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This paper reports on an investigation into the potential effects of the Symbol Literacy Approach (SLA) on the metaphorical reasoning of 25 five-year-old children attending a Maltese Catholic School. This was implemented via six pedagogical activities comprising the 'St. Michael Project', which sought to prompt the children's symbolic engagement with the Judeo-Christian myth concerning the triumph of Archangel Michael against Lucifer. In the final activity, the children's observation, role-play and conversation were prompted in relation to a 17th-century Flemish painting depicting St. Michael, after which the children were invited to draw pictures of anything the activity had made them think about. The research data comprised video recordings of conversations held with the children during the drawing process as well as photographs of the finalised pictures. Thematic analysis subsequently revealed that the SLA had supported most of the children to engage in metaphorical reasoning, while illuminating various facets of this pivotal cognitive process.

Infographics are visual storytelling techniques used to communicate complex information. However, infographics can be misleading if they are not created ethically. When universities teach how to create infographics, they often do so without emphasizing the ethical issues underlying infographics. To address this gap, we designed a study to educate statistics and data science students about the ethics of infographics by using Rest model's three stages: awareness, orientation, and intention. Students' awareness of the ethical issues underlying infographics was captured before and after sensitizing them to five ethical principles derived from the AI4People's framework applied to a data science context. The students were then exposed to scenarios with ethical dilemmas. Their identification of the ethical principles in these scenarios was measured. The results showed a significant increase in students' awareness of the ethical issues underpinning the interpretation of infographics, suggesting that ethical training of current users and future designers would be beneficial.

Lesson study, a collaborative teacher professional development approach, has gained popularity internationally and leading the process with teachers plays a key role in making it sustainable in schools. This paper, which draws on a postgraduate university course for prospective school leaders, examines the dynamic roles in leading lesson study. Drawing on the literature on lesson study and leadership, we analyse how postgraduate students lead lesson study while navigating their status as an insider–outsider. Using a theoretical lens informed by the insider–outsider researcher debate, we propose a classification framework to understand lesson study leaders’ statuses. Presenting two case studies, we explore the strategies for the selection of LS participants, communication, and trust-building, as well as the leaders’ dilemmas and learning opportunities. Drawing on the findings, we highlight the central role of reflective practice in leading lesson study and offer insights for practitioners. This study sheds light on the nuanced dynamics of leading lesson study and its implications for the preparation of prospective leaders.

ObjectiveTo compare secondary patient reported outcomes of perceptions of treatment success and function for patients treated for appendicitis with appendectomy vs. antibiotics at 30 days.Summary background dataThe Comparison of Outcomes of antibiotic Drugs and Appendectomy trial found antibiotics noninferior to appendectomy based on 30-day health status. To address questions about outcomes among participants with lower socioeconomic status, we explored the relationship of sociodemographic and clinical factors and outcomes.MethodsWe focused on 4 patient reported outcomes at 30 days: high decisional regret, dissatisfaction with treatment, problems performing usual activities, and missing >10 days of work. The randomized (RCT) and observational cohorts were pooled for exploration of baseline factors. The RCT cohort alone was used for comparison of treatments. Logistic regression was used to assess associations.ResultsThe pooled cohort contained 2062 participants; 1552 from the RCT. Overall, regret and dissatisfaction were low whereas problems with usual activities and prolonged missed work occurred more frequently. In the RCT, those assigned to antibiotics had more regret (Odd ratios (OR) 2.97, 95% Confidence intervals (CI) 2.05-4.31) and dissatisfaction (OR 1.98, 95%CI 1.25-3.12), and reported less missed work (OR 0.39, 95%CI 0.27-0.56). Factors associated with function outcomes included sociodemographic and clinical variables for both treatment arms. Fewer factors were associated with dissatisfaction and regret.ConclusionsOverall, participants reported high satisfaction, low regret, and were frequently able to resume usual activities and return to work. When comparing treatments for appendicitis, no single measure defines success or failure for all people. The reported data may inform discussions regarding the most appropriate treatment for individuals.Trial registrationClinicaltrials.gov Identifier: NCT02800785.

Abstract Connected and automated vehicles (CAVs) are being developed and designed to operate on existing roads. Their safe and efficient operation during roadworks, where traffic management measures are often introduced, is crucial. Two alternative measures are commonly applied during roadworks on motorways: (i) closing one or multiple lanes (ii) narrowing one or all lanes. The former can cause delays and increased emissions, while the latter can pose safety risks. This study uses a VISSIM‐based traffic microsimulation to compare the effectiveness of these two strategies on traffic efficiency and safety, considering various market penetration rates (MPR) of CAVs. The model was calibrated and validated with the data collected from M1 motorway in the United Kingdom. Results show that average delays per vehicle‐kilometre‐travelled decreased from 102.7 to 2.5 s (with lane closure) and 23.6 to 0.6 s (with narrow lanes) with 0% and 100% CAV MPR, respectively. Moreover, safety in narrow lanes improved by 4.8 times compared to 1.5 times improvement in lane closure with a 100% CAV MPR; indicating that narrow lanes would result in better safety performance. These findings could assist transport authorities in designing temporary traffic management measure that results in better CAV performance when navigating through roadworks.

