Changes In Ratings Research Articles

Clinical learning experiences of healthcare professional students in a student-led clinical learning environment (SLCLE) – A mixed methods evaluation

AimTo evaluate healthcare professional (HCP) students clinical learning experiences’ whilst undertaking placements in a student-led clinical learning environment (SLCLE) and any changes in self-reported ratings of confidence. BackgroundThe English NHS Long Term Workforce Plan (2023) highlights the need to expand domestic education of HCPs to meet workforce shortages. The demand for quality clinical placements to support the preparation of HCP students remains a challenge globally. A creative solution has been the development of student-led learning clinical environments in healthcare settings. SLCLEs provide high-quality learning experience, increase clinical placement capacity whilst maintaining patient care standards. A multisite NHS Trust adopted this model as evidence suggests HCP students will be better prepared on qualification to adopt registered practitioner professional responsibilities. This model has been integrated across three hospital sites within a large teaching hospital, providing care for a diverse population and designed to accommodate students from a range of HCP disciplines and higher educational institutions. DesignA mixed methods convergent design. MethodsAn online survey was administered to SLCLE allocated nursing and allied health profession (AHP) undergraduate and graduate-entry first, second and third-year students (n=132). Face to face focus groups/individual interviews were undertaken with a purposive sample of student participants (n=80) to evaluate their experiences of clinical learning in SLCLEs. Survey data were analysed using descriptive statistics and paired t-tests, interviews using framework method. ResultsUndergraduate and graduate-entry students from four UK universities completed the survey (n=132), 103 students (78 %) responded. Most were year 2 students (n=43/42 %), pursuing nursing programmes (n=82/80 %). Most considered the SLCLE met their expectations (n=76/74 %), reported increased confidence post-placement (n=84/82 %), felt supported by staff (n=80/78 %), peers (n=93/90 %) and clinical educators (n=93/90 %). Self-reported confidence scores post-SLCLE were significantly higher than pre-SLCLE. On-line pre-placement information was infrequently accessed yet identified as an omission. Four themes were identified: (i) preconceptions and initial anxiety; (ii) empowerment, growth and a unique learning experience; (iii) collaborative inter-professional learning and support; and (iv) insights and anticipations. ConclusionsThe SLCLE allocation enhanced students’ confidence and knowledge. Support from clinical educators, ward staff and doctors was perceived as invaluable for creating a positive learning culture. Peer support and opportunities to lead care delivery contributed to students’ professional development. The format and method for providing pre-placement information needs review as do strategies for avoiding delays in completing assessment documentation. Overall, the SLCLE experience offers much potential as a nurturing and effective learning environment for HCP students.

Adaptive multidimensional trust-based recommendation model for peer to peer applications

Abstract In today’s world, the widespread utilization of services such as Nearby Share, Near Field Communication (NFC), and Wi-Fi Direct for deploying various applications has significantly bolstered the demand for reliable and secure distributed ad-hoc peer-to-peer networks. Yet, ensuring the trustworthiness of participating nodes remains a significant challenge. Trust among nodes plays a pivotal role in collaborative network applications, especially in environments like Mobile Ad-hoc Networks and VANET (Vehicular Ad-hoc Networks). Evaluating the trustworthiness of nodes is essential for promptly identifying misleading entities, thereby preemptively preventing their involvement in ongoing transactions. Attributes or characteristics exhibited by nodes, such as honesty, selfishness, or malicious behavior, serve as key factors in trust computation. The effectiveness of trust evaluation directly influences the encouragement of honest nodes and the deterrence of malicious ones, thereby nurturing a healthy and competitive network ecosystem. Recognizing the dynamic nature of network environments, trust computation methods must be adaptable and diverse. The adaptive multidimensional trust (AMT) model introduced in this article goes beyond simple reputation assessment. It offers three distinct methods such as Direct Trust ( Direct Trust ) \left({{\rm{Direct}}}_{{\rm{Trust}}}) , multiple security parameters, identification of qualified recommenders, which got selected dynamically as per change in trust ratings of peers. AMT advocates for an incentive-driven approach to identify legitimate peers, monitoring gradual increases in their performance ratings, whereas, spikes in performance alert to potential colluding peers or nodes displaying erratic behavior. This article evaluates the effectiveness of the AMT through a case study focused on an E-commerce application. It scrutinizes the model’s performance across different percentages of malicious nodes within the network, providing a thorough analysis and discussion of the results based on the trust value of malicious and benign peers and efficiency by selecting genuine service for transaction.

