabilised once they were identified and followed up. Other persons with ID experienced chronic homelessness that appeared to parallel the number and severity of their other problems. When compared with a previous epidemiological study of the homeless in Montreal, the population of homeless persons with ID differed from the overall homeless population in a number of respects. The results suggest prevention and intervention targets. The need for epidemiological research appears particularly clear in light of the fact that below-average intellectual functioning has been identified as a risk factor for homelessness and a predisposing factor for vulnerability among street people. [ABSTRACT FROM AUTHOR]

Previous research has documented a relationship between child sexual abuse and alcohol dependence. This paper extends that work by providing a comprehensive description of past year and lifetime alcohol consumption patterns, consequences, and dependence among women reporting either physical and sexual abuse in a national sample. This study used survey data from 3,680 women who participated in the 2005 U.S. National Alcohol Survey. Information on physical and sexual child abuse and its characteristics were assessed in relation to 8 past year and lifetime alcohol consumption measures. Child physical or sexual abuse was significantly associated with past year and lifetime alcohol consumption measures. In multivariate analyses, controlling for age, marital status, employment status, education, ethnicity, and parental alcoholism or problem drinking, women reporting child sexual abuse vs. no abuse were more likely to report past year heavy episodic drinking (OR = 1.7; 95% CI 1.0 to 2.9), alcohol dependence (OR = 7.2; 95% CI 3.2 to 16.5), and alcohol consequences (OR = 3.6; 95% CI 1.8 to 7.3). Sexual abuse (vs. no abuse) was associated with a greater number of past year drinks (124 vs. 74 drinks, respectively, p = 0.002). Sexual child abuse was also associated with lifetime alcohol-related consequences (OR = 3.5; 95% CI 2.6 to 4.8) and dependence (OR = 3.7; 95% CI 2.6 to 5.3). Physical child abuse was associated with 4 of 8 alcohol measures in multivariate models. Both physical and sexual child abuse were associated with getting into fights, health, legal, work, and family alcohol-related consequences. Alcohol-related consequences and dependence were more common for women reporting sexual abuse compared to physical abuse, 2 or more physical abuse perpetrators, nonparental and nonfamily physical abuse perpetrators, and women reporting injury related to the abuse. Both child physical and sexual abuse were associated with many alcohol outcomes in adult women, even when controlling for parental alcohol problems. The study results point to the need to screen for and treat underlying issues related to child abuse, particularly in an alcohol treatment setting. [ABSTRACT FROM AUTHOR]

Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. A national cross-sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies. [ABSTRACT FROM AUTHOR]

Nutritional support often focuses on cooking and food skills such as food selection, recipe planning and meal preparation. Individuals with greater cooking and food skills confidence have previously displayed higher diet quality scores and lower intakes of overall calories, saturated fat and sugar. Despite this, the cooking and food skills of team sport athletes have yet to be investigated. This study aimed to evaluate the relationship between cooking and food skills confidence and athletes' demographic characteristics. A validated measure for the assessment of cooking and food skills confidence was distributed via an online survey. Participants were required to rate their confidence on a Likert scale (1 "very poor" – 7 "very good") for 14 items related to cooking skills and 19 items for food skills. Food engagement, general health interest and self‐reported fruit and vegetable consumption as a measure of diet quality were also measured. The survey was completed by 266 team sport athletes (male: 150, female: 116, age: 24.8 ± 6.1 years). Group differences were explored using t‐tests and ANOVA and associations were evaluated using Spearman's correlation and hierarchical multiple regressions. Athletes' total cooking and food skills confidence was 62.7 ± 17.4 (64.0 ± 17.8%) and 83.8 ± 20.1 (63.0 ± 15.1%), respectively. Females reported greater confidence in both cooking (+20.3%, p < 0.01) and food skills (+9.2%, p < 0.01). Hierarchical multiple regressions explained 48.8% of the variance in cooking skills confidence and 44% of the variance in food skills confidence with gender, previous culinary training, cooking learning stage, general health interest and food engagement all remaining significant in the cooking skills confidence model and cooking frequency, previous culinary training, general health interest and food engagement remaining significant in the food skills confidence model. Male team sport athletes may benefit the most from educational interventions designed to increase cooking and food skills confidence. [ABSTRACT FROM AUTHOR]

Background: Sensitive responsiveness is an important aspect in affect‐regulation of people with severe to profound intellectual disabilities. Aim: This randomized controlled trial evaluated the Attune & Stimulate‐checklist, a tool for detecting subtle and idiosyncratic communicative behaviours and responding adequately. Methods: Effects on the sensitive responsiveness of professional caregivers and the arousal and valence of adults with severe to profound intellectual disabilities were investigated. Video recordings of 102 interactions were analysed with several observation instruments. Results: Although no significant effect was found on the checklist‐suggestions of responsive behaviours (d = 0.33, p =.052), the intervention increased caregivers' sensitive responsive and affective behaviour (d = 0.94 – 1.10, p <.001) and clients' optimal arousal (d = 0.48, p =.019) and interactive engagement (d = 0.40 – 0.48, p =.018 ‐.050). Conclusion: This low‐intensity intervention had a medium to large immediate effect on the interaction. Future research should investigate medium‐ and long‐term effects. [ABSTRACT FROM AUTHOR]

