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Background: In the United States, breast cancer remains one of the most diagnosed cancers among females and remains the second leading cause of cancer death. In addition, breast cancer is most likely diagnosed at an advanced stage among Hispanic females in the United States due to lower mammogram utilization. Aims: The objective of this study was to determine the effectiveness of a multilevel, multicomponent community-based breast cancer screening intervention called the Breast Cancer Education Screening and NavigaTion (BEST) program. The primary outcome was the completion of a screening mammogram 4 months post-intervention. Method: We used a pragmatic approach for evaluation, utilizing a quasi-experimental delayed intervention design. We recruited women from the community aged between 50 and 75, uninsured or underinsured, and overdue for screening. Results: Six hundred participants were recruited (300 intervention and 300 control). Among completers, the screening rate was 97% in the intervention group and 4.4% in the control group (RR = 22.2, 95% CI: 12.5–39.7, p <.001). In multivariable analysis, age ≥ 65 (RR = 1.29, p =.047), perceived benefits (RR = 1.04, p =.026), curability (RR = 1.24, p <.001), subjective norms (RR = 1.14, p =.014), and fatalism (RR =.96, p =.004) remained significantly associated with screening outcome. Conclusion: A multicomponent, bilingual, and culturally tailored intervention effectively facilitated breast cancer screening completion in an underserved population of Hispanic women. Individuals with improved screening outcomes were more likely to have higher positive beliefs. Our study has important implications regarding using multicomponent interventions in increasing breast cancer screening completion in poorly screened populations. It also highlights differences in health belief motivation for breast cancer screening completion. [ABSTRACT FROM AUTHOR]

This paper explores the design and implementation of a comprehensive, continuous outcome evaluation for youth in therapeutic residential care (TRC) to measure program efficacy, based on The Joint Commission (TJC) accreditation guidelines. Over a 10-year implementation period, researchers analyzed changes in 281 residential care youth from baseline to reassessment after 4–6 months in treatment. The primary assessment instruments included the SASSI-A2, the FACES III, the Measure of Psychosocial Development (MPD), the Behavioral and Emotional Rating Scale (BERS), and the Youth Comprehensive Risk Assessment (YCRA). Results indicated reductions in the risk areas of self-harm, conduct disorder behaviors, and substance abuse. Significant increases occurred in psychosocial development, family engagement, and personal strengths. However, results also revealed continued low levels of youth development in trust vs mistrust, ego integrity vs despair, willingness to disclose loss of control, recognition of negative consequences of substance misuse, and response to conduct disorder treatments. Implications and recommendations for ongoing program evaluation, staff development, and institutional change are discussed. [ABSTRACT FROM AUTHOR]

This article is written to help therapists who are not clinical researchers assess the quality of experimental studies that are designed to compare the relative merits of different approaches to treating distressed couples. To illustrate some of the major difficulties encountered in conducting comparative research with couples (instrumentation, pretreatment assessment, internal validity, external validity, reliability of treatments, outcome evaluation, etc.) hypothetical examples are presented. Suggestions for addressing some of the salient methodological issues identified in the article and implications for determining best practices are offered for consideration. [ABSTRACT FROM AUTHOR]

With the rapid advancement of information technology (IT), mobile learning has gradually become a significant approach in vocational education and training. University students utilize mobile applications for learning, which not only enhances the flexibility and efficiency of their studies but also promotes the equitable distribution of educational resources. However, effectively evaluating the impact of these applications in vocational education and training remains an urgent issue to be addressed. Current study methods predominantly focus on the analysis of static data, which inadequately captures the dynamic changes in students' learning behaviors. Additionally, traditional predictive models exhibit low accuracy and poor generalization capabilities when handling high-dimensional, nonlinear time-series data. This study proposes an evaluation method for vocational education and training outcomes based on an improved gated recurrent unit (GRU) model, which comprises three main components: decomposition of university students' mobile application time-series data based on the variable dependence model (VDM), preprocessing of the mobile application data, and outcome evaluation using the improved GRU model. Incorporation of an attention mechanism enhances the predictive performance of the model, providing data support and a decision-making basis for educators and developers. [ABSTRACT FROM AUTHOR]

Coaching is grounded in three knowledge components: professional, interpersonal and intrapersonal knowledge. Coach development research has shown that coaches value contextual, in situ, learning with mentors more highly than formal, mediated programs that are offered by sporting bodies, which often provide generic content. The aim of this paper is to present the findings of an evaluation of a Coach Developer Program that was implemented across 6 community sports clubs in the southern suburbs of South Australia. The program provided guidance to the clubs in the development of a designated Coach Developer role to support coaches and their practice. This study utilised pre and post program surveys that contained qualitative and quantitative questions. 2 club administrators, 3 coach developers and 29 coaches from the 6 clubs participated in an online pre-program survey, and 22 coaches and 2 coach developers participated in an online post-program survey. Some coaches believed their coaching was positively impacted on the introduction of a Coach Developer role within their club, and the coaching mentoring promoted as part of the Coach Developer Program, however, many were unsure if their coaching practice had been impacted. Therefore, the perceived usefulness of the role of a Coach Developer was considered equivocal in terms of the overall impact. However, when considering individual impact, the role was beneficial for focussing coach development and support. Given the preference of coaches for in situ mentoring expressed in this project and the extant literature, we recommend that governing bodies and community clubs invest in purposeful in situ learning, such as the Coach Developer Program trialled in this study. [ABSTRACT FROM AUTHOR]

The effect of stress on risk‐taking or risk‐averse behavior in decision‐making has been inconclusive in previous research, with few studies revealing the underlying neural mechanisms. This study employed event‐related potentials technique and combined a social cold pressor assessment test with a mental arithmetic task to induce stress responses, aiming to investigate the influence of exogenous stress on the risk decision‐making process. Stress induction results indicated that, in addition to raising heart rate and blood pressure, stress responses were accompanied by enhanced negative emotions, diminished positive emotions, and alterations in neural activity. The outcomes of risk decision‐making showed that stress did not significantly affect risk preference or time of choice but did reduce the feedback‐related negativity/reward positivity, with a particularly significant effect observed for large outcomes. Stress also altered the amplitude of the P3 component, with stress decreasing the P3 value for winning outcomes relative to losing outcomes. The study suggests that understanding how stress affects risk preference should consider the emotional valence induced by stress. Contrary to the reward sensitivity hypothesis, stress weakened reward sensitivity. Stress led to changes in the allocation of cognitive resources for outcome evaluation: compared to negative outcomes, stress reduced cognitive resources for positive outcomes, which might be related to the enhanced negative emotions induced by stress. The study highlights the importance of focusing on the subjective emotional experience induced by stress in future research on stress and risk decision‐making. We find that stress with negative emotions weakens reward sensitivity, which challenges the reward sensitivity hypothesis. Stress also modifies cognitive resource allocation for outcome evaluation: compared to negative outcomes, stress reduced cognitive resources for positive outcomes. This study underscores the significance of incorporating emotional experiences induced by stress into future investigations about stress and risk decision‐making. [ABSTRACT FROM AUTHOR]

