A Review of: Saulnier Lange, J., Johnson, C., & Martin, P. (2024). Service, interrupted: Analyzing chat reference referrals. The Reference Librarian, 65(1–2), 34–58. https://doi.org/10.1080/02763877.2024.2304360 Objective – To analyze service interruptions in chat reference interactions to determine best practices for chat reference delivery and training. Design – Mixed methods analysis of chat reference transcripts using grounded theory. Setting – One large university library in the United States. Subjects – Three hundred chat reference transcripts from the period during and after COVID-19 pandemic closure, that included an identified service interruption such as a referral, deferral, or missed referral. Methods – Researchers analyzed a random sample of relevant chat reference transcripts from May 2020 to June 2022, using a standardized data collection form based on observed transcript patterns and established coding schemes from relevant studies. The analysis considered the following factors: Query type, whether a referral was warranted, frequency of disconnected chats, operator actions, referral recipients, reference strategies employed, knowledge gaps, customer service level, and patron satisfaction level. Main Results – Most service disruptions involved referrals, with reference, library account, and item requests being the most common query types. Disconnected chat rates were lower than expected. In most cases, operators either directly contacted the referred person/unit or provided contact information. They used reference strategies such as asking clarifying questions, attempting to solve the patron’s issue, ensuring correct patron contact information, and inviting additional questions before closing the conversation. Most interactions on the patron satisfaction level were labelled as “polite” (choices were: "active dissatisfaction," "polite," and "extreme gratitude/happiness"), particularly when there was an attempt by the operator to resolve the issue. Customer service level ratings were mostly “satisfactory” (choices were: "poor," "satisfactory," and "excellent"), with higher ratings associated with the use of multiple strategies. Lower ratings were linked to disinterested operators, long wait times, extended searching for information, and the absence of a reference interview. While most questions warranted referral, unwarranted referrals often stemmed from knowledge gaps, a lack of clarifying questions, or operators rushing to refer. Most referrals were directed to other library staff or to Access Services, highlighting gaps in reference operators’ knowledge better aligned with Access Services expertise. Although not measured as a variable, the results also suggested additional challenges for student operators. Conclusion – Based on the analysis, recommendations included: improving communication between Reference and Access Services staff, adding targeted canned chat responses that demonstrate empathy, providing options, managing patron expectations, and improving training to include identified best practices. Additional research is needed to assess student follow through from chat referrals.

This study explores the impact of the Compare and Discuss Multiple Strategies (CDMS) framework for teaching multiple solution methods for factoring trinomials, a foundational algebraic skill serving as a gateway to college-level STEM coursework and frequently identified as a conceptual hurdle for students transitioning from arithmetic to algebraic thinking. Using a mixed-methods pre–post quasi-experimental design, 39 undergraduate students enrolled in developmental mathematics participated in a CDMS-based intervention focusing on multiple solution methods for factoring trinomials. The research investigated performance changes across trinomial types, method usage patterns, and student experiences. Results revealed large effect sizes significantly exceeding typical educational interventions, with substantial improvements across all trinomial types. Method diversity increased from two to four approaches, with students shifting from single-method dependency to flexible use of multiple strategies, particularly visual methods like Box and Tic-Tac-Toe methods. Qualitative findings indicated increased student confidence and strategic thinking, with nearly half expressing appreciation for multiple solution methods. The intervention was consistently effective across different algebraic structures and complexity levels. These findings provide the first empirical evidence for implementing CDMS in developmental mathematics at the college level, demonstrating that multiple solution methods can produce meaningful learning gains among undergraduate students who traditionally struggle with algebraic concepts.