Introduction: This study was performed to evaluate the effects of varying brushing times on the dental plaque‐removal efficacy of a power toothbrush to determine the optimal length of time required to brush the teeth. Methods: A typodont with 32 teeth was divided into four quadrants and further divided into four zones each (two teeth per zone). Using a robotic arm, toothbrushing was performed over eight different brushing times (0, 60, 120, 180, 240, 300, 360, and 420 s) to remove the artificial plaque applied on the labial surface of the teeth in occlusion. Photographs were taken every 60 s from each zone of the typodont. The images obtained were processed using ImageJ software to measure the percentage of remaining plaque. Data were analysed with factorial ANOVA, least squares regression analysis, and post hoc Tukey tests. Results: Plaque removal significantly increased with brushing time across the brushing intervals studied (p < 0.05). Efficient plaque removal was achieved after 240 s of brushing. There was no significant difference in plaque accumulations between the maxillary and mandibular arch (p = 0.19) and the right and left areas after each time interval (p = 0.49). Conclusion: Brushing duration is negatively correlated with the remaining plaque for a given toothbrush. Two minutes of brushing is not sufficient for significant plaque removal. Considering the limitations of this in vitro study, clinical studies are needed in order to change brushing recommendations to 240 s. [ABSTRACT FROM AUTHOR]

The southeastern region of Kenya is prone to aflatoxin outbreaks, yet maternal and infant aflatoxin intake levels remain unclear. We determined dietary aflatoxin exposure of 170 lactating mothers breastfeeding children aged 6 months and below in a descriptive cross‐sectional study involving aflatoxin analysis of maize‐based cooked food samples (n = 48). Their socioeconomic characteristics, food consumption patterns and postharvest handling of maize were determined. Aflatoxins were determined using high‐performance liquid chromatography and enzyme‐linked immunosorbent assay. Statistical analysis was conducted using Statistical Package Software for Social Sciences (SPSS version 27) and Palisade's @Risk software. About 46% of the mothers were from low‐income households, and 48.2% had not attained the basic level of education. A generally low dietary diversity was reported among 54.1% of lactating mothers. Food consumption pattern was skewed towards starchy staples. Approximately 50% never treated their maize, and at least 20% stored their maize in containers that promote aflatoxin contamination. Aflatoxin was detected in 85.4% of food samples. The mean of total aflatoxin was 97.8 μg/kg (standard deviation [SD], 57.7), while aflatoxin B1 was 9.0 μg/kg (SD, 7.7). The mean dietary intake of total aflatoxin and aflatoxin B1 was 7.6 μg/kg/b.w.t/day (SD, 7.5) and 0.6 (SD, 0.6), respectively. Dietary aflatoxin exposure of lactating mothers was high (margin of exposure < 10,000). Sociodemographic characteristics, food consumption patterns and postharvest handling of maize variably influenced dietary aflatoxin exposure of the mothers. The high prevalence and presence of aflatoxin in foods of lactating mothers are a public health concern and calls for the need to devise easy‐to‐use household food safety and monitoring measures in the study area. Key messages: A high prevalence of aflatoxin (84.4%) and high dietary aflatoxin exposure were reported among lactating mothers in the study.The mean concentration of 90% of maize‐based cooked food samples exceeded the 2 and 10 µg/kg set limits for aflatoxin B1 and total aflatoxin, respectively.Household size, education, socioeconomic status and limited food consumption patterns were potential determinants of dietary aflatoxin exposure in lactating mothers. Within dietary diversity, the type of food constituting a diverse diet played an important role.Postharvest handling of maize could be one of the factors contributing to dietary aflatoxin exposure in the study area.The reported results call for the need to devise easy‐to‐use household food safety and monitoring measures in the study area. [ABSTRACT FROM AUTHOR]