Abstract It has been difficult to demonstrate that interprofessional education (IPE) and interprofessional collaboration (IPC) have positive effects on patient care quality, cost effectiveness of patient care, and healthcare provider satisfaction. Here we propose a detailed explanation for this difficulty based on an adjusted theory about cause and effect in the field of IPE and IPC by asking: 1) What are the critical weaknesses of the causal models predominantly used which link IPE with IPC, and IPE and IPC with final outcomes? 2) What would a more precise causal model look like? 3) Can the proposed novel model help us better understand the challenges of IPE and IPC outcome evaluations? In the format of a critical theoretical discussion, based on a critical appraisal of the literature, we first reason that a monocausal, IPE-biased view on IPC and IPC outcomes does not form a sufficient foundation for proper IPE and IPC outcome evaluations; rather, interprofessional organization (IPO) has to be considered an additional necessary cause for IPC; and factors outside of IPC additional causes for final outcomes. Second, we present an adjusted model representing the “multi-stage multi-causality” of patient, healthcare provider, and system outcomes. Third, we demonstrate the model’s explanatory power by employing it to deduce why misuse of the modified Kirkpatrick classification as a causal model in IPE and IPC outcome evaluations might have led to inconclusive results in the past. We conclude by applying the derived theoretical clarification to formulate recommendations for enhancing future evaluations of IPE, IPO, and IPC. Our main recommendations: 1) Focus should be placed on a comprehensive evaluation of factual IPC as the fundamental metric and 2) A step-by-step approach should be used that separates the outcome evaluation of IPE from that of IPC in the overarching quest for proving the benefits of IPE, IPO and IPC for patients, healthcare providers, and health systems. With this critical discussion we hope to enable more effective evaluations of IPE, IPO and IPC in the future.

Humans adjust their behavioral strategies based on feedback, a process that may depend on intrinsic preferences and contextual factors such as visual salience. In this study, we hypothesized that decision-making based on visual salience is influenced by habitual and goal-directed processes, which can be evidenced by changes in attention and subjective valuation systems. To test this hypothesis, we conducted a series of studies to investigate the behavioral and neural mechanisms underlying visual salience-driven decision-making. We first established the baseline behavioral strategy without salience in Experiment 1 (n = 21). We then highlighted the utility or performance dimension of the chosen outcome using colors in Experiment 2 (n = 30). We demonstrated that the difference in staying frequency increased along the salient dimension, confirming a salience effect. Furthermore, the salience effect was abolished when directional information was removed in Experiment 3 (n = 28), suggesting that the salience effect is feedback-specific. To generalize our findings, we replicated the feedback-specific salience effects using eye-tracking and text emphasis. The fixation differences between the chosen and unchosen values were enhanced along the feedback-specific salient dimension in Experiment 4 (n = 48) but unchanged after removing feedback-specific information in Experiment 5 (n = 32). Moreover, the staying frequency was correlated with fixation properties, confirming that salience guides attention deployment. Lastly, our neuroimaging study (Experiment 6, n = 25) showed that the striatum subregions encoded salience-based outcome evaluation, while the vmPFC encoded salience-based behavioral adjustments. The connectivity of the vmPFC-ventral striatum accounted for individual differences in utility-driven, whereas the vmPFC-dmPFC for performance-driven behavioral adjustments. Together, our results provide a neurocognitive account of how task-irrelevant visual salience drives decision-making by involving attention and the frontal-striatal valuation systems. PUBLIC SIGNIFICANCE STATEMENT: Humans may use the current outcome to make behavior adjustments. How this occurs may depend on stable individual preferences and contextual factors, such as visual salience. Under the hypothesis that visual salience determines attention and subsequently modulates subjective valuation, we investigated the underlying behavioral and neural bases of visual-context-guided outcome evaluation and behavioral adjustments. Our findings suggest that the reward system is orchestrated by visual context and highlight the critical role of attention and the frontal-striatal neural circuit in visual-context-guided decision-making that may involve habitual and goal-directed processes.

Background: Unacceptably high levels of e-cigarette use among youth paired with growing research about the dangers of vaping demonstrate a critical need to develop interventions that educate young people to reject e-cigarette use and promote cessation for current users. Vaping: Know the Truth (VKT) is a free digital learning experience prioritizing middle and high school students that aims to improve students' knowledge about the dangers of using e-cigarettes and provide quitting resources for those who already vape. The current study was designed to evaluate whether students receiving the curriculum increased knowledge of the dangers of vaping. Methods: The outcome measures were calculated as the change in the number of correct responses from the pre- to post-module assessments among middle and high school students who completed four modules of the VKT curriculum (N = 103,522). Linear regression was performed to determine the association between the student's pre-module assessment score and the knowledge change score after completion of the four modules. Results: Students' e-cigarette knowledge significantly improved by an average of 3.24 points (SD = 3.54), following implementation of the VKT curriculum. This indicates that participants answered more than 3 additional questions correctly, on average, after the intervention. Conclusion: Findings demonstrate that the Vaping: Know the Truth curriculum is an effective resource for increasing knowledge among youth about the harms associated with e-cigarette use. Further research is needed to evaluate whether the intervention is associated with behavioral outcomes over time. [ABSTRACT FROM AUTHOR]

This study aimed to develop a method using computer vision techniques to accurately detect and delineate the proximal femur in radiographs of Legg–Calvé–Perthes disease (LCPD) patients. Currently, evaluating femoral head deformity, a crucial predictor of LCPD outcomes, relies on unreliable categorical and qualitative classifications. To address this limitation, we employed the pretrained object detection model YOLOv5 to detect the proximal femur on over 2000 radiographs, including images of shoulders and chests, to enhance robustness and generalizability. Subsequently, we utilized the U‐Net convolutional neural network architecture for image segmentation of the proximal femur in more than 800 manually annotated images of stage IV LCPD. The results demonstrate outstanding performance, with the object detection model achieving high accuracy (mean average precision of 0.99) and the segmentation model attaining an accuracy score of 91%, dice coefficient of 0.75, and binary IoU score of 0.85 on the held‐out test set. The proposed fully automatic proximal femur detection and segmentation system offers a promising approach to accurately detect and delineate the proximal femoral bone contour in radiographic images, which is essential for further image analysis in LCPD patients. Clinical significance: This study highlights the potential of computer vision techniques for enhancing the reliability of Legg–Calvé–Perthes disease staging and outcome prediction. [ABSTRACT FROM AUTHOR]

