A systematic review of the impact of childhood vision impairment on reading and literacy in education

Purpose: This systematic review evaluates current literature on the impact vision impairment has on reading and literacy levels within education. Methods: Six databases were searched with inclusion criteria of trials or studies involving children who are blind or vision impaired, and impact on academic or school performance – including reading and literacy. 1262 articles were identified, with 61 papers undergoing full screening. Quality appraisal was performed using Critical Appraisal Skills Program (CASP) and seven articles deemed eligible for inclusion. Results: Included articles achieved a quality score of over 70 % using the CASP checklists. Direct comparison of articles was not possible due to methodological differences in assessing reading and literacy levels. All seven studies investigated aspects of reading speed, with additional measures of reading performance, such as reading reserve, comprehension, and reading accuracy. Discussion: Underlying trends highlighted students with a vision impairment do not perform at same level as their normally sighted peers with respect to reading performance - in terms of speed, but not ability. Additionally, early intervention to enhance literacy skills may help improve educational outcomes. Future direction should be aimed at identifying specific obstacles to learning these students face and providing interventions to improve academic outcomes. (AU)

Resistance training's impact on blood biomarkers and cognitive function in older adults with low and high risk of mild cognitive impairment: a randomized controlled trial.

BACKGROUND: The aging brain exhibits a neuroinflammatory state, driven partly by peripheral pro-inflammatory stimuli, that accelerates cognitive deterioration. A growing body of evidence clearly indicates that physical exercise partly alleviates neuroinflammation and positively affects the aging process and cognition. In this randomized controlled trial, we aimed to observe the effect of 12 weeks of resistance training (RT) on peripheral biomarker levels, cognitive function changes and their interrelationship, and explore differences in those exercise-induced changes in older adults with high risk of mild cognitive impairment (MCI) compared to older adults with low risk of MCI. METHODS: Fifty-two participants (aged 60-85 years old, 28 female) were randomly allocated to a 12 week lower limb RT program consisting of two training sessions per week or waiting list control group. The Montreal Cognitive Assessment (MoCA) was used to stratify participants screened as high (< 26/30) or low risk (≥ 26/30) of MCI. We assessed serum Interleukin 6 (IL-6), Insulin-like Growth Factor-1 (IGF-1), and Kynurenine (KYN) levels. Cognitive measurement consisted of and four subtests of Automated Neuropsychological Assessment Metrics (ANAM), the two-choice reaction time, go/no-go, mathematical processing, and memory search test. RESULTS: Twelve weeks of RT improved Go/No-go test results in older adults with high MCI risk. RT did not significantly affect blood biomarkers. However, IGF-1 level increases were associated with improvements in response time on the mathematical processing test in the exercise group, and IL-6 level increases were associated with improvements in response time on the memory search test in the total group of participants. Finally, KYN levels significantly differed between older adults with low and high MCI risk but no significant associations with performance were found. CONCLUSION: Our study results suggest a different effect of RT on inhibitory control between older adults with low compared to high MCI risk. IGF-1 may play a role in the mechanism behind the cognitive benefit of RT and KYN may be a surrogate biomarker for neurodegeneration and cognitive decline.

Usability and preliminary effectiveness of an app-based physical activity and education program for people with hip or knee osteoarthritis - a pilot randomized controlled trial.