Since the beginning of the SARS-CoV-2 pandemic, the community use of facemasks has been widely recommended. However, their use during exercise has raised safety concerns. Thus, we compared the physiological differences between exercising wearing a surgical (SM) or a double-layer-cotton (DLC) facemask and not wearing a mask (NM). Sixteen volunteers underwent 4 bouts of cycling-based exercise, which consisted of two different intensities: light-to-moderate and moderate-to-high. Facemasks were used as follows: bout-1 and 4: NM; bout-2: SM or DLC and bout-3: DLC or SM. Ventilatory, metabolic, pulmonary gas exchange (PGE) and perceptual variables were collected. At both exercise intensities compared to NM, both facemasks induced similar ventilatory adaptations, increasing inspiratory time and tidal volume and decreasing breathing frequency. Effect sizes (ES) were larger for DLC than for SM. At moderate-to-high, both facemasks reduced the minute ventilation, whereas at light-to-moderate, it was only seen with DLC. End tidal and mixed CO2 pressures, as well as the difference between them, increased with both facemasks. Again, ES was larger for DLC than SM. No relevant oxygen saturation drop was observed with both facemaks and exercise intensities. A small ES increament in VO2 and VCO2 were seen with both facemasks. Effort perception increased at moderate-to-high for both exercise intensities, buth larger EF were with DLC than SM. DLC increased facial temperature during both exercise intensities. In conclusion, ventilatory adjustments imposed during facemask exercise influenced PGE and metabolic and perceptual changes. Larger ES were mostly seen for DLC than SM. Abbreviations: Bf: Breathing frequency.; CPET: Cardiopulmonary exercise test.; CI: Confidence interval.; DLC: Double-layer cotton.; ETCO2: End tidal CO2 pressure.; ES: Effect size.; ΔET-PECO2: Difference between ETCO2 and PECO2.; FMMT: Facemask microclimate temperature.; HR: Heart rate.; IQR: Interquartile range.; NM: No mask.; PECO2: Mixed-expired CO2 pressure.; RER: Respiratory exchange ratio.; RPE: Rate of perceived effort.; SD: Standard deviation.; SM: Surgical Mask.; SpO2: Oxygen saturation.; STP: Subjective thermal perception.; Ti/TTOT: Duty cycle.; VE: Minute ventilation.; VCO2: Carbon dioxide output.; VO2: Oxygen uptake.; VT: Tidal volume.; VT: Ventilatory threshold. Highlights Facemasks affect the breathing pattern by changing the frequency and amplitude of pulmonary ventilation. The augmented ventilatory work increases VO2, VCO2, and RPE and promotes nonconcerning drops in SpO2 and CO2 retention. Increased inspiratory and expiratory pressure can account for the reduction in pulmonary physiological dead space. [ABSTRACT FROM AUTHOR]

Vegan dietary patterns are increasingly being adopted by endurance athletes, yet research examining the influence of this dietary pattern on exercise‐related physiology is limited. This pilot study, therefore, aimed to explore nutrient status, diet quality and cardiovascular and inflammatory responses in aerobically trained adult males following vegan and omnivorous dietary patterns during aerobic exercise. An incremental ramp running test was used to assess peak oxygen consumption (VO2peak) in males aged 18–55 years, engaging in >4 h training/week. Exercise testing was performed during walking and steady‐state running conditions (60% and 90% of VO2peak). Participants were grouped by dietary pattern type and were equivalent for age, training volume and VO2peak. When compared to the omnivorous group (n = 8, age 35.6 years, VO2peak 55.7 mL/kg/min), the vegan group (n = 12, age 33.4 years, VO2peak 56.4 m/kg/min) consumed more energy from carbohydrates (p = 0.007), and less energy from protein (p = 0.001) while exhibiting a higher overall diet quality score (p = 0.008). No differences in inflammatory biomarkers were observed before or after running. Total red blood cell count, haemoglobin and haematocrit levels were lower in the vegan dietary group. In summary, aerobically trained males, following a long‐term vegan diet, can tolerate a short bout of running broadly comparatively to their omnivore counterparts. More arduous endurance exercise conditions should be explored to further uncover potential outcomes of consuming a vegan dietary pattern and exercise‐related physiology. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Upper limb activity measures for children with cerebral palsy have a number of limitations, for example, lack of validity and poor responsiveness. To overcome these limitations, we developed the Children's Arm Rehabilitation Measure (ChARM), a parent‐reported questionnaire validated for children with cerebral palsy aged 5–16 years. This paper describes both the development of the ChARM items and response categories and its psychometric testing and further refinement using the Rasch measurement model. Methods: To generate valid items for the ChARM, we collected goals of therapy specifically developed by therapists, children with cerebral palsy, and their parents for improving activity limitation of the upper limb. The activities, which were the focus of these goals, formed the basis for the items. Therapists typically break an activity into natural stages for the purpose of improving activity performance, and these natural orders of achievement formed each item's response options. Items underwent face validity testing with health care professionals, parents of children with cerebral palsy, academics, and lay persons. A Rasch analysis was performed on ChARM questionnaires completed by the parents of 170 children with cerebral palsy from 12 hospital paediatric services. The ChARM was amended, and the procedure repeated on 148 ChARMs (from children's mean age: 10 years and 1 month; range: 4 years and 8 months to 16 years and 11 months; 85 males; Manual Ability Classification System Levels I = 9, II = 26, III = 48, IV = 45, and V = 18). Results: The final 19‐item unidimensional questionnaire displayed fit to the Rasch model (chi‐square p = .18), excellent reliability (person separation index = 0.95, α = 0.95), and no floor or ceiling effects. Items showed no response bias for gender, distribution of impairment, age, or learning disability. Discussion: The ChARM is a psychometrically sound measure of upper limb activity validated for children with cerebral palsy aged 5–16 years. The ChARM is freely available for use to clinicians and nonprofit organisations. [ABSTRACT FROM AUTHOR]

