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Children with cancer experience recurring hospitalizations and isolation during treatment, which affect their school attendance. This study explores experiences of children with cancer, their classmates, and teachers with using the telepresence robot as a learning mediator in the hybrid classroom during treatment periods. 31 children with cancer (aged 7-17 years), 30 teachers, and 118 classmates participated in interviews and 19 h of participant observations were undertaken in nine classrooms. The Agential Realism Theory and Situational Analysis framed the data analysis. There was a single overarching theme, "Telepresence robot didactic," and five sub-themes (Telepresence mediated learning, school-home collaboration, hybrid robot teaching, intra-actions in class, and inclusive spatiality). This study advocates the complexity of telepresence robot didactics, emphasizing that numerous human and other factors must intra-act and work simultaneously to achieve optimal learning conditions for children during cancer treatment. This includes considerations such as modality availability for the remote child; the teacher's understanding of telepresence robot didactic and hybrid learning; the classmate's ability to involve the remote child in groupwork; the child's own treatment protocol, the robot's functionalities, and spatiality in the class. Strategies for use and the systematic surveillance of telepresence robots are needed to ensure that children during cancer treatment do not lag in academic achievement. This study proposes that children with cancer can continue participating in class while hospitalized or isolated and consequently reduce social and academic setbacks.

Despite increased interest in synchronous remote K-12 education, there is limited research on how students perceive such education. This article explores student perceptions of remote education, tutor support, social presence, learning and satisfaction. We developed a survey, and after distributing it and analyzing the results, the survey was offered to practitioners as a formative assessment tool. The findings showed that students were slightly positive toward synchronous remote education. Key factors that correlated with student perceptions of social presence, learning and satisfaction were positive perceptions of tutors and, to some extent, being enrolled in a smaller class. Some students appreciated the flexibility and quality of remote education, although many experienced technical and communication challenges. Our findings suggest that it is not sufficient only to engage qualified teachers in their subject; there is also a need to consider the continuous development of teaching practices and how to support and use digital technologies in remote education.

Research informing adult education teachers' didactic practices in distance education is scarce. Approaching the adult learner's perspectives on how distance education is perceived is key to informing future initiatives. This study explores adult learners' perception of distance education, concentrating on aspects such as, social presence, course structure, and perceived learning and satisfaction. A survey was distributed to teachers (n = 78) in five schools organising adult distance education. Findings show that teacher accessibility and course structure correlated positively with social presence and perceived learning and satisfaction. Overall, adult learners are satisfied with their distance teaching. A challenge facing adult distance education is to create a sense of social presence despite the high demand for flexibility. Thus, we explored learner perceptions of benefits and challenges in distance education and structured these into social, cognitive, spatio-temporal, emotional, and technical dimensions. Findings reveal that one challenge in the social dimension was a lack of connection with peers, and a benefit in the cognitive dimension referred to autonomy and self-regulation. These findings are important as educational institutions and policymakers may strive for high flexibility, which in turn may lead to lower group cohesion and a lack of social presence.

Biotic and abiotic disturbances modify tree structure and degrade stand health. Accurate geospatial data on stand structure is important for monitoring tree growth, forest health, progression and severity of diseases and pests, and estimating resilience to climate stress. The live crown ratio (LCR) of trees serves as a key health indicator but has been understudied at the landscape level using remote sensing data. This study generated the leaf area index (LAI) and a novel spatial layer of LCR at site and landscape scales using a combination of satellite data and ground observations. We conducted field surveys to collect plot-level (10 m × 10 m) data in four eastern white pine (EWP; Pinus strobus L.)-dominated sites in the state of Maine, USA. The plot-level data were used to develop regression models for LAI and LCR estimation using microwave (Sentinel-1) and optical (Sentinel-2) remote sensing data and applying the Random Forest (RF) and Support Vector Machine (SVM) machine learning algorithms. The RF model showed higher prediction accuracy than the SVM model at the site level. Moreover, the prediction accuracy at the site and landscape levels were comparable for LAI (R2 > 0.76) and LCR (R2 > 0.71) using the RF model. Furthermore, the predicted LAI and LCR were integrated with canopy height and stand density to develop a novel health index map for EWP. The resulting health index map successfully delineated patches representing various health categories. Forestry practitioners and decision-makers can use the derived health index map and intermediate spatial data layers (LAI and LCR) to guide stand management. The developed framework can potentially be applied to other coniferous and broadleaved species for remote sensing-based LCR estimation and forest health assessment upon further studies and verification.