Secondary Analysis of Sweetness Liking from Pilot Study Replacing Sugar Sweetened Soda with Flavored, Unsweetened Sparkling Water

Objective This study aimed to evaluate changes in sensory ratings (liking, sweetness intensity, “just about right” (JAR) level of sweetness) of 0–10.7% w/w sugar in soda after 1 and 2 wk of replacing sugar-sweetened soda consumption with unsweetened, flavored, sparkling water. Methods Consumers of sugar-sweetened sodas (17 men and women, average age 28 years) replaced their sodas with unsweetened, flavored sparkling waters for 2 wk. Changes in sensory ratings were evaluated for sodas ranging from 0–10.7% w/w added sugar. In a secondary analysis, cluster analysis identified “Sweet Likers” (liking increased with sugar concentration) and “Sweet Moderates” (liking peaked in the middle of the concentration range) in the baseline ratings, and models for changes in sensory ratings were reevaluated by sweet-liking group. Results The primary analyses showed no significant effects of the intervention on sweetness intensity or liking ratings. However, the secondary analysis showed that Sweet Likers reduced liking ratings for all sodas, but particularly for the highest concentration (p = 0.0021) after the intervention. Sweet Moderates, however, increased liking ratings after the intervention, driven by an increase in liking for the lower concentrations of sugar (p = 0.0058). Additionally, Sweet Moderates increased their overall ratings for sweetness intensity in sodas (p = 0.00074). Conclusion These results suggest that the intervention may have been more successful in shifting sensory perception and acceptance of less-sweet sodas for Sweet Moderates than for Sweet Likers. These results should be verified in a larger sample that intentionally recruits by sweet liker status, to see if initial liking for sweetness may be a critical factor in interventions aiming to improve liking of less sweet beverages.

Underestimating or Overestimating Improvement in Pain on a Smartphone Pain App: Role of Disability, Negative Affect, and Pain App Engagement

Clinicians often ask people with chronic pain about their perceived benefit from interventions designed to improve their pain. The aim of this study is to identify factors that contribute to underestimating or overestimating perceived changes in daily pain intensity over a month of daily assessments. We examined data from individuals with chronic pain who provided at least 28 daily assessments using a pain app as secondary analyses. Participants provided baseline demographic information and completed questionnaires assessing pain, activity interference, mood, pain disability, and catastrophizing. Using the pain app, they entered daily ratings of pain (0 = none, 10 = worst pain possible) and impressions of perceived day-to-day change (0 = better, 5 = same, and 10 = worse). Two hundred fifty-two (N = 252) subjects with chronic pain met the inclusion criteria of completing at least 28 daily assessments. Those who underestimated their improvement tended to have higher pain intensity at baseline (P < .001), reported greater activity interference and disability (P < .001), and were prone to greater catastrophizing and anxiety and depression (P < .01). People who were more accurate in assessing their improvement engaged less with the app with fewer 2-way messages compared with those who either underestimated or overestimated their improvement and who had more 2-way messaging (P < .05). This longitudinal study suggests that those who report greater levels of catastrophizing and anxiety and depression are more likely to underestimate any improvements in their pain over time but seem to engage more with a pain app. Future research will help in our understanding of what magnitude of perceived change in pain ratings is clinically meaningful. PerspectiveThose who report greater levels of pain, disability, anxiety, depression, and catastrophizing are most prone to underestimate improvements of their pain over time.