Background: Emergency physicians as front-line clinical specialists can directly advance patient care by understanding how gender-specific approaches may affect evaluation and management of diseases in the acute setting. Yet, it is unclear whether the role of gender is systematically examined in research focusing on emergency care. Objectives: The objective was to determine if the effect of gender on health outcomes is examined in published studies targeting emergency medicine (EM). Methods: Using MEDLINE, the term ''emergency'' was used to identify all English-language, EM-related studies of adult human subjects published between January 2006 and April 2009 in which the first, second, or last author belonged to an EM section, division, center, or institution functioning as an emergency department (ED). The alternative chance-corrected statistic was used for intercoder reliability, and chi-square was used to calculate odds ratios (OR) with 95% confidence intervals (CIs). Articles were coded for gender composition, as well as use of gender as a control variable, independent variable, or part of the primary hypothesis. Results: The search revealed 2,487 articles using the selected ''emergency'' terms, and 750 original studies coded as EM-related publications were reviewed. The five topics contributing the most articles (44%) were administration / crowding, cardiovascular disease, emergency medical services, trauma, and sepsis. Seventy-nine percent of articles reported the gender composition of the sample, with 11% including gender as a control variable, 18% including gender as an independent variable, and 2% including gender in the primary hypothesis. The alternative chance-corrected statistic for evaluating gender composition was 0.90 (95% CI = 0.75 to 1.00). Use of gender in the analysis did not differ between federally funded studies versus non-federally funded studies (OR = 0.86; 95% CI = 0.5 to 1.4). The number of articles analyzing the effect of gender on a health outcome increased by 5% over the study period (27%-32%). Conclusions: The majority of research articles targeted EM report gender as a demographic variable; however, few studies examined the effect of gender on health outcome. As the specialty advances into the next decade, the authors recommend that EM researchers 1) include both men and women in their study designs for appropriate gender comparisons; 2) report gender composition of study subjects and gender-specific comparisons study findings; and 3) report prognoses, outcomes, and interventions using gender as an independent variable in the study model. [ABSTRACT FROM AUTHOR]

Reactions to caregiving and depression affect a carer's ability to continue in their caring role. This paper examines the relationship between reactions to caregiving and depression in carers of frail, older people and is a cross-sectional study of carers of community-living people ( ≥70 years), identified as frail, who completed a postal questionnaire. Reactions to caregiving were evaluated using the Caregiver Reaction Assessment. Anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale. Borderline depressive symptoms were reported in 15% of carers, and 10% had abnormal depressive symptoms. Anxiety symptoms in the carers were slightly higher at 24% and 12%, respectively. Multiple regression indicated that the impact on carers' daily schedules (β = 1.419, P = 0.001; β = 1.162, P = 0.025) and their health (β = 1.509, P = 0.007; β = 1.850, P = 0.006) as a result of caregiving explained 49% of the variance in carers' depressive symptoms (P < 0.001) and 42% of the variance in their anxiety symptoms (P < 0.001). Specific reactions to caregiving are important predictors of depressive and anxiety symptoms in carers of frail, older people. Regular carer support services and targeted health-care initiatives could alleviate or lessen negative reactions associated with caregiving, such as depression. [ABSTRACT FROM AUTHOR]

When two actors have the same mental state but one happens to harm another person (unlucky actor) and the other one does not (lucky actor), the latter elicits a milder moral judgement. To understand how this outcome effect would affect post‐harm interactions between victims and perpetrators, we examined how the social role from which transgressions are perceived moderates the outcome effect, and how outcome effects on moral judgements transfer to agentic and communal interpersonal goals. Three vignette experiments (N = 950) revealed similar outcome effects on moral judgement across social roles. In contrast, outcome effects on agentic and communal goals varied by social role: victims exhibited the strongest outcome effects and perpetrators the weakest, with bystanders falling in between. Moral judgement did not mediate the effects of outcome severity on interpersonal goals. We discuss the possibility that outcome severity raises normative expectations regarding post‐harm interactions that are unrelated to moral considerations. [ABSTRACT FROM AUTHOR]