BACKGROUND: Hip and knee osteoarthritis (OA) are highly prevalent worldwide. The guidelines recommend physical activity and education as the core treatments for osteoarthritis. Digital health has the potential to engage people in physical activity and disease management. Therefore, we conducted a pilot trial to assess the usability and preliminary effectiveness of an app-based physical activity and education program (Join2Move) compared to usual care for people with hip and/or knee OA in Germany. METHODS: A randomized controlled pilot study was conducted. Individuals with diagnosed or self-reported knee and hip OA were included. Allocation to the intervention or control group was randomized. The intervention group received the Join2Move program. The Join2Move program was previously developed as a website and evaluated in the Netherlands. For the current study, the program was translated and adapted to the German context and adjusted from a website to an app. The control group received usual care. The primary outcomes were usability and preliminary effectiveness (pain and physical functioning). Measurements were taken at baseline and at twelve weeks. The data analysis was performed using SPSS (IBM SPSS Statistics 29.0). RESULTS: Sixty participants, with a mean age of 61.9 (SD ± 7.2) years, were allocated to the intervention (n = 32) or the control group (n = 28) and included in the analysis. The majority of participants had knee OA (68%), and 12% had hip and knee OA. The dropout rate was n = 11 (18%). No adverse events were reported. Usability was rated as acceptable (mean System Usability Scale = 71.3/100) with a wide range (32.5 to 100). Statistically significant between-group differences were found only for pain (mean difference 8.52 (95% CI 1.01 to 16.04), p = 0.027). CONCLUSIONS: Join2Move demonstrated acceptable usability. The preliminary results of the pilot trial indicate the potential of a stand-alone app for the treatment of patients with hip or knee OA. However, the acceptable usability of Join2Move limits its recommendation for everyone. There appears to be room for improvement in app usability and in identifying patients for whom the app is suitable and the right time to use a stand-alone app. TRIAL REGISTRATION: German Clinical Trials Register DRKS00027164 .

Mismatch novelty exploration training shifts VPAC1 receptor-mediated modulation of hippocampal synaptic plasticity by endogenous VIP in male rats.

Novelty influences hippocampal-dependent memory through metaplasticity. Mismatch novelty detection activates the human hippocampal CA1 area and enhances rat hippocampal-dependent learning and exploration. Remarkably, mismatch novelty training (NT) also enhances rodent hippocampal synaptic plasticity while inhibition of VIP interneurons promotes rodent exploration. Since VIP, acting on VPAC1 receptors (Rs), restrains hippocampal LTP and depotentiation by modulating disinhibition, we now investigated the impact of NT on VPAC1 modulation of hippocampal synaptic plasticity in male Wistar rats. NT enhanced both CA1 hippocampal LTP and depotentiation unlike exploring an empty holeboard (HT) or a fixed configuration of objects (FT). Blocking VIP VPAC1Rs with PG 97269 (100 nM) enhanced both LTP and depotentiation in naïve animals, but this effect was less effective in NT rats. Altered endogenous VIP modulation of LTP was absent in animals exposed to the empty environment (HT). HT and FT animals showed mildly enhanced synaptic VPAC1R levels, but neither VIP nor VPAC1R levels were altered in NT animals. Conversely, NT enhanced the GluA1/GluA2 AMPAR ratio and gephyrin synaptic content but not PSD-95 excitatory synaptic marker. In conclusion, NT influences hippocampal synaptic plasticity by reshaping brain circuits modulating disinhibition and its control by VIP-expressing hippocampal interneurons while upregulation of VIP VPAC1Rs is associated with the maintenance of VIP control of LTP in FT and HT animals. This suggests VIP receptor ligands may be relevant to co-adjuvate cognitive recovery therapies in aging or epilepsy, where LTP/LTD imbalance occurs.

Web-Based Emotion Regulation Training for Sexual Health: Randomized Controlled Trial.

BACKGROUND: Effective emotional regulation (ER) skills are important for sexual function, as they impact emotional awareness and expression during sexual activity, and therefore, satisfaction and distress. Emotion regulation interventions may offer a promising approach to improve sexual health. Web-based emotion regulation may be a therapeutic strategy for men and women with sexual health concerns. Nevertheless, there is a scarcity of intervention trials investigating its effects in this context, much less using the internet. OBJECTIVE: This study aims to investigate the effects of a web-based emotion regulation training program for sexual function in both men and women. METHODS: The participants were recruited based on their self-reported sexual problems, which for men was defined by a score of <25 on the International Index Erectile Function (IIEF) and for women by a score of <26.55 on the Female Sexual Function Index (FSFI). The final sample included 60 participants who were randomized to either a web-based emotion regulation training for sexual function or to a waitlist control group. The treatment consisted of an 8-week web-based emotion regulation training for sexual function. The participants were assessed at baseline, post intervention, and the 3-month follow-up. RESULTS: Of the 60 participants included, only 6 completed all 3 assessment points (n=5, 20% in the treatment group and n=1, 5% in the waitlist control group) after receiving the intervention. At follow-up, there were no significant differences between groups in any measure. Among the intervention completers, large-to-moderate within-group effect sizes were observed between the assessment points on measures of emotion regulation, depression, lubrication, orgasm, thoughts of sexual failure, and abuse during sexual activity. The adherence rate was very low, limiting the generalizability of the findings. CONCLUSIONS: Participants who completed the intervention showed improvements in both sexual function domains and emotion regulation. Nonetheless, due to a high dropout rate, this trial failed to collect sufficient data to allow for any conclusions to be drawn on treatment effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT04792177; https://clinicaltrials.gov/study/NCT04792177.