A growing interest has been directed toward including a fourth dimension in the engagement construct: the social dimension. The aim of this study is twofold: first, to explore how teachers talk about the social dimension of student engagement in online learning, and second, to explore the possibilities of using computational methods for interview data analysis. A longitudinal intervention (interview-diary-interview) was conducted with teachers who actively teach online classes in hybrid, remote, and distance modes of delivery. Natural language processing methods, more specifically topic modelling, were used to extract and analyse topics discussed in the data. Analysis of topic overlap and distinctions were made. Key results reveal that co-creation and shared cognition are core concepts when teachers talk about social engagement. However, results also show that individual engagement is critical for social engagement, and that teacher-student interaction can, potentially, be viewed as a separate component. Interestingly, the teachers' talk also reflected phases in learning such as process and product-based focuses. Following the results, we suggest that computational methods can be combined with traditional (human) analysis to contribute to a richer and more nuanced understanding of abstract topics. Understanding social engagement may inform theory development and is vital for researchers, practitioners, and decision-makers.

In Sweden, upper secondary school teachers made a swift transition into emergency remote teaching in 2020 due to the outbreak of COVID-19. This paper reports on a Design-Based Research intervention in which professional development was designed using the Blended Learning Adoption framework, to support teachers to develop their teaching practices online. Twenty-six teachers participated in the intervention which spanned six months. Data was analysed using thematic analysis. Key results revealed that the pandemic had become an impetus for change, for many teachers, but far from all. Emerging teaching practices in synchronous online learning included: inviting special needs pedagogues in parallel breakout rooms, and grouping and re-grouping students when facilitating varied collaboration. Apart from realising new potentials of online teaching and learning, teachers identified emerging challenges such as: new ways of cheating, ethical aspects of accessing students' private homes via cameras and a lack of guidelines on managing disengagement. Conclusively, teacher's professional development and new experiences elicit new practices that could benefit teachers after the pandemic. Professional development during uncertain times and design principles supporting intervention ownership transfer are discussed.

Summary: Background & Aims: Polyphenols are plant secondary compounds that possess antioxidant properties associated with preventing inflammation-mediated ailments such as cardiovascular disease and cancer. Recent studies hint at their capacity to enhance exercise performance. Berries, in addition to containing high amounts of essential vitamins and minerals, are extremely rich in polyphenols. Therefore, the aim of this systematic review and meta-analysis was to compile relevant human randomized controlled trials exploring the potential of polyphenol-rich berries to enhance exercise performance and associated biomarkers. Methods: The PubMed, Web of Science, and SPORTDiscus databases were searched using keywords related to berry supplementation, exercise performance, and biomarkers of performance. In total, 2374 articles were screened and 14 were included in the analysis. Results: The results indicate no statistically significant effect of berry supplementation on exercise performance and its associated biomarkers. However, there is a trend towards a positive pooled effect size of berry supplementation on time to exhaustion (SMD: 0.57, Z: 1.51, P-value: 0.13). Furthermore, all pooled effect sizes favor berry supplementation. Conclusions: Due to variations in testing protocols and biomarkers of interest among the studies included, no more than 7 articles were included for any given outcome measure. This underscores the necessity for additional high-quality randomized controlled trials (RCTs) to strengthen the evidence and allow for recommendations to be made regarding the performance enhancing effects of berry consumption. This systematic review and meta-analysis was registered on Open Science Framework (DOI 10.17605/OSF.IO/NCAVJ).

Background and objective: There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy. Methods: Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS). Key findings and limitations: In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13–24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16–30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4–14). PFS was 90% (95% confidence interval: 0.86–1) and OS was 100% at 24 mo. Conclusions and clinical implications: RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity. Patient summary: In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.

Background and purpose: The primary aim of this study was to assess the patient’s self-reported change in health 1 year after sustaining an acetabular fracture. The secondary objective was to examine differences in patient-reported outcomes (PROMs) based on sex, age groups, injury mechanisms, type of fracture, and treatment. Methods: Data was collected from the Swedish Fracture Register (SFR) for patients with acetabular fractures sustained between 2014 and 2021. Patients with additional fractures at the time of injury or during the following 18 months, periprosthetic fractures, or pediatric fractures were excluded. The PROM used was the Short Musculoskeletal Function Assessment (SMFA) wherein the subindices of bother, dysfunction, and mobility were analyzed with a higher score indicating worse outcome. The differences in SMFA and in subindices between the score 1 year after fracture and preinjury (recall) were analyzed. Results: Of the 385 included patients with complete PROMs, there was no significant difference in changes in SMFA score between the sexes. Surgically treated patients had significantly higher scores 1 year post-injury compared with non-surgically treated patients with bother index 18.3 (95% confidence [CI] 14.0–22.6) vs 7.2 (CI 4.7–9.8), dysfunction index 15.8 (CI 12.7–18.9) vs 7.0 (CI 5.0–9.0), and mobility index 21.6 (CI 17.9–25.2) vs 9.2 (CI 6.9–11.5). Conclusion: Most patients sustaining an acetabular fracture experience a decline in their functional abilities 1 year after the injury compared with before the injury. Younger patients with high-energy injuries and complex fracture types, which typically require surgical intervention, experience the most unfavorable outcomes. The large group of non-surgically treated patients reported minimal functional changes, likely attributable to selection bias.