Federally funded medical and behavioral healthcare programs often have substantial evaluation outcome tracking and reporting requirements, which can become burdensome to program staff resulting in decreased buy-in, increased chance of staff burnout and turnover, and less rigorous and consistent data collection efforts. To address this issue, a novel data collection approach, "exception reporting," was implemented to supplement and support the required data collection for a federally funded Assertive Outpatient Treatment (AOT) program. This work details the process and outcomes related to exception reporting for this comprehensive behavioral health treatment program that serves justice involved clients with serious mental illness (SMI). Results indicate that exception reporting was easily integrated into clinician's normal workflows and resulted in a number of benefits. Specifically, results indicated that exception reporting decreased the data collection burden for program staff while allowing them to efficiently track program outcomes required by the funder. Additional research into which practice settings exception reporting can most easily be integrated into, and which client outcomes may be best tracked using this methodology, is indicated. [ABSTRACT FROM AUTHOR]

Research objectives (aims) and problem(s): The aim of the article is to present the results of an evaluation study of an educational and preventive programme implemented in eight year 4 groups in six Krakow primary schools. The programme, entitled KOTWICA, ran from December 2021 to June 2022. The evaluation was external and comprehensive. During the programme, the evaluation of the process and of the outcome were carried out in the pre-test–post-test format. The research question is “what are the results of the evaluation of the KOTWICA educational and preventive programme for students of the fourth year of primary school?” Research methods: Eight proprietary tools were used to evaluate the process, and two standardised tools were used to evaluate the result. The collected material was subjected to statistical processing, whilst the qualitative data was encoded, categorised and analysed using tools for qualitative data analysis. Structure of the article: At the beginning, the authors justify the undertaking of the research and introduce the subject of the study on the basis of theoretical findings and the state of research in the field of school prevention. Then the research objectives are described and the research problem is defined. In turn, the research method, the selection criteria for the study group and the principles of data collection and processing are described. The results of the research and the limitations of the research process were also described. Finally, the conclusions of the research and recommendations for the theory and policy of school prevention are described. Research findings and their impact on the development of educational sciences: The results of the evaluation allow us to conclude that the objective of the educational and preventive programme conducted in year 4 was achieved and that it met the needs of the participants. However, they do not allow us to draw clear conclusions as to the effectiveness of the educational activities, due to the limitations of the collected research material. Conclusions and/or recommendations: In the light of the results, the authors drew conclusions regarding the methodology of evaluation studies and recommendations for preventive and educational practice.

The trisecting-acting-outcome (TAO) model of three-way decision (3WD) consists of three steps: trisect a whole, design action strategies, and outcome analysis and measurement. Currently, research on outcome evaluation aims to measure the pre- and post-change in outcomes following the implementation of strategies, and it is still unable to predict which strategy will achieve the maximum effect. To narrow down this gap, this paper focuses on the “acting” and “outcome” of the TAO model and introduces a method for strategy selection and outcome prediction for the change-based three-way decision based on Q-learning in reinforcement learning. Firstly, the approach is to treat the altered tri-partition and the acting in the change-based three-way decision TAO model as states and actions in reinforcement learning, respectively, and to consider the process of obtaining a newly altered tri-partition each time under the acting of action or strategy as a cycle. The reward generated by each cycle is calculated using cumulative prospect theory, and the interaction process between the agent and the environment is represented by a Markov decision process. Secondly, a target reward is set, and the state when the cumulative reward of each cycle reaches the target reward is taken as the termination state of the Markov decision process. Then a Q-learning algorithm is used to iterate a set of actions that achieve the target reward in the shortest cycle and then the action set is used to predict the future utility of the change-based three-way decision. Finally, an example is employed to illustrate the applicability and effectiveness of the method.

Background: The application of nasolabial perforator flap for nasal reconstruction has been reported previously with satisfactory outcomes, but the outcomes and risk factors of postoperative adverse events have been unclear to plastic surgeons. Aims: To statistically analyze the effectiveness of the nasolabial perforator flap in nasal reconstruction and the risk factor of postoperative complications and re‐operation. Patients/Methods: This retrospective study evaluated 58 Chinese patients who underwent nasal reconstruction with the nasolabial perforator flap from 2009 to 2021. The esthetic and blood supply outcomes were measured by plastic surgeons on a 5‐point Likert scale. Binary logistic regression was used to determine the risk factors associated with postoperative complications and re‐operation. Results: The mean age of the cohort was 66.4 ± 2.0 years. The defect size ranged from 6.5 × 5.5 mm2 to 40 × 70 mm2, and 48.3% of defects covered more than one nasal subunit. Venous congestion occurred in 4.9% of flaps, and the immediate overall postoperative score was 7.72/10. More than one nasal subunit of involvement was the risk factor associated with re‐operation (p = 0.004), but no risk factor was associated with complications. Conclusions: The nasolabial perforator flap is reliable for nasal reconstruction with good esthetic outcomes and fewer complications. However, a large number of involved subunits may lead to multiple surgeries for flap trimming in easterners. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the application effect of continuous nursing intervention in type 2 diabetic retinopathy (DR). Methods: Patients with type 2 DR were selected and divided into intervention group and control group by random. The control group received routine nursing intervention, and the intervention group received continuous nursing intervention on the basis of the control group. The clinical effects of the two groups were compared. Results: After 1 and 2 years of intervention, the intervention group compared to the control group. The rate of visual acuity decrease was significantly lower (p < 0.05). Fasting blood glucose, 2 h postprandial blood glucose, and glycosylated hemoglobin were significantly lower (p < 0.05). The self‐management ability and satisfaction were significantly higher, and the readmission rate was significantly lower (p < 0.05). Conclusion: The continuous nursing intervention model has a good clinical effect on the visual acuity of patients with type 2 DR. [ABSTRACT FROM AUTHOR]