Abstract BACKGROUND Cancer-related cognitive impairment (CRCI), also called “brain fog”, is a common complication of cancer and its treatment. Traditional neurocognitive tests lack sensitivity and correlate poorly with patients’ experiences. People of color are underrepresented in most studies of CRCI. The Test of Strategic Learning (TOSL) and Visual Selective Learning Task (VSLT) provide insights into higher-level cognitive functions and have been sensitive to cognitive changes in other populations. METHODS We conducted a single-arm, prospective clinical trial (NCT05519774) among English-speaking breast cancer survivors to determine the correlation of the TOSL and VSLT with patient reported outcomes (PROs), including Patient’s Assessment of Own Function Inventory (PAOFI) and Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), assessed at baseline and 3 months later. A patient advocate provided input on research design and recruitment strategies and served as a liaison between researchers and the patient community; intentional strategies were used to support recruitment of a diverse participant population. RESULTS We enrolled 61 participants: mean age 49.2(SD 9.9), 90% stage I–III, 50% ≥1 year from last chemotherapy, 87% college graduates, 92% heterosexual, and 30% with annual household income <$90K. 36% identified as Black or African American compared to 12% of our general institution breast cancer population (z=5.77, p<0.001). There was high correlation between the PAOFI and FACT-Cog at baseline (rho=.78, p=.001), 3 months (rho=.80, p<0.001), and for the change scores between time points (rho=.87, p<0.001) in the full sample and with similar results observed for both Black and White participants. In contrast, the TOSL and VSLT demonstrated weak correlations with PROs at both time points and for change scores (all rho’s<0.21). The FACT-Cog had greater discrimination at high levels than the PAOFI. CONCLUSION TOSL/VSLT and the PROs measure different aspects of CRCI. Intentional use of multiple strategies is needed to recruit diverse populations.

This paper presents an analysis of how students use strategies for meaning construction through reading English texts. This narrative inquiry utilised in-depth interviews with four secondary-level students to explore their ways of learning English and constructing meaning from English texts. Findings show that students use their prior knowledge, collaborate with their friends, guess meaning from the context, seek the teacher’s support, visit libraries, and use dictionaries to comprehend the texts. This paper reports that struggling readers use limited strategies, such as using dictionaries and asking for support from their friends and teachers, whereas the engaged readers follow strategies such as grasping meaning from the context, using prior knowledge, getting support from others, and visiting libraries. The use of multiple strategies in meaning construction helps students better with library visiting and collaboration for better meaning construction. The findings imply that teachers’ support is necessary for students to develop their reading strategies.

ObjectiveTo evaluate the effectiveness of various de-implementation interventions in primary care, targeting care (treatments or tests) that provides no or limited value for patients (low value care).DesignSystematic review and meta-analysis.Data sourcesMedline and Scopus databases, from inception to 10 July 2024.Eligibility criteria for selecting studiesRandomised trials comparing de-implementation interventions with placebo or sham intervention, no intervention, or other de-implementation intervention strategies in primary care. Eligible trials provided information on the use of low value care, total volume of care, appropriate care, and health outcomes.Data extraction and synthesisTitles, abstracts, and full texts were screened, data were extracted, and risk of bias was assessed independently and in duplicate. Random effects meta-analyses were conducted, and the certainty of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Results13 008 abstracts were screened and 140 were eligible for inclusion in the study. Median follow-up was 287 days (interquartile range 180-365). In 75 (54%) trials the aim was to reduce the use of antibiotics, in 42 (30%) to reduce other drug treatments, in 17 (12%) to reduce imaging, and in 15 (11%) to reduce laboratory testing. The certainty of the evidence was moderate that provider education combined with audit and feedback reduced the use of targeted low value care (odds ratio 0.73, 95% confidence interval (95% CI) 0.63 to 0.84). Provider education (0.86, 95% CI 0.72 to 1.03), audit and feedback (0.82, 0.67 to 1.00), and patient education (0.70, 0.30 to 1.66), and a combination of these strategies (point estimates for odds ratios ranging from 0.57 to 0.64) may reduce the use of targeted low value care (low certainty of evidence for all).ConclusionsThe results suggested with moderate certainty of evidence that provider education combined with audit and feedback reduced the use of targeted low value care. Individual strategies may slightly reduce the use of targeted low value care, but achieving a meaningful impact on low value care may require the use of multiple strategies. The results may be useful for patients, clinicians, policy makers, and guideline developers when deciding on future de-implementation strategies and research priorities.Systematic review registrationPROSPERO CRD42023411768.