Introduction Home-based, virtually-supported care models may represent the most efficient and scalable approach to delivering prehabilitation services. However, virtual approaches to prehabilitation are understudied. This manuscript describes the protocol for an internal pilot randomised controlled trial of a virtually-delivered, multimodal prehabilitation intervention.Methods and analysis We will conduct a pragmatic, individual patient, internal pilot randomised controlled trial of home-based, virtually supported, multimodal prehabilitation compared with standard perioperative care in adults undergoing elective, inpatient thoracic, abdominal, pelvic and vascular surgery at five Canadian hospitals. Participants will be partially blinded; clinicians and outcome assessors will be fully blinded. The intervention consists of 3–12 weeks of a home-based, multimodal (exercise, nutrition and psychosocial support) prehabilitation programme supported through an online platform. The primary feasibility outcomes and their progression targets are (1) monthly recruitment of>6 participants at each centre, (2) intervention adherence of>75%, (3) retention of>90% of participants at the patient-reported primary outcome point of 30-days after surgery and (4) elicitation of patient, clinician and researcher-identified barriers to our pragmatic trial. A sample size of 144 participants will be adequate to estimate recruitment, adherence and retention rates with acceptable precision. All participants will be followed to either death or up to 1 year. As an internal pilot, if no substantive changes to the trial or intervention design are required, pilot participant outcome data will migrate, unanalysed by allocation, to the future full-scale trial.Ethics and dissemination Ethical approval has been granted by Clinical Trials Ontario (Project ID: 4479) and our ethics review board (Protocol Approval #20230399–01T). Results will be disseminated through presentations at scientific conferences, peer-reviewed publications, partner organisations and engagement of social and traditional media.Trial registration number ClinicalTrials.gov identifier NCT06042491. Protocol, V.1.2, dated 6 June 2024.

Chemical risk assessments typically focus on single substances, often overlooking real-world co-exposures to chemical mixtures. Mixture toxicology studies using representative mixtures can reveal potential chemical interactions, but these do not account for the unique chemical profiles that occur in the blood of diverse individuals. Here we used the H295R steroidogenesis assay to screen personalized mixtures of 24 persistent organic pollutants (POPs) for cytotoxicity and endocrine disruption. Each mixture was reconstructed at a human exposure relevant concentration (1×), as well as at 10- and 100-fold higher concentration (10×, 100×) by acoustic liquid handling based on measured blood concentrations in a Swedish cohort. Among the twelve mixtures tested, nine mixtures decreased the cell viability by 4–18%, primarily at the highest concentration. While the median and maximum mixtures based on the whole study population induced no measurable effects on steroidogenesis at any concentration, the personalized mixture from an individual with the lowest total POPs concentration was the only mixture that affected estradiol synthesis (35% increase at the 100× concentration). Mixtures reconstructed from blood levels of three different individuals stimulated testosterone synthesis at the 1× (11–15%) and 10× concentrations (12–16%), but not at the 100× concentration. This proof-of-principle personalized toxicity study illustrates that population-based representative chemical mixtures may not adequately account for the toxicological risks posed to individuals. It highlights the importance of testing a range of real-world mixtures at relevant concentrations to explore potential interactions and non-monotonic effects. Further toxicological studies of personalized contaminant mixtures could improve chemical risk assessment and advance the understanding of human health, as chemical exposome data become increasingly available.

Background and purpose: Patient-reported outcome measures (PROMs) following ankle fractures, including all fracture types, have not been reported. It is therefore unclear whether fracture morphology correlates with outcome. We aimed to analyze PROMs in patients with an ankle fracture in relation to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture classification using population-based register data from the Swedish Fracture Register (SFR). Methods: All patients aged ≥ 18 years with an ankle fracture (AO/OTA 44A1–C3) registered in the SFR between 2012 and 2019 were retrieved from the register. Patients with completed PROM questionnaires (Short Musculoskeletal Function Assessment and EuroQol-Visual Analogue Scale) on both day 0 (pre-trauma) and 1-year post-trauma were included. The difference in PROMs between day 0 and 1 year was calculated for each patient (delta value) and mean delta values were calculated at group level, based on the AO/OTA fracture classification. Results: 11,733 patients with 11,751 fractures with complete PROMs were included. According to the AO/OTA classification, 21% were A fractures, 67% were B fractures and 12% were C fractures. All groups of patients, regardless of fracture class (A1–C3), displayed an impairment in PROMs after 1 year compared with day 0. Type C fractures displayed a larger impairment in PROMs at group level than type B, which in turn had a greater impairment than type A. The same pattern was seen in groups 3, 2, and 1 for A and B fractures. Conclusion: We found that the AO/OTA classification is prognostic, where more complex fractures were associated with poorer PROMs.