Acetaminophen influences musculoskeletal signaling but not adaptations to endurance exercise training.

Acetaminophen (ACE) is a widely used analgesic and antipyretic drug with various applications, from pain relief to fever reduction. Recent studies have reported equivocal effects of habitual ACE intake on exercise performance, muscle growth, and risks to bone health. Thus, this study aimed to assess the impact of a 6-week, low-dose ACE regimen on muscle and bone adaptations in exercising and non-exercising rats. Nine-week-old Wistar rats (n = 40) were randomized to an exercise or control (no exercise) condition with ACE or without (placebo). For the exercise condition, rats ran 5 days per week for 6 weeks at a 5% incline for 2 min at 15 cm/s, 2 min at 20 cm/s, and 26 min at 25 cm/s. A human equivalent dose of ACE was administered (379 mg/kg body weight) in drinking water and adjusted each week based on body weight. Food, water intake, and body weight were measured daily. At the beginning of week 6, animals in the exercise group completed a maximal treadmill test. At the end of week 6, rats were euthanized, and muscle cross-sectional area (CSA), fiber type, and signaling pathways were measured. Additionally, three-point bending and microcomputer tomography were measured in the femur. Follow-up experiments in human primary muscle cells were used to explore supra-physiological effects of ACE. Data were analyzed using a two-way ANOVA for treatment (ACE or placebo) and condition (exercise or non-exercise) for all animal outcomes. Data for cell culture experiments were analyzed via ANOVA. If omnibus significance was found in either ANOVA, a post hoc analysis was completed, and a Tukey's adjustment was used. ACE did not alter body weight, water intake, food intake, or treadmill performance (p > .05). There was a treatment-by-condition effect for Young's Modulus where placebo exercise was significantly lower than placebo control (p < .05). There was no treatment by condition effects for microCT measures, muscle CSA, fiber type, or mRNA expression. Phosphorylated-AMPK was significantly increased with exercise (p < .05) and this was attenuated with ACE treatment. Furthermore, phospho-4EBP1 was depressed in the exercise group compared to the control (p < .05) and increased in the ACE control and ACE exercise group compared to placebo exercise (p < .05). A low dose of ACE did not influence chronic musculoskeletal adaptations in exercising rodents but acutely attenuated AMPK phosphorylation and 4EBP1 dephosphorylation post-exercise.

Implementation of an intervention aimed at deprescribing benzodiazepines in a large US healthcare system using patient education materials: a pre/post-observational study with a control group.