This paper explores the use of impoliteness strategies in Dave Chappelle’s stand-up comedy, focusing on how he combines positive and negative strategies to intensify face-threaten- ing acts (FTAs) and enhance humor. It conducts a descriptive pragmatic discourse analysis, both qualitative and quantitative, of a stand-up comedy transcript downloaded from the Internet. It categorizes excerpts following Culpeper’s (1996) framework on positive and negative impolite- ness strategies and examines their combinations. The analysis reveals a frequent use of multiple strategies, particularly the combination of the negative strategies of condescending and associ- ating a person with something unfavorable with the positive strategies of using taboo words and offensive labels to refer to a person. These combinations are frequently and simultaneously em- ployed and as a result create a stronger FTA, but they do not intensify the humorous effect. Pos- itive strategies, such as using taboo words and calling the other names, predominantly function as intensifiers that strengthen the impact of negative strategies, rather than as the main sources of humor. NNegative strategies, including condescension, scorn or ridicule, and explicitly asso- ciating the other with a negative aspect, are the ones having a primary role in employing FTAs in the corpus. The multilayered use of impoliteness strategies demonstrates their important role for FTAs ins comedic discourse.

Psychotic disorders are characterized by emotion regulation abnormalities that predict greater symptom severity and poor functional outcomes. However, it is unclear whether these abnormalities also occur in individuals at clinically high risk for psychosis (CHR). The current study used ecological momentary assessment (EMA) to address this question and examined the nature of abnormalities at three stages of emotion regulation (identification, selection, implementation). Participants included 120 CHR and 59 CN who completed 1week of EMA surveys evaluating emotional experience, emotion regulation, context, and symptoms. Multi-level models examined concurrent and time-lagged effects. CHR evidenced elevated state negative affect and abnormalities at all three stages of emotion regulation. At the identification stage (i.e., determining the need to regulate), regulatory attempts were made too frequently and with too much effort at low levels of negative affect and not frequently enough and with insufficient effort at high levels of negative affect. Selection stage abnormalities (i.e., choosing the exact strategy to attempt based on context) were characterized by increased frequency of selecting individual strategies and greater polyregulation (i.e., use of multiple strategies concurrently). Implementation stage (i.e., executing the selected strategy) abnormalities were indicated by being less effective at decreasing the intensity of negative affect from time t to t+1. It is not only heightened stress reactivity that confers risk for psychosis, but also abnormalities in applying emotion regulation strategies to control the stress response. The profile of abnormalities observed in CHR is similar to schizophrenia, suggesting treatment targets that transcend phases of psychotic illness.

This paper presents an analysis of students' strategies for reading English texts. The narrative inquiry research design was used to study four secondary-level students' experiences of different reading strategies of English texts. The findings show that the students use different cognitive and metacognitive strategies to understand the texts according to their level of reading engagement. They monitor their plans and evaluate their understanding while reading. This study found that reading silently and reading aloud, using previous knowledge while reading new texts, rereading and summarizing the texts, and solving problems are the main strategies used in reading English texts. This study reports that engaged readers use diverse strategies; however, struggling readers use limited strategies. The use of multiple strategies in the reading of English texts helps students better for their achievements and engagement in reading. The study shows that teacher support is important in using strategies because teachers can help students in selecting appropriate reading strategies. This study will be important for English language learners, teachers, educators, researchers, and motivators for future student-centered pedagogical approaches to transform teaching and learning experiences into EFL classrooms.

Abstract The Cameroon Grassfields faced extreme violence during German colonization in the early twentieth century. The German colonial army used various strategies, such as armed attacks, executions, looting, hostage-taking, and other repressive measures. After military subjugation by the German colonial army, however, the use of various forms of violence continued. Germans made use of multiple strategies in this mountain region to procure laborers for the colonial apparatus on the coast. At the same time, they claimed to be fighting “slave trade” and “slavery.” However, the coercive measures and violence used for this purpose were and are often characterized by those affected and their descendants as forms of “slave trade” and “slavery.” This article adopts an actor-centered approach that combines written sources with corresponding oral accounts and sheds light on local narratives about “labor recruitment.” This will reveal how and why colonized actors conceptualized the systems of coercion they resisted against differently from the German colonizers. The article argues that taking the perspective of colonized actors into account calls into question the distinction between “slave trading” and “labor recruitment.”