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Minimally invasive access and fast recovery are trends of gynecomastia surgery. We placed great importance on liposuction and modified original pull-through technique. The purpose of this study was to present a refined surgical strategy for gynecomastia in grade I and II. The refined strategy embraced enhanced liposuction to remove the intraglandular fat sufficiently, followed by open resection of gland using the pull-through and bottom-up technique with adjuvant liposuction in the end. Surgical data were recorded and satisfactory questionnaires with 5-point scales were administered during follow-up. Between January 2017 and May 2022, 165 patients underwent enhanced liposuction combined with the pull-through and bottom-up technique for gland excision. Age ranged from 12 to 56 years. The median length of surgery was 100 min. A median of 300 ml of fat was aspirated and a median of 20.8 g of gland was excised. Seventy-seven patients (46.7%) responded the questionnaires at least 6 months postoperatively, and the average overall satisfaction was 4.68 ± 0.52 points. Thirteen sides of breasts developed complications with a rate of 4.0%. Enhanced liposuction combined with pull-through and bottom-up technique proved effective to treat grade I and II gynecomastia with minimal scarring and high satisfaction. The refined strategy was simple and safe, and would obtain optimal outcomes even for inexperienced surgeons. • Enhanced liposuction combined with pull-through and bottom-up technique is simple and safe to treat gynecomastia. • The refined strategy consists of three steps: the intraglandular fat removing, gland excision and adjuvant liposuction. • The end point of the enhanced liposuction includes a pinch thickness of 1–2 cm and a fully isolated gland moving smoothly. • The refined strategy is characterized by minimal invasiveness and complete avoidance of saucer deformity. [ABSTRACT FROM AUTHOR]

Research objectives (aims) and problem(s): The aim of the article is to present the results of an evaluation study of an educational and preventive programme implemented in eight year 4 groups in six Krakow primary schools. The programme, entitled KOTWICA, ran from December 2021 to June 2022. The evaluation was external and comprehensive. During the programme, the evaluation of the process and of the outcome were carried out in the pre-test--post-test format. The research question is "what are the results of the evaluation of the KOTWICA educational and preventive programme for students of the fourth year of primary school?" Research methods: Eight proprietary tools were used to evaluate the process, and two standardised tools were used to evaluate the result. The collected material was subjected to statistical processing, whilst the qualitative data was encoded, categorised and analysed using tools for qualitative data analysis. Structure of the article: At the beginning, the authors justify the undertaking of the research and introduce the subject of the study on the basis of theoretical findings and the state of research in the field of school prevention. Then the research objectives are described and the research problem is defined. In turn, the research method, the selection criteria for the study group and the principles of data collection and processing are described. The results of the research and the limitations of the research process were also described. Finally, the conclusions of the research and recommendations for the theory and policy of school prevention are described. Research findings and their impact on the development of educational sciences: The results of the evaluation allow us to conclude that the objective of the educational and preventive programme conducted in year 4 was achieved and that it met the needs of the participants. However, they do not allow us to draw clear conclusions as to the effectiveness of the educational activities, due to the limitations of the collected research material. Conclusions and/or recommendations: In the light of the results, the authors drew conclusions regarding the methodology of evaluation studies and recommendations for preventive and educational practice. [ABSTRACT FROM AUTHOR]

In our daily lives, we spontaneously or passively make various social comparisons. In terms of the abilities that are closely linked to our lives, how interpersonal distance affects outcome evaluation in an ability-based social comparison context is largely unknown. In the current study, we used a 2 interpersonal distance × 2 self-outcome × 2 other-outcome within-participant factorial design to investigate how interpersonal distance affects the processing of accuracy outcomes and monetary reward outcomes in social comparison from a temporal processing perspective (N = 25, Mage = 19.84, 52% female). Event-related potentials (ERPs) were measured while the participants performed a dot estimation task with a friend and with a stranger. Regarding behavioral level, the participants were more satisfied when they received positive outcomes and preferred positive outcomes for the friend over the stranger. Regarding ERP level, the effect of interpersonal distance on the processing of judgment accuracy outcomes in social comparison was reflected in the FRN and P300. Specifically, whether the participants were paired with a friend or a stranger, the FRN was larger for other-incorrect than for other-correct in the self-incorrect condition. Only when a participant was paired with a stranger was the FRN larger for stranger-incorrect than for stranger-correct in the self-correct condition. Additionally, the P300 was larger when the participants received the same outcomes as the strangers. Overall, our findings suggest that interpersonal distance moderates the evaluation of social comparison outcomes. Even in a noncompetitive context, individuals tend to compare themselves to strangers. [ABSTRACT FROM AUTHOR]

Abstract Nature‐based school field trips gained policy support from China governments. However, in a highly exam‐oriented education system, schools might be unwilling to implement such activities which they believe are merely fun journeys and useless for knowledge acquisition. We designed an experiential learning field trip to a local mangrove reserve for third graders and assessed how it changed their mental models about the mangrove ecosystem through pre‐ and post‐drawings. We analysed and scored the paired drawings through a rubric developed based on grounded theory coding procedures, used paired t‐tests to examine the changes, and qualitatively interpreted three example pairs from three groups divided by pre‐drawing scores. We deemed that participants' mental models improved, reflecting better knowledge about the mangrove ecosystem. We suggest that the notion of mental models of the environment is relevant to the needs of both formal schools and environmental organizations. By demonstrating a relatively successful nature‐based school field trip case involving pupils from China, we hope that formal schools of this country in the exam‐oriented educational context could utilize it as a justification and vicarious experience to participate in or implement such trips. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Background Go Nisha Go™ (GNG), is a mobile game combining behavioural science, human-centric design, game-based learning, and interactive storytelling. The model uses a direct-to-consumer (DTC) approach to deliver information, products, services, interactive learning, and agency-building experiences directly to girls. The game’s five episodes focus on issues of menstrual health management, fertility awareness, consent, contraception, and negotiation for delay of marriage and career. The game’s effectiveness on indicators linked to these issues will be measured using an encouragement design in a randomized controlled trial (RCT). Methods A two-arm RCT will be conducted in three cities in India: Patna, Jaipur, and Delhi-NCR. The first arm is the treatment (encouragement) arm (n = 975) where the participants will be encouraged to download and play the game, and the second arm (n = 975) where the participants will not receive any nudges/encouragement to play the game. They may or may not have access to the game. After the baseline recruitment, participants will be randomly assigned to these two arms across the three locations. Participants of the treatment/encouragement arm will receive continuous support as part of the encouragement design to adopt, install the game from the Google Play Store at no cost, and play all levels on their Android devices. The encouragement activity will continue for ten weeks, during which participants will receive creative messages via weekly phone calls and WhatsApp messages. We will conduct the follow-up survey with all the participants (n = 1950) from the baseline survey after ten weeks of exposure. We will conduct 60 in-depth qualitative interviews (20 at each location) with a sub-sample of the participants from the encouragement arm to augment the quantitative surveys. Discussion Following pre-testing of survey tools for feasibility of methodologies, we will recruit participants, randomize, collect baseline data, execute the encouragement design, and conduct the follow-up survey with eligible adolescents as written in the study protocol. Our study will add insights for the implementation of an encouragement design in RCTs with adolescent girls in the spectrum of game-based learning on sexual and reproductive health in India. Our study will provide evidence to support the outcome evaluation of the digital mobile game app, GNG. To our knowledge this is the first ever outcome evaluation study for a game-based application, and this study is expected to facilitate scalability of a direct-to-consumer approach to improve adolescent sexual and reproductive health outcomes in India. Trial registration number: ctri.nic.in: CTRI/2023/03/050447.