OBJECTIVES: Long-term benzodiazepine use is common despite known risks. In the original Eliminating Medications Through Patient Ownership of End Results (EMPOWER) Study set in Canada, patient education led to increased rates of benzodiazepine cessation. We aimed to determine the effectiveness of implementing an adapted EMPOWER quality improvement (QI) initiative in a US-based healthcare system. DESIGN: We used a pre-post design with a non-randomised control group. SETTING: A network of primary care clinics. PARTICIPANTS: Patients with ≥60 days' supply of benzodiazepines in 6 months and ≥1 risk factor (≥65 years of age, a concurrent high-risk medication prescribed or a diazepam equivalent daily dose ≥10) were eligible. INTERVENTION: In March 2022, we engaged 22 primary care physicians (PCPs), and 308 of their patients were mailed an educational brochure, physician letter and flyer detailing benzodiazepine risks; the control group included 4 PCPs and 291 of their patients. PRIMARY AND SECONDARY MEASURES: The primary measure was benzodiazepine cessation by 9 months. We used logistic regression and a generalised estimating equations approach to control for clustering by PCP, adjusting for demographics, frailty, number of risk factors, and diagnoses of arthritis, depression, diabetes, falls, and pain. RESULTS: Patients in the intervention and control groups were comparable across most covariates; however, a greater proportion of intervention patients had pain-related diagnoses and depression. By 9 months, 26% of intervention patients (81 of 308) had discontinued benzodiazepines, compared with 17% (49 of 291) of control patients. Intervention patients had 1.73 greater odds of benzodiazepine discontinuation compared with controls (95% CI: 1.09, 2.75, p=0.02). The unadjusted number needed to treat was 10.5 (95% CI: 6.30, 34.92) and the absolute risk reduction was 0.095 (95% CI: 0.03 to 0.16). CONCLUSIONS: Results from this non-randomised QI initiative indicate that patient education programmes using the EMPOWER brochures have the potential to promote cessation of benzodiazepines in primary care.

Contextual cueing during lethal force training: How target design and repetition can alter threat assessments.

Lethal force training requires individuals to make threat assessments, which involves holistic scenario processing to identify potential threats. Photorealistic targets can make threat/non-threat judgments substantially more genuine and challenging compared to simple cardboard or silhouette targets. Unfortunately, repeated target use also brings unintended consequences that could invalidate threat assessment processes conducted during training. Contextually rich or unique targets could be implicitly memorable in a way that allows observers to recall weapon locations rather than forcing observers to conduct a naturalistic assessment. Experiment 1 demonstrated robust contextual cueing effects in a well-established shoot/don't-shoot stimulus set, and Experiment 2 extended this finding from complex scene stimuli to simple actor-only stimuli. Experiment 3 demonstrated that these effects also occurred among trained professionals using rifles rather than computer-based tasks. Taken together, these findings demonstrate the potential for uncontrolled target repetition to alter the fundamental processes of threat assessment during lethal force training.

A social-ecological examination of sleep among Airmen in technical training.

Inadequate sleep is an on-going risk to the health and mission readiness of U.S. Armed Forces, with estimates of sleep problems high above U.S. civilian populations. Intervening early in the career of active duty Air Force personnel (or "Airmen") with education and the establishment of healthy behaviors may prevent short and long term-detriments of sleep problems. This paper describes the results of a qualitative study seeking to understand the facilitators and barriers to achieving good sleep in a technical training school during the first year of entry into the United States Air Force. Using the social ecological framework and content analysis, three focus groups with Airmen were conducted to explore themes at the individual, social, environmental, and organizational/policy level. Overall, results indicated a cohort motivated to achieve good sleep, and also struggling with a number of barriers across each level. This paper highlights opportunities for population health interventions during technical training aimed at supporting Airmen in developing healthy sleep behaviors early in the course of their career.

[Dance-specific eligibility of vocational ballet students - examinations at a governmental training institution for classical ballet]. / Tanzspezifische Eignung professioneller Ballettschüler*innen ­ Untersuchungen an einer Ausbildungseinrichtung für klassischen Bühnentanz.