The purpose of this narrative review was to assess the limited literature on fetal anomalies diagnosed in the second trimester of pregnancy and parental decision-making and identify sources of information deemed as facilitators and barriers to medical decisions. This was a literature review of source material and information about fetal anomalies diagnosed in the second trimester of pregnancy, decision-making, decision tools or aids, and sources of information for anomalies. The search string used explored related peer-reviewed publications and systematic reviews between 2007 and 2024. We also reviewed references from publications meeting inclusion criteria. The search was conducted between June 2022 and February 2024. Exclusion criteria included conference abstracts, non-peer reviewed literature, and articles not available in English language. A total of 77 publications were identified by searching multiple databases using a predefined search string. The search encompassed full text articles from 2007 to 2024 and 11 full-text publications were ultimately included in the review. A list of 45 co-occurring keywords was generated from the included texts, with each keyword having a minimum of two co-occurrences. Key themes identified included (1) the role of the clinician and need for development of professional knowledge and empathy surrounding discussion of fetal anomalies with patients; (2) information gathering, with individuals reporting use of multiple strategies to obtain information; while the majority found information satisfying, they preferred more details on diagnosis, long-term outcomes of the fetus/child and management of the pregnancy or termination process; and (3) decision-making, the path and process of how individuals made decisions about the pregnancy including quality of life, future fertility, and seeking other people's experiences. Many factors contribute to an individual's decision-making after a diagnosis of a fetal anomalies diagnosed in the second trimester of pregnancy, ranging from personal beliefs and goals to shared experiences of others and access to care. Understanding how sources of information may be deemed both as facilitators and barriers to different individuals during the decision-making process is important for healthcare providers in order to understand how to most effectively support patients. There is a dearth of information on training healthcare professionals to provide support to patients facing these decisions.

Lipid-bilayer-based liposomes are gaining attention in scientific research for their versatile role in drug delivery. With their amphiphilic design, liposomes efficiently encapsulate and deliver drugs to targeted sites, offering controlled release. These artificial structures hold great promise in advancing cancer therapy methodologies. Bibliometric research analyzes systematic literary data statistically. This study used bibliometric indicators to examine, map, and evaluate the applications of liposomes in cancer therapy. A Scopus search was conducted to identify all English-language peer-reviewed scientific publications on the applications of liposomes in cancer therapy within the past twenty years. Bibliometric indicators were calculated using VOSviewer and Biblioshiny. We produced thematic, conceptual, and visualization charts. A total of 14,873 published documents were obtained. The procedure of keyword mapping has effectively identified the main areas of research concentration and prevailing trends within this specific field of study. The significant clusters discovered through theme and hotspot analyses encompassed many topics such as the use of multiple strategies in chemotherapy and different forms of cancer, the study of pharmacokinetics and nanomedicine, as well as the investigation of targeted drug delivery, cytotoxicity, and gene delivery. Liposomes were employed as drug delivery systems so as to selectively target cancer cells and improve the bioavailability of anticancer drugs. The work showcased the capacity to tailor these liposomes for accurate drug delivery by including potent anticancer medications. Our findings not only bring attention to the latest progress in utilizing liposomes for cancer treatment but also underscore the vital need for ongoing research, collaborative efforts, and the effective translation of these breakthroughs into tangible clinical applications, emphasizing the dynamic and evolving nature of cancer therapeutics.

Dementia, a prevalent condition among older individuals, has profound societal implications. Extensive research has resulted in no cure for what is perceived as the most common dementing illness: Alzheimer disease (AD). AD is defined by specific brain abnormalities - amyloid-β plaques and tau protein neurofibrillary tangles - that are proposed to actively influence the neurodegenerative process. However, conclusive evidence of amyloid-β toxicity is lacking, the mechanisms leading to the accumulation of plaques and tangles are unknown, and removing amyloid-β has not halted neurodegeneration. So, the question remains, are we making progress towards a solution? The complexity of AD is underscored by numerous genetic and environmental risk factors, and diverse clinical presentations, suggesting that AD is more akin to a syndrome than to a traditional disease, with its pathological manifestation representing a convergence of pathogenic pathways. Therefore, a solution requires a multifaceted approach over a single 'silver bullet'. Improved recognition and classification of conditions that converge in plaques and tangle accumulation and their treatment requires the use of multiple strategies simultaneously.