IntroductionFlavored tobacco appeals to new users. This paper describes evaluation results of California's early ordinances restricting flavored tobacco sales.MethodsA multicomponent evaluation of proximal policy outcomes involved the following: (a) tracking the reach of local ordinances; (b) a retail observation survey; and (c) a statewide opinion poll of tobacco retailers. Change in the population covered by local ordinances was computed. Retail observations compared availability of flavored tobacco at retailers in jurisdictions with and without an ordinance. Mixed models compared ordinance and matched no-ordinance jurisdictions and adjusted for store type. An opinion poll assessed retailers' awareness and ease of compliance with local ordinances, comparing respondents in ordinance jurisdictions with the rest of California.ResultsThe proportion of Californians living in a jurisdiction with an ordinance increased from 0.6% in April 2015 to 5.82% by January 1, 2019. Flavored tobacco availability was significantly lower in ordinance jurisdictions than in matched jurisdictions: menthol cigarettes (40.6% vs. 95.0%), cigarillos/cigar wraps with explicit flavor descriptors (56.4% vs. 85.0%), and vaping products with explicit flavor descriptors (6.1% vs. 56.9%). Over half of retailers felt compliance was easy; however, retailers in ordinance jurisdictions expressed lower support for flavor sales restrictions.ConclusionsThe proportion of California's population covered by a flavor ordinance increased nine-fold between April 2015 and January 2019. Fewer retailers in ordinance jurisdictions had flavored tobacco products available compared to matched jurisdictions without an ordinance, but many still advertised flavored products they could not sell. Comprehensive ordinances and retailer outreach may facilitate sales-restriction support and compliance.

Objective: The aim of this study was to evaluate the impact that domestic violence (DV) service organizations' (SO) agency-wide adoption of CARE had on improving DVSO trauma-informed care (TIC) practices, overall, and in relation to addressing brain injury and mental health. CARE is an advocacy intervention designed to raise DVSOs' capacity to CONNECT with survivors; ACKNOWLEDGE that head trauma, strangulation, and mental health challenges are common; RESPOND by accommodating needs in services and providing targeted referrals; and EVALUATE effectiveness of response to meet survivors' stated concerns. We hypothesized that TIC would significantly improve among DVSO staff with the agency's use of CARE. Setting/Participants/Design: Pre- (n = 53) and 1-year post-CARE (n = 60) implementation online surveys were completed by staff at 5 DVSOs in Ohio from 2017 to 2019. Main Measures: Trauma-Informed Practice Scales (TIPS) were used to assess agency support and overall staff impression of implementing TIC; scales were modified to assess the use of TIC-practices related to head trauma, strangulation, mental health, suicide, and substance use. Attitudes Regarding Trauma-Informed Care (ARTIC-45) subscales assessed DVSO staff's endorsement of personal and organizational support in implementing TIC practices. Response options on the Survivor Defined Practice Scale (SDPS) were modified to gain staff insight into DVSO's ability to facilitate survivor empowerment. Differences in endorsement of TIC practices between pre- and post-CARE implementation were evaluated using regression models. Results: DVSO agency environment (P < .01) and overall staff impression (P < .001) regarding implementing TIC practices, and in respect to head trauma (P < .01), strangulation (P < .01), mental health (P < .01), suicide (P = .04), and substance use (P < .01), significantly improved with the agency's use of CARE. CARE increased DVSO staff's belief in personal and organizational support to implement TIC (P < .01 and P = .02, respectively) and in their agency's ability to foster survivor empowerment (P < .01). Conclusion: CARE improved TIC practices of DVSOs, overall, and to address brain injury and mental health. [ABSTRACT FROM AUTHOR]

Objective: Multicomponent interventions are recommendable to achieve the greatest mental health benefits, but are difficult to evaluate due to their complexity. Defining long-term outcomes, arising from a Theory of Change (ToC) and testing them in a pilot phase, is a useful approach to plan a comprehensive and meaningful evaluation later on. This article reports on the pilot results of an outcome evaluation of a complex mental health intervention and examines whether appropriate evaluation measures and indicators have been selected ahead of a clustered randomised control trial (cRCT). Methods: The MENTUPP pilot is an evidence-based intervention for Small and Medium Enterprises (SMEs) active in three work sectors and nine countries. Based on our ToC, we selected the MENTUPP long-term outcomes, which are reported in this article, are measured with seven validated scales assessing mental wellbeing, burnout, depression, anxiety, stigma towards depression and anxiety, absenteeism and presenteeism. The pilot MENTUPP intervention assessment took place at baseline and at 6 months follow-up. Results: In total, 25 SMEs were recruited in the MENTUPP pilot and 346 participants completed the validated scales at baseline and 96 at follow-up. Three long-term outcomes significantly improved at follow-up (p < 0.05): mental wellbeing, symptoms of anxiety, and personal stigmatising attitudes towards depression and anxiety. Conclusions: The results of this outcome evaluation suggest that MENTUPP has the potential to strengthen employees' wellbeing and decrease anxiety symptoms and stigmatising attitudes. Additionally, this study demonstrates the utility of conducting pilot workplace interventions to assess whether appropriate measures and indicators have been selected. Based on the results, the intervention and the evaluation strategy have been optimised. [ABSTRACT FROM AUTHOR]