Providing microbiology education to rural nurses: A case study

Objective: This case study assesses a microbiology and infection control education workshop delivered to rural nurses. The study assesses workshop value through changes in respondents’ self-assessed confidence using measures of microbiology knowledge, teaching, and best practice. Respondents also identified the aspects of the education perceived as most useful to their practice and barriers to implementing microbiology education in practice. Study design and methods: Pre- and post-workshop surveys were administered to the participants. The surveys used a 7-point ordinal scale to measure respondents’ confidence in explaining key concepts and their perception of the influence of such education opportunities on positive patient outcomes. Change in ratings was analysed using Wilcoxon signed-ranks tests; whilst the open-ended survey responses were analysed using a manifest content analysis. Results: All thirteen nurses who participated in the education workshop responded to both surveys. The results demonstrated a significant increase post-workshop in confidence measures and belief that microbiology and infection control education influence positive patient outcomes. The perceived barriers to implementation of microbiology education in practice included poor organisational culture, lack of access to training, and lack of resources. Discussion: This case study describes a method of providing microbiology education to rural nurses and highlights the benefit of this access, particularly in the mode of face-to-face learning. A suggestion for future iterations of the program is to include content that would support nurses’ implementation of theory to practice. Conclusion: A face-to-face microbiology and infection prevention workshop, which enables participants to discuss content and undertake a tour of the pathology laboratory for practical insights, enhances nurses’ self-rated confidence on this topic. Implications for research, policy, and practice: This study demonstrates the significance of microbiology education for rural nurses and describes how this can be undertaken in practice, with insight provided on the most valued aspects. It also shows the importance of supporting in-person education. Future research could address the medium to long terms effects of this education for nurses and their practice. What is already known about the topic? Access to continuing professional development is difficult for rural nurses, particularly in comparison to their urban counterparts. Nurses hold a vital role in infection prevention and infection control. Increased knowledge leads to positive patient care and positive patient outcomes. What this paper adds It demonstrates that providing microbiology education to rural nurses increases their confidence in the topical area. It provides an example program for delivering microbiology education to rural nurses. It highlights the benefits of the face-to-face aspect of education and practical component of the laboratory tour.

Evaluating possible ‘next day’ impairment in insomnia patients administered an oral medicinal cannabis product by night: a pilot randomized controlled trial

Cannabis and its major constituents, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are being widely used to treat sleep disturbances. However, THC can cause acute cognitive and psychomotor impairment and there are concerns that driving and workplace safety might be compromised the day after evening use. Here, we examined possible ‘next day’ impairment following evening administration of a typical medicinal cannabis oil in adults with insomnia disorder, compared to matched placebo. This paper describes the secondary outcomes of a larger study investigating the effects of THC/CBD on insomnia disorder. Twenty adults [16 female; mean (SD) age, 46.1 (8.6) y] with physician-diagnosed insomnia who infrequently use cannabis completed two 24 h in-laboratory visits involving acute oral administration of combined 10 mg THC and 200 mg CBD (‘THC/CBD’) or placebo in a randomised, double-blind, crossover trial design. Outcome measures included ‘next day’ (≥9 h post-treatment) performance on cognitive and psychomotor function tasks, simulated driving performance, subjective drug effects, and mood. We found no differences in ‘next day’ performance on 27 out of 28 tests of cognitive and psychomotor function and simulated driving performance relative to placebo. THC/CBD produced a small decrease (-1.4%, p=.016, d=-0.6) in accuracy on the Stroop-Colour Task (easy/congruent) but not the Stroop-Word Task (hard/incongruent). THC/CBD also produced a small increase (+8.6, p=.042, d=0.3) in self-ratings of Sedated at 10 h post-treatment, but with no accompanying changes in subjective ratings of Alert or Sleepy (p’s>0.05). In conclusion, we found a lack of notable ‘next day’ impairment to cognitive and psychomotor function and simulated driving performance following evening use of 10 mg oral THC, in combination with 200 mg CBD, in an insomnia population who infrequently use cannabis.

Assessing readiness: the impact of an experiential learning entrustable professional activity-based residency preparatory course