Video 1 Underwater traction-assisted endoscopic submucosal dissection of a recurrent duodenal adenoma using the pocket-creation method. ▶ Fig. 1 Optimal exposure of submucosal space. ▶ Fig. 2 Dissection under the fibrosis. ▶ Fig. 3 Complete closure of scar, sparing the major papilla.

Academic examinations are highly emotional for university students, making ER essential for preventing or reducing the negative consequences of negative emotions on well-being and academic performance. Initial theorizing and research suggest that flexibly applying combinations of strategies can promote successful ER. However, studies using intraindividual approaches to examine ER strategy use in specific contexts across multiple occasions, are lacking. Moreover, the combinations of strategies used by students within different contexts, and the adaptiveness of different strategies for regulating different emotions, remain unexplored. To address these gaps, we conducted an experience sampling study to identify patterns of students' momentary ER and to examine how context (achievement-related vs. nonachievement-related), emotions (anxiety vs. hope), and academic performance function as potential covariates. Over 200 university students rated their anxiety, hope, and use of eight ER strategies over a 7-day period, six times a day, prior to an important exam in 2016 and 2017. Results of a two-level latent profile analysis revealed distinct profiles of ER that differed on both levels. Intraindividually, ER patterns differed as a function of type of emotion and context experienced. More specifically, momentary use of multiple strategies tended to be associated with greater anxiety, while in the achievement context this association was reduced. Interindividually, students' tendencies to use different ER patterns were not related to test performance. Our findings suggest that ER strategy selection depends on both context and emotions, and advance ER research by considering intraindividual strategy use in concrete achievement situations. Yet the sample is not sufficiently representative. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Microplastics (MP) are plastic particles less than 5 mm in size. There are two categories of MP: primary and secondary. Primary or microscopic-sized MP are intentionally produced material. Fragmentation of large plastic debris through physical, chemical, and oxidative processes creates secondary MP, the most abundant type in the environment. Microplastic pollution has become a global environmental problem due to their abundance, poor biodegradability, toxicological properties, and negative impact on aquatic and terrestrial organisms including humans. Plastic debris enters the aquatic environment via direct dumping or uncontrolled land-based sources. While plastic debris slowly degrades into MP, wastewater and stormwater outlets discharge a large amount of MP directly into water bodies. Additionally, stormwater carries MP from sources such as tire wear, artificial turf, fertilizers, and land-applied biosolids. To protect the environment and human health, the entry of MP into the environment must be reduced or eliminated. Source control is one of the best methods available. The existing and growing abundance of MP in the environment requires the use of multiple strategies to combat pollution. These strategies include reducing the usage, public outreach to eliminate littering, reevaluation and use of new wastewater treatment and sludge disposal methods, regulations on macro and MP sources, and a wide implementation of appropriate stormwater management practices such as filtration, bioretention, and wetlands.

In any given situation, the environment can be parsed in different ways to yield decision variables (DVs) defining strategies useful for different tasks. It is generally presumed that the brain only computes a single DV defining the current behavioral strategy. Here to test this assumption, we recorded neural ensembles in the frontal cortex of mice performing a foraging task admitting multiple DVs. Methods developed to uncover the currently employed DV revealed the use of multiple strategies and occasional switches in strategy within sessions. Optogenetic manipulations showed that the secondary motor cortex (M2) is needed for mice to use the different DVs in the task. Surprisingly, we found that regardless of which DV best explained the current behavior, M2 activity concurrently encoded a full basis set of computations defining a reservoir of DVs appropriate for alternative tasks. This form of neural multiplexing may confer considerable advantages for learning and adaptive behavior.