BACKGROUND: During their training, pre-professional ballet students are confronted with physical stresses comparable to those of competitive sports. In competitive sports, there are mandatory and binding aptitude tests to ensure that the growing athlete meets the requirements. In ballet, there are no such mandatory examinations preceding the start of training. For adult professional dancers, musculoskeletal ideals could be isolated from the dance medicine literature. However, only a few studies describe musculoskeletal characteristics of pre-professional ballet students. It is neither known at what age a student should meet the ideal measurements for an adult nor what deviations from the ideal can be considered normal. This study aims to describe sociodemographic and musculoskeletal characteristics of pre-professional ballet students and discusses to what extent they already meet or deviate from dance-specific eligibility criteria for adult professional ballet dancers. MATERIAL AND METHODS: In this study, n = 414 female and n = 192 male students of John Cranko School (JCS) were seen by an experienced orthopaedist and dance physician. Mean age was 13.9 years (SD 3.5, range 5-22 years). Their medical history was taken (age; nationality; start of ballet/training) and a physical examination was performed (height/weight; symmetry of shoulder girdle, spine, waist triangles; pelvic tilt; tibial torsion; range of motion of base of index finger joint, spine, hips, ankle and base of great toe joint). Subsequently, the results of this study were compared with suitability criteria for adult professional ballet dancers that had been isolated from the dance medicine literature for a previous article. RESULTS: Examinees were from 49 different nations. 34.6% of the female subjects (≥16 years) were between 165 and 170 cm and 33.3% of the male subjects (≥18 years) were between 178 and 185 cm tall. 45.0% of those examined showed low body weight (<10th percentile, BMI <18.5 kg/m²). The trunk of 61.0-84.8% of those examined was erect and symmetrical. 25.2% had scoliosis. Half (53.5%) were found to have a bilateral external rotation of the hips of at least 60°, and 68.7% had a bilateral internal rotation between 20 and 50°. 87.3% exhibited a bilateral tibial torsion between 15 and 40°. A bilateral en dehors of 90° was calculated for 25.0%. In 9.1% of those examined, the upper ankle joints presented a dorsiflexion of at least 25°, and in 70.2%, a plantarflexion of at least 70° was seen. In 88.0%, the metatarsophalangeal joint of the great toe was 90° (f) and 80° (m) on both sides. CONCLUSION: The results of this study showed that pre-professional ballet students fulfil many characteristics of adult professional ballet dancers. High values already among young age groups suggest a ballet-specific selection. Nevertheless, not all students fulfil the theoretical "ideal measurements" for professional classical ballet. These anatomical limits should be considered individually in training to protect the growing pre-professional ballet dancer. The high ballet-specific anatomical demands, but especially the large number of students with a low body weight, underline the necessity of mandatory aptitude tests at the beginning and regular check-ups in the course of training to avert compensatory mechanisms and their consequential damage and to screen for eating disorders and disorders of eating behaviour.

Improving usual care outcomes in major depression in youth by targeting memory specificity: A randomized controlled trial of adjunct computerized memory specificity training (c-MeST).

OBJECTIVE: Extending on previous findings that computerized MeST (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment. METHODS: Participants aged 15-25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups. RESULTS: The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p = .022), but not at three or six months (d's < 0.15, p's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p = .606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p = .327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p = .266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p = .023) and six-months (d = 0.84, p = .001), but not three-months (d = 0.13, p > .05). CONCLUSIONS: c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention.

A Modified Delphi Study for Curricular Content of Simulation-Based Medical Education for Pediatric Residency Programs.

OBJECTIVE: We sought to establish core knowledge topics and skills that are important to teach pediatric residents using simulation-based medical education (SBME). METHODS: We conducted a modified Delphi process with experts in pediatric SBME. Content items were adapted from the American Board of Pediatrics certifying exam content and curricular components from pediatric entrustable professional activities (EPAs). In round 1, participants rated 158 items using a four-point Likert scale of importance to teach through simulation in pediatric residency. A priori, we defined consensus for item inclusion as ≥ 70% rated the item as extremely important and exclusion as ≥ 70% rated the item not important. Criteria for stopping the process included reaching consensus to include and/or exclude all items, with a maximum of 3 rounds. RESULTS: A total of 59 participants, representing 46 programs and 25 states participated in the study. Response rates for the three rounds were 92%, 86% and 90%, respectively. The final list includes 112 curricular content items deemed by our experts as important to teach through simulation in pediatric residency. Seventeen procedures were included. Nine of the seventeen EPAs had at least 1 content item that experts considered important to teach through simulation as compared to other modalities. CONCLUSIONS: Using consensus methodology, we identified the curricular items important to teach pediatric residents using SBME. Next steps are to design a simulation curriculum to encompass this content. WHAT'S NEW: It is unknown what content pediatric residents should learn through SBME. Consensus on which core material is important to teach through SBME to supplement existing curricula will allow residency training programs to utilize simulation most effectively.