ABSTRACT As medical schools move to integrate the Core Entrustable Professional Activities for Entering Residency (EPAs) into curricula and address the transition from student to resident, residency preparatory courses have become more prevalent. The authors developed an experiential learning EPA-based capstone course for assessment to determine impact on learner self-assessed ratings of readiness for residency and acquisition of medical knowledge. All fourth-year students from the classes of 2018–2020 completed a required course in the spring for assessment of multiple EPAs, including managing core complaints, performing basic procedures, obtaining informed consent, and providing patient handoffs. Learners selected between three specialty-based parallel tracks – adult medicine, surgery, or pediatrics. Students completed a retrospective pre-post questionnaire to provide self-assessed ratings of residency preparedness and comfort in performing EPAs. Finally, the authors studied the impact of the course on knowledge acquisition by comparing student performance in the adult medicine track on multiple choice pre- and post-tests. Four hundred and eighty-one students were eligible for the study and 452 (94%) completed the questionnaire. For all three tracks, there was a statistically significant change in learner self-assessed ratings of preparedness for residency from pre- to post-course (moderately or very prepared: adult medicine 61.4% to 88.6% [p-value < 0.001]; surgery 56.8% to 81.1% [p-value < 0.001]; pediatrics 32.6% to 83.7% [p-value 0.02]). A similar change was noted in all tracks in learner self-assessed ratings of comfort from pre- to post-course for all studied EPAs. Of the 203 students who participated in the adult medicine track from 2019–2020, 200 (99%) completed both the pre- and post-test knowledge assessments. The mean performance improved from 65.0% to 77.5% (p-value < 0.001). An experiential capstone course for the assessment of EPAs can be effective to improve learner self-assessed ratings of readiness for residency training and acquisition of medical knowledge.

Calculation of Overall Hospital Quality Star Ratings With and Without Inclusion of the Peer Grouping Step.

The Centers for Medicare & Medicaid Services (CMS) Overall Star Rating is widely used by patients and consumers, and there is continued stakeholder curiosity surrounding the inclusion of a peer grouping step, implemented to the 2021 Overall Star Rating methods. To calculate hospital star rating scores with and without the peer grouping step, with the former approach stratifying hospitals into 3-, 4-, and 5-measure group peer groups based on the number of measure groups with at least 3 reported measures. This cross-sectional study used Care Compare website data from January 2023 for 3076 hospitals that received a star rating in 2023. Data were analyzed from April 2023 to December 2023. Peer grouping vs no peer grouping. The primary outcome was the distribution of star ratings, with 1 star being the lowest-performing hospitals and 5 stars, the highest. Analyses additionally identified the number of hospitals with a higher, lower, or identical star rating with the use of the peer grouping step compared with its nonuse, stratified by certain hospital characteristics. Among 3076 hospitals that received a star rating in 2023, most were nonspecialty (1994 hospitals [64.8%]), nonteaching (1807 hospitals [58.7%]), non-safety net (2326 hospitals [75.6%]), non-critical access (2826 hospitals [91.9%]) hospitals with fewer than 200 beds (1822 hospitals [59.2%]) and located in an urban geographic designations (1935 hospitals [62.9%]). The presence of the peer grouping step resulted in 585 hospitals (19.0%) being assigned a different star rating than if the peer grouping step was absent, including considerably more hospitals receiving a higher star rating (517 hospitals) rather than a lower (68 hospitals) star rating. Hospital characteristics associated with a higher star rating included urbanicity (351 hospitals [67.9%]), non-safety net status (414 hospitals [80.1%]), and fewer than 200 beds (287 hospitals [55.6%]). Collectively, the presence of the peer grouping step supports a like-to-like comparison among hospitals and supports the ability of patients to assess overall hospital quality. In this cross-sectional study, inclusion of the peer grouping in the CMS star rating method resulted in modest changes in hospital star ratings compared with application of the method without peer grouping. Given improvement in face validity and the close association between the current peer grouping approach and stakeholder needs for peer-comparison, the current CMS Overall Star Rating method allows for durable comparisons in hospital performance.

Skill-Based Matchmaking for Competitive Two-Player Games

Skill-based matchmaking is a crucial component of competitive multiplayer games and it is directly tied to how the players would enjoy the game. We present a simple matchmaking algorithm that aims to achieve a target win rate for all players, making long win/loss streaks less probable. It is based on the estimated skill levels of players. Therefore, we also present a rating estimation for players that does not require any game-specific information and purely relies on game outcomes. Our evaluation shows that our methods are effective in estimating a player's rating, responding to changes in rating, and achieving a desirable win rate that avoids long win/loss streaks in competitive two-player games.

Public Reporting of Heart Transplant Center Performance: Promoting Clarity or Causing Confusion?