Abstract Face attribute classification (FAC) has received considerable attention due to its excellent application value in bio‐metric verification and face retrieval. Current FAC methods suffer two typical challenges: complex inter‐attribute correlations and imbalanced learning. Aims at the challenges, presents an end‐to‐end FAC framework with integrated use of multiple strategies, which consists of a convolutional neural network (CNN) and a graph convolutional network (GCN). The GCN is used to model the semantic correlations among attributes and capture inter‐dependency among them. The correlation information learnt via the GCN is used to guide the learning of the inter‐dependent classification features of the FAC network. An adaptive thresholding strategy and a boosting scheme are adopted to alleviate the effect of the class‐imbalance. To deal with the task imbalance problem, a new dynamic weighting scheme is proposed to update the weight of each attribute classification task in the training process. We apply four evaluation metrics to evaluate the proposed method. Experimental results show all the proposed strategies are effective, and our approach outperforms state‐of‐the‐art FAC methods on two challenging datasets CelebA and LFWA.

Abstract The present study investigated the use of apology response (AR) strategies by L1-Chinese L2-English learners and L1-English L2-Chinese learners from a cross-linguistic perspective. A total of 18 Taiwanese college students who were learning English as a foreign language and 18 foreigners in Taiwan who were learning Chinese as a second language were recruited to complete an oral discourse completion task both in Chinese and English. The major findings are as follows: First, the two groups showed no significant difference in their choice of AR strategies, both favoring Acceptance and Minimization, two face-preserving types, to show politeness. Second, cross-linguistic influence was found to affect our participants’ AR performances. Both positive and negative influences occurred. Finally, regarding the use of multiple strategies, both groups of participants tended to combine Acceptance with other strategies to maintain social relationships. The results showed both language universal and language-specific features in the AR realizations in Chinese and English. The dominant use of positive response strategies, namely Acceptance and Minimization, highlights the profound influence of politeness principles.

BackgroundRetention remains a major challenge for many clinical trials. The SPIRIT guidelines state the following information on retention should be included in the trial protocol “Plans to promote participant retention and complete follow-up, including list of any outcome data to be collected for participants who discontinue or deviate from intervention protocols”. This guidance shows the importance of planning retention methods and handling missing data as this can impact how the results of the trial are interpreted. The most recent Cochrane review of strategies to improve retention in clinical trials highlighted that some trials implemented multiple retention strategies and we questioned whether the use of multiple strategies was planned at the design stage and included in the protocol or are strategies implemented when retention becomes an issue within the trial. The purpose of our scoping review is to establish if and how trial teams prepare for retention at the design phase of clinical trials.Methods and analysisWe will follow the methodological framework and guidelines for scoping reviews outlined by the Joanna Briggs Institute. We will search MEDLINE/PubMed, Scopus, EMBASE, CINAHL (EBSCO), and Web of Science. A comprehensive search strategy for PubMed was developed in collaboration with an experienced research librarian. We will include protocols for phase 2, 3, and 4 RCTs as well as pilot and feasibility studies. The screening process will involve two reviewers. EM will independently screen all titles and abstracts. FS will screen 10% of the overall search output, and where necessary full protocol texts will be screened to determine eligibility. We will randomly sample eligible protocols to ensure the protocols represent a variety of trial and intervention types. Data will be extracted from each protocol and the results will be synthesised. The analysis will be qualitative using a narrative summary and descriptive statistics where appropriate.DiscussionThe scoping review will help trial methodologists better understand if retention strategies are planned for during the design stage of the trial contributing to the PRioRiTy II unanswered question “How should people who run trials plan for retention during their funding application and creation of the trial (protocol development)?”.

Abstract Bio-inspired design is a highly promising avenue for uncovering novel traumatic brain injury prevention equipment designs. Nature has a history of providing inspiration for breakthrough innovations, particularly in cases when the traditional engineering mindset has failed to advance problem- solving. This work identifies patterns and trends in the ways that nature defends against external stimuli and predators, investigating them with the goal of highlighting promising inspiration for brain injury prevention. Two key strategies were found missing in engineering applications while identifying patterns and strategies used in nature: (1) connections between layers in multilayered material structures and (2) the use of multiple strategies in a single design. Nine organisms are highlighted in detail as examples of patterns in biological methods of protection, both on a macro and microscale. These findings include the coconut’s shell, the pomelo fruit’s peel, the golden scale snail’s shell, the ironclad beetle’s exoskeleton, the woodpecker’s skull, the Arapaima fish’s scales, conch shells, and the dactyl club of shrimp. The results highlight knowledge gaps preventing these findings from being applied as well as recommendations for moving toward their use in engineering design.