The aim of this prospective cohort study was to assess the maximum intensity of postoperative pain at rest in 620 adults after an elective surgery as well as to determine demographic and clinical predictors of pain. The Hospital Anxiety and Depression Scale was used to evaluate the preoperative mental condition of the patient. Preoperative and postoperative pain were assessed at rest based on the Numeric Rating Scale (range: 0–10). The total median maximum intensity of pain was 3 (interquartile range: 1–5). The linear regression model for the maximum intensity of postoperative pain was statistically significant and very well fitted – the coefficient of determination was 62%. Preoperative anxiety, pain, cancer, a medical history of thyroid (vs abdominal) surgery, and an operation resulting in major (vs moderate) tissue injury have a positive impact on the maximum intensity of postoperative pain. Eye surgery and lower limb operations gave lower scores than abdominal surgery. The early identification of these predictors in patients at risk for postoperative pain will help in preparing an individual pain management plan. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore the association between diabetes‐related distress as a dependent variable and fear of hypoglycaemia as a independent variable in Chinese individuals with type 2 diabetes, which can provide a basis for the development of effective nursing interventions. Design: A cross‐sectional descriptive study. Methods: Pre‐piloted scales were used to determine whether they experienced fear of hypoglycaemia and whether this impacted upon their management of the disease. From June–October 2019, participants were asked to complete the "hypoglycaemia fear survey" and "diabetes distress scales" to assess levels of fear and distress. Stepwise multivariate regression analysis was applied to reveal relationship between distress as a dependent variable and fear as a independent variable. Covariates included demographic, clinical or lifestyle factors. Results: A total of 258 participants were recruited for the survey, and they were characterized by little or no distress (39.53%), moderate distress (45.35%) and high distress (15.12%). The prevalence of moderate to severe distress in patients was 60.47%. Increased diabetes‐related distress was strongly correlated with increased fear of hypoglycaemia and closely associated with the scores of the worry and behaviour subscales. These results indicated that 62.3% of diabetes‐related distress may be explained by fear of hypoglycaemia. Conclusion: Increased diabetes‐related distress is associated with increased fear of hypoglycaemia in individuals with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aim: To validate the polyunsaturated food frequency questionnaire (PUFA FFQ) and test for reproducibility in people with end stage renal disease on dialysis treatment. Methods: Participants (n = 32) completed the PUFA FFQ and three 24‐hour recalls. Erythrocyte samples (n = 29) were used for erythrocyte fatty acid analysis. The triangular relationship between the PUFA FFQ, 24‐hour recalls and the biomarker was assessed using the method of triads. Agreement between the two dietary methods was also assessed using Bland–Altman plots and classification by quintiles. Reproducibility was tested on a subset of the group (n = 8). Results: The PUFA FFQ was a valid measure of all PUFA except for docosapentaenoic acid (DPA) and arachidonic acid (AA). Strong validity coefficients were found for n‐3 long‐chain PUFA (LCPUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) of 0.914 (95% CI: 0.665, 0.997) and 0.889 (95% CI: 0.706, 0.994), respectively. In the Bland–Altman plots 91–100% of observations fell between the limits of agreement for all PUFA. There were significant correlations between the initial FFQ and the repeat FFQ for all PUFA except DPA and AA. Conclusions: The PUFA FFQ is a valid tool for assessing PUFA intake in people with end stage renal disease. [ABSTRACT FROM AUTHOR]

The impact of university rankings has driven scholars to increase productivity, and expanding collaboration has dramatically changed the publishing patterns in the academic publication system. The aim of this study was to develop a scholar classification scheme from publication patterns in academic science. Classification schemes are ways of describing groups that display different clusters of behaviors, approaches, or perspectives, and useful in the development of typologies. In this research, sample data are selected from three representative universities, considered a leading university, a middle‐tier university, and a noncomprehensive university. A final set of 11,427 effective scholars and their 284,128 journal publication records were used to develop the classification scheme via cluster analysis. The results identify six types of scholars, labeled as: singleton (8%), small‐team low performer (16%), small‐team high performer (17%), big‐team strategist (22%), free‐style follower (21%), and life‐time warrior (17%). These six scholar types demonstrate different approaches to publishing that can be used to understand both individual and research team performance across different institutional settings. Additionally, possible future work was identified that uses the scholar classification scheme to define the behavior for agents in an agent‐based model to simulate the strategic‐behavior‐driven academic publication system. [ABSTRACT FROM AUTHOR]

Objectives: To compare 3 mouthwashes: 0.20% chlorhexidine (CHX) with Anti‐Discoloration System (ADS), 0.20% CHX and 0.12% CHX with 0.05% cetylpyridinium chloride (CPC), in terms of reduction of plaque and gingival bleeding and side effects. Methods: Mild gingivitis patients were randomly divided into three Groups: they underwent professional oral hygiene and received instructions: oral rinse with 10 mL for 1', twice a day, 30' after tooth brushing, for 14 days. Primary outcomes were plaque and gingival bleeding, assessed with Plaque Control Record and Gingival Bleeding Index. Feedback questionnaire and spectrophotometer evaluated secondary outcomes: adverse events. Timing of the study was T0 (baseline), T1 (professional oral hygiene) and T2 (14th day after mouthwash use). Results: Sixty‐six patients were recruited, two patients dropped out, and 64 patients completed the study. PCR T1‐T2 mean variation was 30.67 (SD = 15.22; 95% CI 23.55 to 37.80; P = 0.000), 19.93 (SD = 11.03; 95% CI 14.90 to 24.95; P = 0.000) and 16.24 (SD = 15.35; 95% CI 9.60 to 22.88; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. GBI mean variation (T0‐T2) was −9.82 (SD = 9.27; 95% CI −5.48 to 14.16; P = 0.000), −19.31 (SD = 11.33; 95% CI −14.15 to −24.47; P = 0.000) and −21.13 (SD = 12.56; 95% CI −15.70 to −26.56; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. Statistical significance was found in lower efficacy of 0.2% CHX + ADS Group. Patients tolerated 0.12% CHX + CPC mouthwash better in bleeding perception (95.5%; P = 0.046), burning sensation (13.6%; P = 0.006), and mouthwash taste (100%; P = 0.000). Results on staining were no statistically significant (P = 0.106). Conclusions: Addition of CPC allows reduction of CHX percentage in mouthwash formulation while keeping equal efficacy and less side effects. ADS addition decreases CHX efficacy in reducing plaque and bleeding, while resulting more tolerated than CHX. [ABSTRACT FROM AUTHOR]