BackgroundTransplant center report cards are publicly available and used by regulators, insurance payers, and importantly patients and families. ObjectivesIn this study, the authors sought to evaluate the variability in reported public performance ratings of pediatric and adult heart transplant centers. MethodsProgram-specific reports from the Scientific Registry of Transplant Recipients from 2017-2021 were used to evaluate stability, volatility, and reliability of 3 publicly reported ratings: waitlist survival (WS), getting to a faster transplant (FT), and post-transplantation graft failure (GF). ResultsThere were 112 adult and 55 pediatric centers. Over the study period, nearly all centers (98%) had at least 1 change in rating in at least 1 of the tiers. The average time to the first rating change of any magnitude was 12-18 months for all tiers and centers. For adult centers, the most volatile rating was WS (SD: 0.77), followed by GF (SD: 0.76) and then FT (SD: 0.57). For pediatric centers, the most volatile rating was WS (SD: 0.79), followed by both GF (SD: 0.66) and FT (SD: 0.68), which were equally volatile. All tiers except adult FT had an estimated Fleiss’s kappa <0.20, indicating poor agreement/consistency across the study period. In addition, the intraclass correlation coefficient for all tiers was <0.50, indicating poor reliability. ConclusionsThe current 5-tier reporting of transplant center performance is highly volatile and has poor reliability and consistency. Given the unintended and significant negative consequences these reports can have, critical revision of these ratings is warranted.

Effects of credit rating changes on corporate capital structure in South Africa

Orientation: The changes in credit ratings for corporates have a great impact on corporate funding decisions, costs and capital structures.Research purpose: The study aimed to identify the relationship between credit ratings and capital structures in emerging economies such as South Africa.Motivation for study: Investors, financial managers, regulatory authorities and financial analysts focus on the credit quality of companies as measured by credit ratings in making financing and investing choices. The credit rating is a significant communication tool, and businesses consider it crucial when deciding on capital structure. An ideal capital structure of a company is one that reduces its relative cost of capital by striking a balance between the capital structure proportions to enhance value.Research approach, design and method: A systematic and quantitative approach using semi-annual data from 2011 to 2020 sourced from EquityRT and the JSE.Main findings: Credit ratings have a positive and material impact on the capital structure decisions of South Africa’s top 40 companies. Thus, a higher debt-to-asset ratio is encouraged when the credit score improves, and a downgrade is more likely to be followed by a capital reduction behaviour.Practical/managerial implications: Investors, managers and regulators can use the findings of this study for financial decision-making purposes, anticipating changes in future corporate capital structures and monitoring funding opportunities as well as balancing debt to equity in the capital construction of an organisation.Contribution/value-add: The evidence generated by the study presented that credit rating changes influence capital structure.

Perceived helpfulness of various sources of help for 5 mental illnesses

Introduction1 in 8 people worldwide live with a mental illness (MI). This is expected to rise with increasing societal pressures. Despite the availability of evidence-based treatments, MIs remain undertreated. In Singapore, efforts such as the ‘It’s OK to Reach Out’ campaign was launched to encourage help-seeking. Help-seeking behavior is complex; determined by an interplay of factors including perceptions towards help sources. As seeking ineffective sources contributes to unmet needs, understanding beliefs towards various sources of help is vital.ObjectivesThe study aims to examine perceived helpfulness of various sources of help for 5 mental illnesses and changes in perceptions towards them over time.MethodsThe Mind Matters 2023 (M2) is an ongoing nationwide survey of mental health literacy among Singapore residents aged 18-65 years. Analysis is based on a preliminary sample (N=2500). Interviewers read a vignette depicting 1 of 5 randomly assigned MIs- depression (DP), schizophrenia (SZ), obsessive-compulsive disorder (OCD), alcohol abuse (AA) or dementia (DT). Respondents were asked to rate whether 10 Professional/Informal sources and 12 Actions were ‘helpful, ‘harmful’ or ‘neither’ for the person in the vignette. Frequencies of helpful ratings were compared with the first Mind Matters study (M1) conducted in 2015 (N=3006).ResultsIn M2, seeing a psychiatrist, psychologist and counsellor were rated helpful most frequently (79%-96%) while seeking traditional medicine and religious advisors were rated the least (12%-60%) across the vignettes, except for DT where doctor and close family (81%-85%) replaced psychologist and counsellor (66%-70%). Compared to M1, phone counselling saw an increase in helpfulness rating across all vignettes (p&lt;.05) except AA. For Actions, reading about how others dealt with similar problems was rated helpful most frequently (76%-89%) while dealing with problems on one’s own was rated the least across all vignettes (3%-11%) in M2. Compared to M1, being more social saw an increase in helpfulness (p&lt;.001) rating for DP but a decrease for AA (p&lt;.001). Admission to an institution was associated with a decrease in helpfulness rating for DP (p=.006) and OCD (p=.04) but increase for AA (p=.03).ConclusionsThe findings suggest recognition that MIs would be helped by professionals and self-reliance is ineffective to address these problems. Increased perceived helpfulness of telephone counselling was promising as studies have shown high client satisfaction coupled with its potential in reducing some barriers to care. Differences in directional changes in helpfulness rating for institutional care and socialising for DP and AA may represent understanding of the importance of behavioral activation and stimulus control for these MIs respectively. Literacy regarding help-seeking sources has improved in Singapore over the last 8 years which may translate into increments in seeking appropriate care.Disclosure of InterestNone Declared