Objectives The authors aimed to evaluate whether blood cadmium (B-Cd), lead (B-Pb) and mercury (B-Hg) in children differ regionally in 9 countries, and to identify factors correlating with exposure. Material and Methods The authors performed a cross-sectional study of children aged 7–14 years, living in 2007–2008 in urban, rural, or potentially polluted (“hot spot”) areas (ca. 50 children from each area, in total 1363 children) in 6 European and 3 non-European countries. The authors analyzed Cd, Pb, and total Hg in blood and collected information on potential determinants of exposure through questionnaires. Regional differences in exposure levels were assessed within each country. Results Children living near industrial “hot-spots” had B-Cd 1.6 (95% CI: 1.4–1.9) times higher in the Czech Republic and 2.1 (95% CI:1.6–2.8) times higher in Poland, as compared to urban children in the same countries (geometric means [GM]: 0.13 μg/l and 0.15 μg/l, respectively). Correspondingly, B-Pb in the “hot spot” areas was 1.8 (95% CI: 1.6–2.1) times higher than in urban areas in Slovakia and 2.3 (95% CI: 1.9–2.7) times higher in Poland (urban GM: 19.4 μg/l and 16.3 μg/l, respectively). In China and Morocco, rural children had significantly lower B-Pb than urban ones (urban GM: 64 μg/l and 71 μg/l, respectively), suggesting urban exposure from leaded petrol, water pipes and/or coal-burning. Hg “hot spot” areas in China had B-Hg 3.1 (95% CI: 2.7–3.5) times higher, and Ecuador 1.5 (95% CI: 1.2–1.9) times higher, as compared to urban areas (urban GM: 2.45 μg/l and 3.23 μg/l, respectively). Besides industrial exposure, traffic correlated with B-Cd; male sex, environmental tobacco smoke, and offal consumption with B-Pb; and fish consumption and amalgam fillings with B-Hg. However, these correlations could only marginally explain regional differences. Conclusions These mainly European results indicate that some children experience about doubled exposures to toxic elements just because of where they live. These exposures are unsafe, identifiable, and preventable and therefore call for preventive actions. Int J Occup Med Environ Health. 2023;36(3):349–64

Abstract Background Older adults with frailty are at an increased risk of adverse outcomes after surgery. Exercise before surgery (exercise prehabilitation) may reduce adverse events and improve recovery after surgery. However, adherence with exercise therapy is often low, especially in older populations. The purpose of this study was to qualitatively assess the barriers and facilitators to participating in exercise prehabilitation from the perspective of older people with frailty participating in the intervention arm of a randomized trial. Methods This was a research ethics approved, nested descriptive qualitative study within a randomized controlled trial of home-based exercise prehabilitation vs. standard care with older patients (≥ 60 years) having elective cancer surgery, and who were living with frailty (Clinical Frailty Scale ≥ 4). The intervention was a home-based prehabilitation program for at least 3 weeks before surgery that involved aerobic activity, strength and stretching, and nutritional advice. After completing the prehabilitation program, participants were asked to partake in a semi-structured interview informed by the Theoretical Domains Framework (TDF). Qualitative analysis was guided by the TDF. Results Fifteen qualitative interviews were completed. Facilitators included: 1) the program being manageable and suitable to older adults with frailty, 2) adequate resources to support engagement, 3) support from others, 4) a sense of control, intrinsic value, noticing progress and improving health outcomes and 5) the program was enjoyable and facilitated by previous experience. Barriers included: 1) pre-existing conditions, fatigue and baseline fitness, 2) weather, and 3) guilt and frustration when unable to exercise. A need for individualization and variety was offered as a suggestion by participants and was therefore described as both a barrier and facilitator. Conclusions Home-based exercise prehabilitation is feasible and acceptable to older people with frailty preparing for cancer surgery. Participants identified that a home-based program was manageable, easy to follow with helpful resources, included valuable support from the research team, and they reported self-perceived health benefits and a sense of control over their health. Future studies and implementation should consider increased personalization based on health and fitness, psychosocial support and modifications to aerobic exercises in response to adverse weather conditions.