A Pilot Randomized Trial of Combined Cognitive-Behavioral Therapy and Exercise Training Versus Exercise Training Alone for the Management of Chronic Insomnia in Obstructive Sleep Apnea.

Insomnia treatment among individuals with comorbid insomnia and obstructive sleep apnea is suboptimal. In a pilot randomized controlled trial, 19 individuals with comorbid insomnia and obstructive sleep apnea were allocated to one of two arms: EX + EX, consisting of two 8-week phases of exercise training (EX), or RE + CBTiEX, encompassing 8 weeks of relaxation training (RE) followed by 8 weeks of combined cognitive-behavioral therapy and exercise (CBTiEX). Outcomes included Insomnia Severity Index (ISI), polysomnography, and cardiorespiratory fitness measures. A mixed-model analysis of variance revealed a Group × Time interaction on peak oxygen consumption change, F(1, 14) = 10.1, p = .007, and EX increased peak oxygen consumption (p = .03, g' = -0.41) and reduced ISI (p = .001, g' = 0.82) compared with RE (p = .49, g = 0.16) post-8 weeks. Post-16 weeks, there was a significant Group × Time interaction (p = .014) driven by RE + CBTiEX yielding a larger improvement in ISI (p = .023, g' = 1.48) than EX + EX (p = .88, g' < 0.1). Objective sleep was unchanged. This study showed promising effects of regular EX alone and combined with cognitive-behavioral therapy for insomnia on ISI in comorbid insomnia and obstructive sleep apnea.

Promoting diversity, equity and inclusion awareness in clinical documentation through postgraduate year one training.

BACKGROUND AND PURPOSE: As healthcare providers increasingly focus on emerging issues of diversity, equity and inclusion (DEI) in patient care, less is known about the training in postgraduate year one (PGY1) pharmacy residency on DEI clinical documentation considerations. This pilot project explored whether training, discussion and self-reflection within a peer review activity promoted DEI self-awareness in clinical documentation through a centralized curriculum of a multisite PGY1. EDUCATIONAL ACTIVITY AND SETTING: Building upon an established peer review of clinical documentation activity, PGY1 pharmacy residents practicing in ambulatory care settings received training on DEI considerations and completed small and large group discussions, a post-activity mixed methods survey with self-reflection prompts, and a three-month follow-up survey. FINDINGS: Twenty-two residents participated in the peer review of clinical documentation activity, DEI training and discussions. Twelve residents completed the post-activity survey with reflection prompts; 6 (50%) reported similar previous DEI training prior to residency. After the DEI training and discussions, 12 (100%) agreed or strongly agreed that their awareness of DEI documentation considerations increased; 10 (83%) would document their submitted notes differently, while one resident was unsure and one would not make changes. Twelve residents completed the follow-up survey three months following the activity. Themes from the free-text responses on key learnings collected post-activity and three-month post (respectively) included: 1) new knowledge, increased self-awareness, and intended action and 2) increased self-awareness and changes in note-making convention. SUMMARY: Integrating DEI training, discussion, and self-reflection prompts into a peer review clinical documentation activity increased self-awareness and knowledge of DEI considerations and promoted intended changes in patient care documentation for pharmacy residents. Regardless of previous training, residents reported continued self-awareness and changes in documentation conventions continued three months later.

Effectiveness of a Voice Training Program for Religious Officials in Turkey.

This study examines the effectiveness of a voice training program designed for Islamic religious officials, who are occupational voice users with a significant vocal load. The participants included 34 healthy religious officials whose acoustic measures were within normal voice ranges for healthy adults (jitter < 1%; shimmer < 3%) and reported no voice complaints. Participants were randomly divided into two groups (experimental, n = 17; control, n = 17). The two-stage voice training program consisted of 32 sessions over 8 weeks with informative and voice exercise stages. Objective and subjective voice measurements were performed at the beginning and end of the research. Objective measurements included fundamental frequency, percentage of vocal pitch perturbation (jitter), percentage of vocal intensity perturbation (shimmer), and harmonics-to-noise ratio. Subjective voice measurements included the Singing Voice Handicap Index, Vocal Fatigue Index (VFI), and Voice-Related Quality of Life (V-RQoL) scores. All initial measurements other than VFI scores were within acceptable limits for both groups. There were no significant differences between the groups initially (p > 0.05) and no significant changes in the control group in the second evaluation (p > 0.05). However, there was significant improvement in the experimental group after the training program in all measures, including VFI scores (p < 0.05). This study shows the positive results of a voice training program. Voice training should be integrated into the formal education of occupational voice users or in-service training programs of relevant institutions.