Comparison of the What Works Clearinghouse Standards for Single-Case Research: Applications for Systematic Reviews

Systematic reviews of single-case experimental research (SCER) in special education often use the What Works Clearinghouse (WWC) Standards to assess the methodological rigor of studies within a given literature base. While significant changes were made between the two most recent versions of the WWC standards, no research to date has evaluated the extent to which these standards would result in different evaluation outcomes. To examine potential differences, we applied version 4.1 and 5.0 of the standards to a sample database of SCER addressing the challenging behavior of students with autism in general education settings. Systematic search, screening, and review procedures resulted in a total of 20 articles included for this review. Findings indicated a 27% change in overall ratings across the studies, with version 5.0 leading to lower ratings than version 4.1, due to factors such as a lack of assessment of procedural fidelity, therapeutic baseline trends, and insufficient data points in the first baseline phase. We discuss implications for research based on our findings and recommend future directions for SCER in the field of special education.

Diachronic predictor of affective ratings of English words

This work considers implementation of a diachronic predictor of valence, arousal and dominance ratings of English words. The estimation of affective ratings is based on data on word co-occurrence statistics in the large diachronic Google Books Ngram corpus. Affective ratings from the NRC VAD dictionary are used as target values for training. When tested on synchronic data, the obtained Pearson‘s correlation coefficients between human affective ratings and their machine ratings are 0.843, 0.779 and 0.792 for valence, aroused and dominance, respectively. We also provide a detailed analysis of the accuracy of the predictor on diachronic data. The main result of the work is creation of a diachronic affective dictionary of English words. Several examples are considered that illustrate jumps in the time series of affective ratings when a word gains a new meaning. This indicates that changes in affective ratings can serve as markers of lexical-semantic changes.

Measuring returns to experience using supervisor ratings of observed performance: The case of classroom teachers

AbstractWe study the returns to experience in teaching, estimated using supervisor ratings from classroom observations. We describe the assumptions required to interpret changes in observation ratings over time as the causal effect of experience on performance. We compare two difference‐in‐differences strategies: the two‐way fixed effects estimator common in the literature, and an alternative which avoids potential bias arising from effect heterogeneity. Using data from Tennessee and Washington, DC, we show empirical tests relevant to assessing the identifying assumptions and substantive threats—e.g., leniency bias, manipulation, changes in incentives or job assignments—and find our estimates are robust to several threats.

Relationships of change in Clinical Dementia Rating (CDR) on patient outcomes and probability of progression: observational analysis