Nature‐based school field trips gained policy support from China governments. However, in a highly exam‐oriented education system, schools might be unwilling to implement such activities which they believe are merely fun journeys and useless for knowledge acquisition.We designed an experiential learning field trip to a local mangrove reserve for third graders and assessed how it changed their mental models about the mangrove ecosystem through pre‐ and post‐drawings.We analysed and scored the paired drawings through a rubric developed based on grounded theory coding procedures, used paired t‐tests to examine the changes, and qualitatively interpreted three example pairs from three groups divided by pre‐drawing scores. We deemed that participants' mental models improved, reflecting better knowledge about the mangrove ecosystem.We suggest that the notion of mental models of the environment is relevant to the needs of both formal schools and environmental organizations.By demonstrating a relatively successful nature‐based school field trip case involving pupils from China, we hope that formal schools of this country in the exam‐oriented educational context could utilize it as a justification and vicarious experience to participate in or implement such trips. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

Background: Go Nisha Go™ (GNG), is a mobile game combining behavioural science, human-centric design, game-based learning, and interactive storytelling. The model uses a direct-to-consumer (DTC) approach to deliver information, products, services, interactive learning, and agency-building experiences directly to girls. The game's five episodes focus on issues of menstrual health management, fertility awareness, consent, contraception, and negotiation for delay of marriage and career. The game's effectiveness on indicators linked to these issues will be measured using an encouragement design in a randomized controlled trial (RCT). Methods: A two-arm RCT will be conducted in three cities in India: Patna, Jaipur, and Delhi-NCR. The first arm is the treatment (encouragement) arm (n = 975) where the participants will be encouraged to download and play the game, and the second arm (n = 975) where the participants will not receive any nudges/encouragement to play the game. They may or may not have access to the game. After the baseline recruitment, participants will be randomly assigned to these two arms across the three locations. Participants of the treatment/encouragement arm will receive continuous support as part of the encouragement design to adopt, install the game from the Google Play Store at no cost, and play all levels on their Android devices. The encouragement activity will continue for ten weeks, during which participants will receive creative messages via weekly phone calls and WhatsApp messages. We will conduct the follow-up survey with all the participants (n = 1950) from the baseline survey after ten weeks of exposure. We will conduct 60 in-depth qualitative interviews (20 at each location) with a sub-sample of the participants from the encouragement arm to augment the quantitative surveys. Discussion: Following pre-testing of survey tools for feasibility of methodologies, we will recruit participants, randomize, collect baseline data, execute the encouragement design, and conduct the follow-up survey with eligible adolescents as written in the study protocol. Our study will add insights for the implementation of an encouragement design in RCTs with adolescent girls in the spectrum of game-based learning on sexual and reproductive health in India. Our study will provide evidence to support the outcome evaluation of the digital mobile game app, GNG. To our knowledge this is the first ever outcome evaluation study for a game-based application, and this study is expected to facilitate scalability of a direct-to-consumer approach to improve adolescent sexual and reproductive health outcomes in India. Trial registration number: ctri.nic.in: CTRI/2023/03/050447. Plain language summary: Our paper describes implementation of a study protocol for an outcome evaluation of a mobile game app called Go Nisha Go™, produced by the Game of Choice, Not Chance™ project, funded by USAID. Consenting adolescent girls, aged 15–19, from three cities in India will be enrolled to participate in an encouragement design led RCT. Girls will be randomly assigned to either, a) a treatment (encouragement) arm where they will be nudged to play the game for ten weeks, or b) a control arm where participants will not be provided any encouragement to download or play the game. The study will be evaluated using surveys at baseline and follow-up. The findings from this study will support the measurement of effectiveness of the digital intervention and facilitate scalability of a direct-to-consumer approach, using a game-based application to improve adolescent sexual and reproductive health outcomes in India. [ABSTRACT FROM AUTHOR]

In complex and diverse social circumstances, decision making is affected by social feedback. Although previous studies have examined the electrophysiological correlates of social feedback with a binary valence, those related to non-binary feedback, or the magnitude of social feedback, remain unclear. This study investigated the electrophysiological correlates of non-binary social feedback and subsequent action selection processing. Participants were asked to complete a Gabor patch direction judgment task in which they were required to make judgments before and after receiving social feedback. They were informed that the feedback stimuli represented the degree to which other participants made the same choice. The results revealed that feedback that was highly concordant with the participant's judgments elicited greater P300 activity, which was associated with the fulfillment of expectations regarding social reward. Moreover, moderately concordant feedback induced stronger theta band power, which may indicate monitoring of subjective conflict. Temporal changes in theta power during feedback phase may also relate to adjustments in prediction error. Additionally, when an initial judgment was maintained following social feedback, we observed a stronger increase in beta power, indicating an association with post-social-feedback action processing. • This study aims to investigate electrophysiological evidence for processing non-binary magnitudes of social agreement. • We employed a series of pseudo-gradually changing natural numbers to represent non-binary social feedback. • Using CBPT, we observed electrophysiological correlates linked to non-binary social feedback and following action selection. [ABSTRACT FROM AUTHOR]

BackgroundAddressing the health challenges of lower socioeconomic groups in Ethiopia is still a huge problem. In that regard, the government piloted the community-based health insurance (CBHI) in 2011 in a few districts and subsequently scaled up. However, the effectiveness of the program on the utilization of health services and its impact was not well explored. Thus, we aimed to evaluate the effectiveness of CBHI toward health services’ utilization and its impact in northwest Ethiopia.MethodsA quasi-experimental matched comparison group evaluation design with sequential explanatory mixed methods was employed. To evaluate the CBHI program, the effectiveness and impact dimensions from the Organization for Economic Cooperation and Development framework were used. A multistage sampling technique was used to select a total of 332 households enrolled in the CBHI program; 341 comparison households who did not enroll in the program were also randomly selected. A structured interviewer-administrated questionnaire was used to evaluate the effectiveness and impact of CBHI on health service utilization. The Propensity score matching model was employed for the estimation of the effect of the CBHI program on health service utilization. Challenges for program achievement toward health service utilization were explained through qualitative data and these were then analyzed thematically.ResultsThe evaluation showed 1.3 visits per capita per year of health service utilization among CBHI members. Households enrolled in CBHI increased health service utilization by 6.9 percentage points (ATT = 0.069; 95% CI: 0.034, 0.114). There was an improvement in health service utilization after the introduction of CBHI, however, there are challenges: (i) shortage of human resources, (ii) out-of-stock of drugs and medical supplies, and (iii) long waiting times for service and reimbursement claims. These issues limit the success of the program toward health service utilization.ConclusionThe CBHI program contributed to health service utilization improvement among CBHI members. However, the utilization rate of health services among CBHI members is still less than the target stated for the program and also the WHO recommendation. Therefore, the findings of this evaluation can be used by program implementers, policy makers, and other stakeholders to overcome the identified challenges and to increase the success of the program.