Transgender and gender diverse curriculum in medical imaging programs: a case study.

BACKGROUND: Transgender and gender diverse (TGD) individuals face barriers, including harassment and discrimination, when accessing healthcare services. Medical imaging procedures require personal information to be shared, such as date of last menstrual cycle and/or pregnancy status; some imaging exams are also invasive or intimate in nature. Terminology is based on binary sex creating an inherently cis-heteronormative environment. TGD patients fear being outed and often feel a need to function as educators and advocates for their care. Incorporation of inclusive healthcare curriculum related to TGD populations is an effective means of educating new health providers and promotes safer and more inclusive spaces in healthcare settings. Educators face barriers which hinder the creation and implementation of TGD content. The purpose of this study was to examine the impacts educators are faced with when creating and delivering TGD content in their medical imaging curriculum. METHODS: A case study of medical imaging programs at a Canadian post-secondary institute was undertaken. Data was collected via semi-structured interviews with faculty. Relevant institutional documents such as strategic plans, policies/procedures, websites, and competency profiles were accessed. Framework analysis was used to analyze the data. RESULTS: The study found seven themes that influence the development of TGD curriculum as follows: familiarity and comfort with the curriculum and content change process; collaboration with other healthcare programs; teaching expertise; management of course workload and related. duties; connections to the TGD community; knowledge of required TGD content and existing gaps in curriculum; and access to supports. CONCLUSIONS: Understanding educators' perspectives can lead to an increased sense of empowerment for them to create and incorporate TGD curriculum in the future. Many post- secondary institutions are incorporating an inclusive lens to educational plans; this research can be used in future curriculum design projects. The goal is improved medical imaging experiences for the TGD population.

Uptake of self-management education programmes for people with type 2 diabetes in primary care through the embedding package: a cluster randomised control trial and ethnographic study.

BACKGROUND: Self-management education programmes are cost-effective in helping people with type 2 diabetes manage their diabetes, but referral and attendance rates are low. This study reports on the effectiveness of the Embedding Package, a programme designed to increase type 2 diabetes self-management programme attendance in primary care. METHODS: Using a cluster randomised design, 66 practices were randomised to: (1) a wait-list group that provided usual care for nine months before receiving the Embedding Package for nine months, or (2) an immediate group that received the Embedding Package for 18 months. 'Embedders' supported practices and self-management programme providers to embed programme referral into routine practice, and an online 'toolkit' contained embedding support resources. Patient-level HbA1c (primary outcome), programme referral and attendance data, and clinical data from 92,977 patients with type 2 diabetes were collected at baseline (months - 3-0), step one (months 1-9), step 2 (months 10-18), and 12 months post-intervention. An integrated ethnographic study including observations, interviews, and document analysis was conducted using interpretive thematic analysis and Normalisation Process Theory. RESULTS: No significant difference was found in HbA1c between intervention and control conditions (adjusted mean difference [95% confidence interval]: -0.10 [-0.38, 0.18] mmol/mol; -0.01 [-0.03, 0.02] %). Statistically but not clinically significantly lower levels of HbA1c were found in people of ethnic minority groups compared with non-ethnic minority groups during the intervention condition (-0.64 [-1.08, -0.20] mmol/mol; -0.06% [-0.10, -0.02], p = 0.004), but not greater self-management programme attendance. Twelve months post-intervention data showed statistically but not clinically significantly lower HbA1c (-0.56 [95% confidence interval: -0.71, -0.42] mmol/mol; -0.05 [-0.06, -0.04] %; p < 0.001), and higher self-management programme attendance (adjusted odds ratio: 1.13; 95% confidence interval: 1.02, 1.25; p = 0.017) during intervention conditions. Themes identified through the ethnographic study included challenges for Embedders in making and sustaining contact with practices and providers, and around practices' interactions with the toolkit. CONCLUSIONS: Barriers to implementing the Embedding Package may have compromised its effectiveness. Statistically but not clinically significantly improved HbA1c among ethnic minority groups and in longer-term follow-up suggest that future research exploring methods of embedding diabetes self-management programmes into routine care is warranted. TRIAL REGISTRATION: ISRCTN23474120, registered 05/04/2018.