BackgroundUnderstanding the relationship among changes in Clinical Dementia Rating (CDR), patient outcomes, and probability of progression is crucial for evaluating the long-term benefits of disease-modifying treatments. We examined associations among changes in Alzheimer’s disease (AD) stages and outcomes that are important to patients and their care partners including activities of daily living (ADLs), geriatric depression, neuropsychiatric features, cognitive impairment, and the probabilities of being transitioned to a long-term care facility (i.e., institutionalization). We also estimated the total time spent at each stage and annual transition probabilities in AD.MethodsThe study included participants with unimpaired cognition, mild cognitive impairment (MCI) due to AD, and mild, moderate, and severe AD dementia in the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS) database. The associations among change in AD stages and change in relevant outcomes were estimated using linear mixed models with random intercepts. The probability of transitioning to long-term care facilities was modeled using generalized estimating equations. The total length of time spent at AD stages and annual transition probabilities were estimated with multistate Markov models.ResultsThe estimated average time spent in each stage was 3.2 years in MCI due to AD and 2.2, 2.0, and 2.8 years for mild, moderate, and severe AD dementia, respectively. The annual probabilities of progressing from MCI to mild, moderate, and severe AD dementia were 20, 4, and 0.7%, respectively. The incremental change to the next stage of participants with unimpaired cognition, MCI, and mild, moderate, and severe AD dementia (to death) was 3.2, 20, 26.6, 31, and 25.3%, respectively. Changes in ADLs, neuropsychiatric features, and cognitive measures were greatest among participants who transitioned from MCI and mild AD dementia to more advanced stages. Participants with MCI and mild and moderate AD dementia had increasing odds of being transitioned to long-term care facilities over time during the follow-up period.ConclusionsThe findings demonstrated that participants with early stages AD (MCI or mild dementia) were associated with the largest changes in clinical scale scores. Early detection, diagnosis, and intervention by disease-modifying therapies are required for delaying AD progression. Additionally, estimates of transition probabilities can inform future studies and health economic modeling.

Prospective Randomized Double-Blind Vehicle-Controlled Study of Topical Coconut and Sunflower Seed Oil-Derived Isosorbide Diesters on Atopic Dermatitis.

Background: Preliminary studies support the use of topical coconut and sunflower seed oil for atopic dermatitis (AD). However, standardized topical formulations of fatty acids from these sources have not been studied. Objective: This study investigates whether coconut oil- and sunflower seed oil-derived isosorbide diesters can be used in conjunction with colloidal oatmeal to improve itch, AD severity, and the need for topical steroids in adults. Methods: This was a single-center, 4-week, randomized, double-blind, and vehicle-controlled study conducted between 2021 and 2022. Thirty-two male and female adults with mild-to-moderate AD were enrolled and completed the study. Participants were randomized to receive either 0.1% colloidal oatmeal (vehicle) or isosorbide diesters (IDEAS, 4% isosorbide dicaprylate and 4% isosorbide disunflowerseedate) along with 0.1% colloidal oatmeal. The main outcomes of the study were changes in the visual analogue rating of itch and 75% improvement in the Eczema Area and Severity Index score (EASI 75) at 4 weeks. Other measures included the use of topical steroids and the relative abundance of skin Staphylococcus aureus. Results: Participants in the IDEAS group had a 65.6% improvement in itch compared with 43.8% in the vehicle group (P = 0.013). In total, 56.5% and 25% of the those in the IDEAS and vehicle groups, respectively, achieved EASI 75 at 4 weeks (P = 0.07). There was no difference in skin hydration or transepidermal water loss. The relative abundance of S. aureus was decreased in the IDEAS group at week 4 compared with no change in the vehicle group (P = 0.044). Topical corticosteroid use increased in the vehicle group compared with a decrease in the IDEAS group at week 1 (292.5% vs 24.8%; P value = 0.039) and week 2 (220% vs 46%; P value = 0.08). Conclusions: Topical application of emollients containing coconut oil- and sunflower seed oil-derived fatty esters may improve itch, reduce topical steroid use, and reduce the relative abundance of S. aureus in mild-to-moderate AD. CTR number: NCT04831892.

The Relationship between the Change in Pelvic Alignment during Moderate-Intensity Running and the Subjective Rating of Perceived Exertion, Rating of Perceived Exertion for Legs and Gluteus Muscles Fatigue in Female Novice and Recreational Runners