Background/aim: Cocaine consumption may result in irreversible structural changes in the brain. The long‐term effects of cocaine are related to a wide range of deteriorated cognitive functions. This study aimed to examine the fine motor control and hand‐function in cocaine users compared to healthy controls. Methods: An observational study was conducted. Sociodemographic variables, substance consumption, the Purdue Pegboard and the Jebsen–Taylor Hand‐function Test were evaluated bilaterally in 35 participants who were cocaine users and in 35 healthy participants. Differences between sides (dominant and non‐dominant hands) and groups were analysed with analysis of variance (ANOVA). Results: The ANOVA revealed significant differences between groups (P < 0.001) and between sides (dominant and non‐dominant hands) (P = 0.005) for the one‐hand pin placement subtest of the Purdue Pegboard Test. Also, ANOVA tests showed significant differences between sides, but not groups, for the simulated feeding (P < 0.001) and stacking checkers (P < 0.001) Jebsen–Taylor subtests. Cocaine user participants exhibited significantly lower scores in bilateral pin placement and required more time for the Jebsen–Taylor subtests compared to healthy participants. Conclusions: Cocaine user participants display deficits of fine motor control and some aspects of manual dexterity when compared to healthy controls. These findings show the convenience of incorporating functional rehabilitation by occupational therapists as a key component within the treatment of cocaine users. This study therefore opens a new field of practice for occupational therapy based on the assessment and treatment of motor deficits in the hand and the upper limb of people who consume cocaine. [ABSTRACT FROM AUTHOR]

Background: Communication impairments are common and pervasive for people a long time following acquired brain injury (ABI). These impairments have a significant impact on a person's quality of life (QOL) post‐injury. Project‐based treatment is a treatment approach that could have an impact on communication skills and QOL for people with ABI a long‐term post‐injury. This treatment is embedded in a context of meaningful activities chosen by people with ABI, whereby, as a group, they work collaboratively to achieve a tangible end product. Aims: To evaluate the feasibility and initial efficacy of project‐based treatment on improving the communication skills and QOL for people with ABI. Methods & Procedures: An exploratory controlled trial with alternate allocation of groups, and follow‐up at 6–8 weeks, was completed. Twenty‐one people with chronic ABI were recruited in groups of two to three from community settings, allocated to either a TREATMENT (n = 11) or WAITLIST group (n = 10). Participants attended a 20‐h group‐based treatment over 6 weeks where they worked towards achieving a project that helped others. To determine feasibility, four criteria were used: demand, implementation, practicality and acceptability. A range of communication and QOL outcomes was used to determine a fifth feasibility criterion, initial efficacy. Some of these criteria were additionally used to evaluate the feasibility of the outcomes. Outcomes & Results: All participants received the treatment as allocated with high attendance and no dropouts. The treatment was feasible to deliver as intended and was highly acceptable to participants. Medium and large effect sizes were found from pre‐ to post‐treatment, and from pre‐treatment to follow‐up for measures of conversation, perceived communicative ability and QOL. Conclusions & Implications: Project‐based treatment is feasible with indications of initial efficacy for both communication skills and QOL. The treatment provides a promising new approach for improving communication skills and QOL in people with chronic acquired brain injuries in the community setting. [ABSTRACT FROM AUTHOR]

Aim: Obesity is an emerging public health problem, with its incidence on the rise. An abnormal metabolic profile is a risk factor for developing obesity. Dietary factors play a central role in the regulation of inflammation and obesity. The aim of the present study was to determine the prevalence of metabolically healthy obese and metabolically unhealthy obese (MUO) phenotypes, and their association with dietary inflammatory index (DII) among obese Iranian people. Methods: A cross‐sectional study was conducted from July to October 2017 among 300 obese participants in southern Tehran. DII scores were computed based on the overall inflammatory properties of 32 dietary components using dietary intake assessed by food frequency questionnaire. MUO phenotype was defined as having three or more of these metabolic abnormalities: high blood glucose, high triglycerides, low high‐density lipoprotein cholesterol, elevated blood pressure or abdominal obesity. The association was determined using logistic regression analysis. Results: The MUO phenotype (n = 176) was found in 63.5% of obese participants. Compared with participants in the first quartile, those in the fourth quartile of DII score (more pro‐inflammatory diet) had higher odds of MUO phenotype (odds ratio, OR: 2.58 (95% CI: 1.19–5.59), P = 0.04), and there was a significant association between the continuous form of DII score and the odds of MUO phenotype (OR: 1.18 (95% CI: 1.01–1.37)) after adjusting for potential confounders. Conclusions: Higher DII scores were positively associated with the MUO phenotype. A more pro‐inflammatory diet is a potential risk factor for MUO phenotype. [ABSTRACT FROM AUTHOR]