The Making Pre-K Count and High 5s studies represent a recent application of a phased two-stage, multi-level design, which was used to examine the effects of two aligned math programs implemented in early childhood settings. The purpose of this paper is to describe the challenges encountered in implementing this two-stage design and to describe approaches to resolving them. We then present a set of sensitivity analyses the study team used to examine the robustness of the findings. During the pre-K year, pre-K centers were randomly assigned either to receive an evidence-based early math curriculum and associated professional development (Making Pre-K Count) or to a pre-K-as-usual control condition. In the kindergarten year, students who had been in Making Pre-K Count program classrooms in pre-K were then individually randomly assigned within schools to small-group supplemental math clubs that were designed to sustain the gains from the pre-K program, or to a business-as-usual kindergarten experience. Making Pre-K Count took place in 69 pre-K sites, comprising 173 classrooms across New York City. High 5s took place in the 24 sites that were part of the public school treatment arm of the Making Pre-K Count study and included 613 students. The study focuses on the effect of the Making Pre-K Count and High 5s programs on children's math skills at the end of kindergarten as measured by two instruments, the Research-Based Early Math Assessment-Kindergarten (REMA-K) and the Woodcock–Johnson Applied Problems test. The multi-armed design, while logistically and analytically challenging, balanced multiple considerations of power, the number of research questions that could be answered, and efficiency of resources. Robustness checks suggest that the design created groups that were both meaningfully and statistically equivalent. Decisions to use a phased multi-armed design should consider both its strengths and weaknesses. While the design allows for a more flexible, expansive research study, it also introduces complexities that need to be addressed both logistically and analytically. [ABSTRACT FROM AUTHOR]

The process of outcome evaluation effectively navigates subsequent choices in humans. However, it is largely unclear how people evaluate decision outcomes in a sequential scenario, as well as the neural mechanisms underlying this process. To address this research gap, the study employed a sequential decision task in which participants were required to make a series of choices in each trial, with the option to terminate their choices. Based on participants' decisions, two outcome patterns were classified: the "reached" condition and the "unreached" condition, and the event-related potentials (ERPs) were recorded. Further, in the unreached condition, we investigated how the distance (i.e., the position interval between the actual outcome and potential outcome) modulated outcome evaluation. Behavioral data showed a higher emotion rating when people got a reward rather than a loss (i.e., the reached condition), while the opposite was true in the unreached condition. ERP results showed a larger feedback-related negativity (FRN), a smaller P3, and a larger late positive potential (LPP) when people got a loss compared to a reward. Importantly, a hierarchical processing pattern was found in the unreached condition: people processed separately the potential outcome and the distance at the early stage, manifested in the FRN amplitude; subsequently, the brain focused on the distance—a lower distance elicited an enhanced P3 amplitude. Finally, the potential outcome and distance were processed interactively in the LPP amplitude. Overall, these findings shed light on the neural underpinnings of outcome evaluation in sequential decision-making. • This study investigated the outcome evaluation of early termination and completed decisions in sequential decision-making. • We observed a classic ERP pattern of outcome evaluation in sequential decision-making when people reached the final potential outcome. • In premature sequential decision-making, our ERP findings reveal a hierarchical processing pattern. • Our findings emphasize the impact of the distance factor when people prematurely terminate their decisions. [ABSTRACT FROM AUTHOR]

Individuals often measure their performance through social comparison. With the increase in the deviation degree between the self and others, the outcome evaluation of individuals' abilities in the social comparison context is still unknown. In the current study, we used a two self-outcomes × three others' outcomes within-participant design to investigate the effect of the deviation degree of the self versus others in the social comparison context. Event-related potentials (ERPs) were measured while participants performed a three-person dot estimation task with two other people. When participants received positive results, the amplitudes of feedback-related negativity (FRN) and P300 showed a significant gradient change in the degree of deviation between the self and others (even win vs. better win vs. best win conditions). However, we did not find a similar progressive effect when participants received negative results (even loss vs. worse loss vs. worst loss conditions). These findings suggest that the deviation degree affects the primary and later processing stages of social comparison outcomes only when individuals received positive outcomes, which may reflect how people develop an empathic response to others. In contrast, people tended to avoid deeper social comparison that threatened their self-esteem when they received negative outcomes. [ABSTRACT FROM AUTHOR]

To explore and compare the perspectives of patients and their parents (PPs) with a brachial plexus birth injury (BPBI) with those of health care professionals (HCPs). We conducted a study using a questionnaire among PPs and HCPs. Importance of different outcome categories was scored on a Likert scale. Items were linked to corresponding categories of the International Classification of Functioning, Disability and Health. Means were compared using analysis of variance (ANOVA). Data were collected from 184 patients and 65 HCPs. We found a difference in 7/14 outcome categories between joint PP groups and HCPs. Parents scored outcome evaluation categories as more important than patients, categories filled out together by patient and parent scored in between (p < 0.05). The majority of PPs and HCPs rated outcome assessment as important in more domains than "Body functions" and "Body structures". The biggest difference was found in the importance of evaluation of pain. Outcome assessment in the domains "Activities and participation" and "Environmental factors" was rated as important by both PPs and HCPs. Evaluation of pain was more often scored as important by PPs. Different domains seem to be underestimated by HCPs and need more attention during consultation. The importance of outcome evaluation concerning "Pain", "Interaction with peers", and "Interaction with medical and paramedical specialists" should be taken into account in the rehabilitation for this specific group of patients and their parents (PPs). Comparison of perspectives on functioning between brachial plexus birth injury (BPBI) PPs and health care professionals. Outcome assessment in domains "Activities and participation" and "Environmental factors" is important. Health care professionals undervalue the importance of pain evaluation in BPBI as compared with PPs. [ABSTRACT FROM AUTHOR]