Osteoporosis is a multifactorial bone disease characterised by reduced bone mass and increased fracture risk. Family studies have made significant contribution in unravelling the genetics of osteoporosis. Yet, most of the underlying molecular and biological mechanisms remain unknown prompting the need for further studies. This review outlines the proper phenotyping and advanced genetic techniques in the form of high-throughput DNA sequencing used to identify genetic factors underlying monogenic osteoporosis in a family-based setting. The steps related to variant filtering prioritisation and curation are also described. From an evolutionary perspective, deleterious risk variants with higher penetrance tend to be rare as a result of negative selection. High-throughput sequencing (HTS) can identify rare variants with large effect sizes which are likely to be missed by candidate gene analysis or genome-wide association studies (GWAS) wherein common variants with small to moderate effect sizes are identified. We also describe the importance of replicating implicated genes, and possibly variants, identified following HTS to confirm their causality. Replication of the gene in other families, singletons or independent cohorts confirms that the shortlisted genes and/or variants are indeed causal. Furthermore, novel genes and/or variants implicated in monogenic osteoporosis require a thorough validation by means of in vitro and in vivo assessment. Therefore, analyses of families can continue to elucidate the genetic architecture of osteoporosis, paving the way for improved diagnostic and therapeutic strategies.

Background Surgical site infections (SSIs) are a frequent postoperative complication that nurses commonly need to provide asepsis-specific meticulous care for. The application of a closed-incisional negative pressure wound therapy (iNPWT) device is regarded as a novel technique that aims to lower the risk of external wound contamination. Aim The purpose of this review was to evaluate the effectiveness of iNPWT on high-risk closed laparotomy incisions with the aim to inform nursing practitioners and physicians engaged in multieffort wound care practices. Nursing professionals play a crucial role in mitigating the incidence of SSIs, from the time of application, through ongoing assessment tissue condition, and ensuring asepsis, thereby enhancing patient care and safety. The Research Question Is prophylactic negative pressure wound therapy effective in reducing the incidence of (closed) surgical site wound infections postlaparotomy? PICO Elements The population studied included patients undergoing laparotomy surgery. The intervention under review included the application of iNPWT, compared to the use of standard gauze dressing. The expected outcome was SSI reduction. Methods and Results A systematized literature search was conducted using various databases to identify published studies that address the PICO question. The PRISMA checklist and Critical Appraisal Skills Programme tools allowed to exclude irrelevant articles and to critically appraise the evidence, respectively. Eleven key articles were retrieved including four RCTs and seven systematic reviews and meta-analysis. The results indicated an overall positive association between iNPWT and a reduction in SSI in laparotomy surgeries when compared to standard dressings. Linking Evidence to Action Data across most studies reviewed support the benefits with the use of iNPWT as a preventive strategy to lower the rates of SSI, with some claiming no difference. Although heterogeneity in the studies precludes a definite conclusion, nurses may make a more informed decision when navigating the demands of SSI prevention targeted nursing care.

Primary mitochondrial diseases are a group of genetically and clinically heterogeneous disorders resulting from oxidative phosphorylation (OXPHOS) defects. COX11 encodes a copper chaperone that participates in the assembly of complex IV and has not been previously linked to human disease. In a previous study, we identified that COX11 knockdown decreased cellular adenosine triphosphate (ATP) derived from respiration, and that ATP levels could be restored with coenzyme Q10 (CoQ10 ) supplementation. This finding is surprising since COX11 has no known role in CoQ10 biosynthesis. Here, we report a novel gene-disease association by identifying biallelic pathogenic variants in COX11 associated with infantile-onset mitochondrial encephalopathies in two unrelated families using trio genome and exome sequencing. Functional studies showed that mutant COX11 fibroblasts had decreased ATP levels which could be rescued by CoQ10 . These results not only suggest that COX11 variants cause defects in energy production but reveal a potential metabolic therapeutic strategy for patients with COX11 variants.