Background: Family violence (FV) is a prevalent health issue around the world and health care services have an important role in both recognizing and treating the consequences of violence. However, FV experiences among health care professionals themselves have not been investigated much. We also lack specific knowledge on the associations between FV and mental health. Aim: The purpose of the study was to investigate the prevalence and effects of FV in a sample of Finnish health care professionals. In addition to analysing direct connections between different types of FV and mental health, the mediating effect of sleep quality was also taken into account. Methods: The study followed a cross‐sectional design. The sample comprised 1952 health care professionals from Central Finland, who participated in a survey measuring their health and well‐being. The dependent variables were perceived sleep quality and mental health as measured by depressive symptoms and the mental health continuum short form (MHC‐SF) questionnaire. Data were analysed using cross‐tabulations, anova and structural equation modelling. Results: Thirty‐eight per cent of the participants reported experiencing FV. The most common forms of abuse were 'psychological FV only' and 'psychological & physical abuse'. Participants with FV experiences scored significantly worse on depressive symptoms (p < 0.001), MHC‐SF classification (p = 0.008), sleep quality (p = 0.001) and emotional (p < 0.001), social (p < 0.001), and psychological (p = 0.008) well‐being. The mediation analyses indicated that the harmfulness of FV was at least partially explained by impaired sleep quality. Conclusion: The results indicate that FV experiences are common among Finnish health care professionals and that they can significantly affect their mental health. FV should thus be taken to account in seeking to promote the occupational well‐being of health care professionals. The results also suggest that the harmfulness of FV might be mediated by sleep quality. This finding prompts the need for further investigation and FV‐related interventions. [ABSTRACT FROM AUTHOR]

Abstract: Background: Constraint‐induced (language) aphasia therapy (CIAT), based on constraint usage of the language channel only, massed practice and shaping through therapeutic language games, has been suggested as a more efficient therapy approach than traditional aphasia therapies. Aims: To examine the comparative efficacy of CIAT and a traditional therapy approach on expressive language ability, with the intensity of therapy controlled and matched, in the treatment of post‐stroke aphasia. Methods & Procedures: Two successive 4‐week blocks of intense (1 h, 5 days a week) of aphasia therapy programmes were delivered in a randomized within‐subject crossover design: one therapy block consisted of stimulation aphasia therapy (SAT, a common traditional therapy approach), another of CIAT. Twenty consecutive patients, up to 1 year after stroke, were randomly assigned either to have SAT followed by CIAT (S1C2 group) or to have CIAT followed by SAT (C1S2 group). Measurements of naming (Boston Naming Test) and spontaneous sentence production (Cookie Theft Picture description task) were carried at the baseline, following the first therapy block, following the second therapy block and 4 weeks following the last therapy block. Outcomes & Results: Both groups of patients significantly improved in all variables of expressive language skills; the improvement was maintained 1 month post‐treatment. However, patients who started with CIAT and continued with SAT (C1S2 group) tended to have higher final improvement than the patients who started with SAT and continued with CIAT (S1C2 group). This was particularly pronounced for naming. Moreover, when CIAT was the first therapy (the C1S2 group) the improvement achieved in naming following CIAT significantly exceeded the improvements achieved following SAT, not only in the same group (when SAT was the second) but also in the S1C2 group (when SAT was the first). In addition, the improvement in naming following CIAT in the C1S2 group exceeded the one in the S1C2 group, too. Similarly, the improvement in the total number of sentences produced following each therapy was quite clear and significant in the C1S2 group (when CIAT was the first), while in the S1C2 group it was much more modest and not significant. Conclusions & Implications: Results suggest that the maximization of quantity and frequency of language therapy have a significant impact on the improvement of expressive language ability. Moreover, if practised early in aphasia therapy, the constrained usage of the language modality, as practised in CIAT, confers an additional benefit to massed practice, particularly on naming ability. [ABSTRACT FROM AUTHOR]

Abstract: Background: As allied health professions change over time to keep up with and reflect a rapidly changing society, it is quite possible that the people attracted to the profession may also change. If this is the case, then knowing this could be critical for future workforce marketing, training and planning. Aims: The aim was to investigate whether the personality of students entering a speech‐language pathology (SLP) program had changed over time and whether there were generational differences in personality. Methods & Procedures: The study used the Big Five personality inventory to consider whether there were differences in the personality in speech–language pathology (SLP) students enrolled in the same regional university in Australia in 2005 and 2016. Outcomes & Results: The results showed there were significant differences between the two groups on the Agreeableness and Extroversion scales. The students who were more Conscientious were also more Confident in their ability to perform as an SLP. Generational differences across the two cohorts were also considered. Conclusions & Implications: SLP is a dynamic profession that is reflected through an evolving scope of practice, increasing utilization of technology and specialization. As careers evolve it is logical that the people attracted to those careers may also shift; as demonstrated here via changes in the personality of SLP students. Understanding the personality of current SLP students and future Generation Z students may assist universities to identify specific skills and experiences students need to be successful in the workforce. [ABSTRACT FROM AUTHOR]