Background: The documentation of goals and outcomes of nutrition care in Electronic Health Records is insufficient making further exploration of this of particular interest. Identifying common features in documentation practice among Scandinavian dietitians might provide information that can support improvement in this area. Aims: To explore the associations between clinical dietitians' self‐reported documentation of patients' goals and outcomes and demographic factors, self‐reported implementation of the systematic framework the Nutrition Care Process 4th step (NCP) and its associated terminology, and factors associated with the workplace. Methods: Data from a cross‐sectional study based on a previously tested web‐based survey (INIS) disseminated in 2017 to dietitians in Scandinavia (n = 494) was used. Respondents were recruited through e‐mail lists, e‐newsletters and social media groups for dietitians. Associations between countries regarding the reported documentation of goals and outcomes, implementation levels of the NCP 4th step, demographic information and factors associated with the workplace were measured through Chi‐square test. Associations between dependent‐ and independent variables were measured through logistic regression analysis. Results: Clinically practicing dietitians (n = 347) working in Scandinavia, Sweden (n = 249), Norway (n = 60), Denmark (n = 38), who had completed dietetic education participated. The reported documentation of goals and outcomes from nutrition intervention was highly associated with the reported implementation of NCP 4th step terminology (OR = 5.26; p = 0.009, OR = 3.56; p = 0.003), support from the workplace (OR = 4.0, p < 0.001, OR = 8.89, p < 0.001) and area of practice (OR = 2.02, p = 0.017). Years since completed dietetic training and educational level did not have any significant associations with documentation practice regarding goals and outcomes. Conclusion: Findings highlight strong associations between the implementation of the NCP 4th step terminology and the documentation of goals and outcomes. Strategies to support dietitians in using standardized terminology and the development of tools for comprehensive documentation of evaluation of goals and outcome are required. [ABSTRACT FROM AUTHOR]

Transgender women (TGW) in India, especially those who engage in sex work, are at high risk for HIV. Guided by the information-motivation-behavioral skills model and qualitative formative research findings, Sakhi (girlfriend), a 3-week smartphone-based pilot intervention consisting of short videos (one/week) and text messages (two/week), was implemented using a one-group pre- and post-test design to test its efficacy in promoting condom use and HIV testing among TGW (n = 50) who engage in sex work in Chennai. Changes in outcomes were assessed by conducting multivariable analyses using generalized estimating equations. Participants’ mean age was 26 years, and the mean monthly income was INR 21700 (USD 292). About one-third completed college, and 96% were HIV-negative. Significant changes in the desired direction were observed in the primary outcomes: condom use – decrease in the engagement of condomless anal sex with male partners (12% to 2%, p < 0.05) and HIV testing – increase in intentions to undergo HIV testing every 6 months (34% to 86%, p < 0.001); and in some of the secondary outcomes: decrease in alcohol use before sex, increase in intentions to use condoms consistently and increase in the well-being score. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the Sakhi intervention and warrants a larger randomized trial among diverse subgroups in diverse settings.

Background: Patient satisfaction following rhinoplasty is a growing area of research; and researchers have developed various validated tools to evaluate postoperative outcomes. It remains a key measure of surgical success with functional and aesthetic outcomes. The current study aims to assess patient satisfaction with cosmetic and functional surgical outcomes following rhinoplasty in the Saudi population via the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). Methods: This study was conducted in a cross-sectional design with an electronic survey among adult patients 6 to 12 months after rhinoplasty in a private center in Riyadh, Saudi Arabia. The SCHNOS assessment tool was used in this study, a simple, valid, and reliable method for evaluating the success of cosmetic rhinoplasty. Results: A total of 205 patients participated in the current study. Results showed significant differences in the SCHNOS-O subscale in those aged > 35 years (median = 10.0, IQR = 0.0–27.5) being significantly lower than those of the other age categories. Furthermore, divorced participants scored higher than those married (median = 47.5, IQR = 45.0–60.0). Finally, participants with the highest household income scored lower nasal obstruction scores (median = 30.0, IQR = 10.0–40.0) than those in the lowest income category. Conclusions: Saudi patients above the age of 35 reported higher satisfaction levels with the surgical outcome following rhinoplasty. Divorced patients were more likely to be dissatisfied with the surgical outcome. Compared to patients in other parts of the Kingdom, patients in the Central region had fewer nasal obstruction symptoms and better cosmetic results. Level of evidence: Not ratable [ABSTRACT FROM AUTHOR]

The framing effect refers to the phenomenon that different descriptions of the same option lead to a shift in the choice of the decision maker. Several studies have found that emotional contexts irrelevant to a decision in progress still influence the framing effect on decision making. However, little is known about the potential role of emotional contexts in the framing effect on outcome evaluation under uncertainty and the related neural mechanisms. The present study measured event‐related potentials (ERPs) to capture the time series of brain activities during the processing of gain‐ and loss‐framed choices and outcomes primed with neutral and negative emotional contexts. The results revealed that in the neutral emotional context, the P300 amplitudes following both positive and negative feedback were greater in the gain‐framed condition than those in the loss‐framed condition, demonstrating a framing effect, whereas in the negative emotional context, this effect was unstable and observed only following negative feedback. In contrast, regardless of whether the feedback was positive or negative, the framing effect on the feedback‐related negativity (FRN) amplitudes was insensitive to neutral and negative emotional contexts. Furthermore, the time‐frequency analysis showed that the framing effect on the theta power related to the FRN was also insensitive to neutral and negative emotional contexts. Our findings suggest that brain responses to framing effects on outcome evaluation in a later cognitive appraisal stage of decision making under uncertainty may depend on the emotional context, as the effects were observed only following negative feedback in the negative emotional context. The framing effect refers to the phenomenon that different descriptions of the same option lead to a shift in the choice of the decision‐maker. This study first uses ERPs to explore the neural mechanism underlying the relationship between emotional contexts and framing effects on outcome evaluation in decision‐making under uncertainty. Findings indicate the negative emotion stimulus disrupts framing effects on the outcome evaluation only in the later cognitive appraisal stage in decision‐making under uncertainty. [ABSTRACT FROM AUTHOR]

The clinical questions of acupuncture-moxibustion (Acup-Mox) guidelines are complicated, including not only the curative effect of Acup-Mox intervention measures, but also the operational elements of Acup-Mox. This paper aimed to put forward the idea and process of collecting clinical questions in developing international acupuncture clinical practice guidelines. The experience was collected and the idea of collecting clinical questions of Acup-Mox was formed through expert consultation and discussion in combination with expert opinions. Based on the characteristics of Acup-Mox discipline. This paper put forward the thinking of collecting elements of clinical questions following the intervention-population-outcome-control (I-P-O-C) inquiry process, according to the discipline of Acup-Mox. It was emphasized that in the process of collecting clinical questions, "treatable population" and "alleviable outcome indicators" for a specific Acup-Mox intervention with certain therapeutic effect should be focused on, so as to highlight the pertinence of clinical questions of Acup-Mox guidelines in terms of population and outcome elements. [ABSTRACT FROM AUTHOR]