A major threat to biodiversity is represented by Invasive Alien Species (IAS), particularly on freshwater ecosystems, which are already heavily altered by human activities. Two of the most pernicious IAS are the eastern and western mosquitofish, i.e., Gambusia holbrooki and G. affinis. These two poeciliids are morphologically very close to each other, and soon after their formal description, G. holbrooki was considered a subspecies of G. affinis. In the following years, several studies proved that these two entities belonged to two different species; nevertheless, it was only at the end of the 1990s that their separate taxonomic status was re-established. In the 1920s and 1930s, both G. holbrooki and G. affinis were asynchronously introduced from the United States into Europe and subsequently translocated globally as biocontrol agents of the malaria vector (i.e., the larvae of the Anopheles mosquitoes), with dramatic consequences for the inland water native fauna. However, due to taxonomic uncertainties and nomenclatural instability, for years, there were doubts about which Gambusia species had been introduced in different regions. The first available molecular studies confirmed the occurrence of G. holbrooki in Europe, but no evidence confirming the occurrence of G. affinis was found. Despite this, some records report the occurrence of western mosquitofish in Italy and Malta. Considering the negative effects that the mosquitofish has on the native biota, it is of paramount importance to know the precise biological diversity of the native and non-native species to better implement environmental management strategies to properly preserve the already-fragile waterbodies. Therefore, to check for the possible occurrence of G. affinis in Italy and Malta, we conducted extensive sampling in Sicily (Italy) and in the Maltese archipelago, aiming to verify the identity of Gambusia populations occurring in the study area. Based on sequences of the mitochondrial cytochrome b gene, we consistently observed the occurrence of only G. holbrooki in the investigated area, finding, almost exclusively, the most common haplotype known for the species in the whole invaded range (i.e., “HOL1”).

This qualitative, exploratory research study is positioned within the field of Family Language Policy (FLP). Contextualised in bilingual Malta, where Maltese is the majority language, the study inquires into the effects of a plurilingual family language programme on the language ideologies within English-speaking Maltese families. The programme was followed by four such families over a four-week period, during which data were collected via the participants' weekly entries into semi-structured family language journals. Upon the programme's completion, a second set of data was collected via one-off, semi-structured, family focus group interviews, for the purpose of triangulation. The findings highlight interrelated issues across the macro, meso and micro levels of language ideology, contributing to existing research by postulating the potential of a family language programme to prompt ideological shifts in support of heritage-language engagement, transmission and maintenance.

Purpose – Cybersecurity vulnerabilities are often due to human users acting according to their own ethical priorities. With the goal of providing tailored training to cybersecurity professionals, the authors conducted a study to uncover profiles of human factors that influence which ethical principles are valued highest following exposure to ethical dilemmas presented in a cybersecurity game. Design/methodology/approach – The authors’ game first sensitises players (cybersecurity trainees) to five cybersecurity ethical principles (beneficence, non-maleficence, justice, autonomy and explicability) and then allows the player to explore their application in multiple cybersecurity scenarios. After playing the game, players rank the five ethical principles in terms of importance. A total of 250 first-year cybersecurity students played the game. To develop profiles, the authors collected players' demographics, knowledge about ethics, personality, moral stance and values. Findings – The authors built models to predict the importance of each of the five ethical principles. The analyses show that, generally, the main driver influencing the priority given to specific ethical principles is cultural background, followed by the personality traits of extraversion and conscientiousness. The importance of the ingroup was also a prominent factor. Originality/value – Cybersecurity professionals need to understand the impact of users' ethical choices. To provide ethics training, the profiles uncovered will be used to build artificially intelligent (AI) non-player characters (NPCs) to expose the player to multiple viewpoints. The NPCs will adapt their training according to the predicted players’ viewpoint.

In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) guideline on the endoscopic management of choledocholithiasis modified the individual predictors of choledocholithiasis proposed in the widely referenced 2010 guideline to improve predictive performance. Nevertheless, the primary literature, especially for the 2019 iteration, is limited. We performed a systematic review with meta-analysis to examine the diagnostic performance of the 2010, and where possible the 2019, predictors. PROSPERO protocol CRD42020194226. A comprehensive literature search from 2001 to 2020 was performed to identify studies on the diagnostic performance of any of the 2010 and 2019 ASGE choledocholithiasis predictors. Identified studies underwent keyword screening, abstract review, and full-text review. The primary outcomes included multivariate odds ratios (ORs) and 95% confidence intervals for each criterion. Secondary outcomes were reported sensitivities, specificities, and positive and negative predictive value. A total of 20 studies met inclusion criteria. Based on reported ORs, of the 2010 guideline "very strong" predictors, ultrasound with stone had the strongest performance. Of the "strong" predictors, CBD > 6 mm demonstrated the strongest performance. "Moderate" predictors had inconsistent and/or weak performance; moreover, all studies reported gallstone pancreatitis as non-predictive of choledocholithiasis. Only one study examined the new predictor (bilirubin > 4 mg/dL and CBD > 6 mm) proposed in the 2019 guideline. Based on this review, aside from CBD stone on ultrasound, there is discordance between the proposed strength of 2010 choledocholithiasis predictors and their published diagnostic performance. The 2019 guideline appears to do away with the weakest 2010 predictors.