The m:n:θb procedure is often used for validating an assay for precision, where m levels of an analyte are measured with n replicates at each level, and if all m estimates of coefficient of variation (CV) are less than θb , then the assay is declared validated for precision. The statistical properties of the procedure are unknown so there is no clear statistical statement of precision upon passing. Further, it is unclear how to modify the procedure for relative potency assays in which the constant standard deviation (SD) model fits much better than the traditional constant CV model. We use simple normal error models to show that under constant CV across the m levels, the probability of passing when the CV is θb is about 10% to 20% for some recommended implementations; however, for extreme heterogeniety of CV when the largest CV is θb , the passing probability can be greater than 50%. We derive 100q% upper confidence limits on the CV under constant CV models and derive analogous limits for the SD under a constant SD model. Additionally, for a post-validation assay output of y, we derive 68.27% confidence intervals on either the mean or log geometric mean of the assay output using either y±s (for the constant SD model) or log(y)±rG (for the constant CV model), where s and rG are constants that do not depend on y. We demonstrate the methods on a growth inhibition assay used to measure biologic activity of antibodies against the malaria parasite. [ABSTRACT FROM AUTHOR]

Dietary intake during pregnancy may influence child neurodevelopment and cognitive function. This study aims to investigate the associations between dietary patterns obtained in pregnancy and intelligence quotients (IQ) among offspring at 8 years of age. Pregnant women enrolled in the Avon Longitudinal Study of Parents and Children completed a food frequency questionnaire at 32 weeks' gestation ( n = 12,195). Dietary patterns were obtained by cluster analysis. Three clusters best described women's diets during pregnancy: 'fruit and vegetables,' 'meat and potatoes,' and 'white bread and coffee.' The offspring's IQ at 8 years of age was assessed using the Wechsler Intelligence Scale for Children. Models, using variables correlated to IQ data, were performed to impute missing values. Linear regression models were employed to investigate associations between the maternal clusters and IQ in childhood. Children of women who were classified in the meat and potatoes cluster and white bread and coffee cluster during pregnancy had lower average verbal (β = −1.74; p < .001 and β = −3.05; p < .001), performance (β = −1.26; p = .011 and β = −1.75; p < .001), and full-scale IQ (β = −1.74; p < .001 and β = −2.79; p < .001) at 8 years of age when compared to children of mothers in the fruit and vegetables cluster in imputed models of IQ and all confounders, after adjustment for a wide range of known confounders including maternal education. The pregnant women who were classified in the fruit and vegetables cluster had offspring with higher average IQ compared with offspring of mothers in the meat and potatoes cluster and white bread and coffee cluster. [ABSTRACT FROM AUTHOR]

Objectives As the need for greater global health competency increases for health care professionals in South Korea, educational efforts for nursing students have begun. This study examined the effectiveness of two educational courses for freshmen and sophomores that were designed to improve students' global health competencies. Design and Sample A trend study was conducted for all undergraduate nursing students enrolled in a 4-year undergraduate nursing program in 2013 and 2014. Measures We assessed students' global health competencies (1-knowledge and interests in global health and health equity, 2-global health skills, and 3-learning needs) in 2013 and 2014 and analyzed variance between mean scores by year and by course exposure, using 95% confidence intervals. Results Students who took both global health courses (sophomores in both years) reported higher global health-related knowledge and interests than did freshmen ( p < .01); these scores were not sustained a year later. Conclusions The two courses may have improved students' global health competencies. Reinforcement of knowledge in later courses may be needed to build on the global competencies. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the expression of p-AKT, p-JNK, FoxO3a, and Ki-67 in samples of oral squamous cell carcinoma (OSCC) and oral epithelial dysplasias (OEDs) to understand their possible involvement in the malignant transformation process of oral lesions. Materials and Methods Tissue samples of 20 cases of OSCCs, 20 OEDs, and normal oral mucosa were subjected to immunohistochemistry reactions for anti-p-AKT, anti-p-JNK, anti-FoxO3a, and anti-Ki-67 antibodies. It was analyzed using quantitative (number of immunostained cells) and qualitative (immunostaining intensity) parameters in different cell immunostaining sublocations. Results Nuclear p-AKT was observed significantly greater immunostaining in OSCC (21.2 ± 19.0) than in dysplasias (7.9 ± 8.1) and controls (1.8 ± 4.7) ( P = 0.002). Immunostaining of strong nuclear p-JNK was greater in controls (48.3 ± 13.7) than in OEDs (11.0 ± 10.3) and OSCCs (1.1 ± 1.3) ( P < 0.001). Strong nuclear immunostaining of FoxO3a proved to be absent in OSCCs (0.0 ± 0.1) with little staining on dysplasias (3.2 ± 5.4) and increased expression in controls (13.5 ± 4.8) ( P < 0.001). Immunostaining of strong nuclear Ki-67 was grater in OSCCs (48.1 ± 49.6) than in OED (11.8 ± 10.6) and controls (1.9 ± 2.0) ( P < 0.001). Conclusions Malignant process of OEDs in this research may involve the same mechanisms of established malignant lesions. [ABSTRACT FROM AUTHOR]