Running has become 1 of the 2 most well-known exercises for health; however, running may cause injuries. The purpose of this analytical descriptive study was to examine the occurrence of pelvic drop during moderate-intensity running in female novice and recreational runners; as well as investigating the relationship between the change in pelvic alignment and Rating of Perceived Exertion (RPE), Rating of Perceived Exertion for Legs (RPElegs) and Gluteus muscles fatigue in novice and recreational runners. The participants, aged between 18 and 35 years old, comprised 27 novice runners (less than 1 year of running experience) and 27 recreational runners (2 - 4 years running experience). The participants in both groups performed the maximal oxygen uptake (VO2max) test and ran at a self-selected speed on a treadmill for 30 min at moderate-intensity within the specified heart rate range of 40 - 59 % heart rate reserve (HRR). RPE, RPElegs and sEMG were collected every 2 min and the pelvic kinematic data were also recorded every minute during the 30 min treadmill running test. The data were analyzed with a statistical significance level at p-value &lt; 0.05. The results demonstrated that the time in starting pelvic drop was 8.15 ± 5.07 and 18.37 ± 6.70 min in female novice and recreational runner groups, respectively (p &lt; 0.01). Pearson’s correlations showed relationship between the pelvic alignment and RPE in novice runners (r = 0.47, p &lt; 0.01) and recreational runners (r = 0.39, p &lt; 0.01). Besides, Pearson’s correlations showed relationship between the pelvic alignment and RPElegs in novice runners (r = 0.48, p &lt; 0.01) and recreational runners (r = 0.32, p &lt; 0.01). In both groups, there was no relationship between the pelvic alignment and Gluteus medius and Gluteus maximus muscle fatigue. According to the study, the occurrence of a pelvic drop in novice runners was faster than recreational runners. The study indicated that consideration of RPE and RPElegs variables might be beneficial for female runners and future studies. HIGHLIGHTS The occurrence of pelvic drop in novice runners was faster than recreational runners. There was a relationship between the change in pelvic alignment and RPE and also RPElegs in female novice and recreational runners. The study indicated that consideration of RPE and RPElegs variables might be beneficial for female runners and future studies. GRAPHICAL ABSTRACT

App-based self-monitoring as an intervention to support attention in students with learning difficulties

This study examines the effectiveness of an app-based self-monitoring intervention to support attention in students with learning difficulties. Two quantitative single-case studies were conducted in special education school settings. Study 1 used an AB design in which 12 seventh-grade students with learning difficulties were assessed for attentional behavior during a math exercise by systematic observation using the Munich Attention Inventory with five-second time sampling by two raters. Study 2 used a multiple baseline design to assess the attentional behavior of three students with combined learning and attention difficulties during a math exercise by systematic observation using Direct Behavior Rating to measure on-task and off-task behavior. Both studies also used a competency screening to elicit teacher ratings of change in attention behavior in a pre-post measurement. The results indicate that the app-based self-monitoring interventions were successful, highlighting the potential of app-based self-monitoring to support students with learning and attention difficulties. In particular, the development of personalized self-monitoring interventions holds promising potential for improving learning outcomes in this target group.

Disrupted social perception in frontotemporal dementia and Alzheimer's disease – Associated cognitive processes and clinical implications

BackgroundSocial perception refers to the ability to adapt and update one's behaviour in accordance with the current context and provides the foundation for many complex social and emotional interactions. Alterations in social cognition are a hallmark of the behavioural variant of frontotemporal dementia (bvFTD), yet the capacity for social perception in this syndrome remains unclear. MethodsWe examined social perception in 18 bvFTD and 13 Alzheimer's disease (AD) patients, in comparison with 17 healthy older controls, using a social perception task derived from the Dewey Story Test. Participants also completed a comprehensive neuropsychological battery and carers provided ratings of behavioural and neuropsychiatric changes. Results: Overall, bvFTD and AD performance diverged significantly from control ratings on the social perception task, however, no significant difference was found between patient groups. Standardised values relative to the mean control rating revealed considerable variability within the patient groups in terms of the direction of deviation, i.e., over- or under-rating the vignettes relative to healthy controls (range z-scores = −1.79 to +1.63). Greater deviation from control ratings was associated with more pronounced memory (p = .007) and behavioural (p = .009) disturbances in bvFTD; whilst social perception performance correlated exclusively with verbal fluency in AD (p = .003). ConclusionsSocial perception is comparably disrupted in bvFTD and AD, yet likely reflects the differential breakdown of distinct cognitive processes in each dementia syndrome. Our findings have important clinical implications for the development of targeted interventions to manage disease-specific changes in social perception in dementia.