The academic formation challenges: what does retail expect from higher education institutions in pharmacy?

BACKGROUND: The drug retail represents the main area of activity for pharmacists worldwide. In Brazil, this sector is responsible for employing around 80% of professionals. Before this reality, the academic training of pharmacists requires specialized skills and knowledge so they can fulfill their tasks. In this sector, considering the influence of managers and mentors on the model of pharmaceutical practice, their perceptions about the demands of the market can help discussions related to the training of pharmacists. AIM: To analyze the academic training of pharmacists for the drug retail market from the perspective of managers and mentors. METHOD: This is a qualitative study conducted with managers and mentors of the drug retail market. A semi-structured interview guide was prepared and applied to the intentionally selected participants. The study was approved by the Research Ethics Committee under the number 4,169,752. The interviews were conducted through videoconference by an experienced researcher. The data obtained were analyzed using Bardin's analysis technique, following the steps of categorical thematic content analysis using the ATLAS.ti software. RESULTS: 19 interviews were carried out. Among the reports, the interviewees highlighted the importance of retail in the employability of pharmacists, as well as inconsistency in the academic training for this sector, originating the following categories: curriculum reform to include the market demands, follow-up and career plan, training for entrepreneurship and sales, practical application of knowledge, and encouragement of experience. CONCLUSION: Pharmaceutical academic training is linked to several challenges, whether organizational, structural, or budgetary. To overcome these challenges, it is necessary to unite the interested parties in the formulation and implementation of a strategy for the professionalization of pharmacists, considering their social role in patient care, aligned with the company's sustainability, so that both coexist.

A 12-Week Ballroom Dance Training Improves Physical Fitness Performance More Than Walking Training in Older Women, Regardless of Vitamin B12 or D Adequacy.

AIM: This study aimed to compare the effects of Ballroom Dancing (BD) versus Walking Training (WT) on the physical fitness performance in physically independent older women with adequate or inadequate levels of vitamins B12 and D. METHODS: Forty-three sedentary women aged 68.5 ± 6.5 years, were allocated to the BD (n = 23) or WT (n = 20) groups. They took part in a 12-week intervention, performed 3 times a week, for about 50 minutes with moderate effort intensity. Data were collected through Short Physical Performance Battery (SPPB), 6 minutes Walk Test (6MWT), Hand Grip Test (HGT), Isokinetic tests for lower limbs and blood tests to detect serum levels of vitamins B12 and D. RESULTS: The BD group performed better after the intervention in relation to the WT in the Sit and Stand Test (SST) (BD pre = 3.1 score vs post = 3.8 score; WT pre = 2.8 score vs post = 3.4 score; P = .02) and in the Peak Torque 180° extension (PKTOQ 180° extension) (BD pre = 56.7 Nm vs post = 61.2 Nm, WT pre = 56.7 Nm vs post = 56.1; P < .01). CONCLUSION: A time effect was observed in all other variables, with the exception of HGT. Both interventions improved physical fitness performance, regardless of the adequacy of vitamins B12 and D, but the older women from BD obtained significant improvements in more variables than the WT.

The Effect of Stroboscopic Vision Training on Blind-folded Straight-line Walking.

Stroboscopic vision training has shown to improve visual-motor control and dynamic visual acuity in sport performance; however, no studies have considered using this training to enhance kinesthetic awareness during walking, applicable to high fall-risk populations. Purpose: The purpose of this study was to assess the effect of stroboscopic vision training on blind-folded straight-line walking. Methods: Thirty-seven college-aged healthy participants (age: 20.14 ± 1.23 years; females: N = 32, males: N = 5) completed this study. In this pre-posttest quasi-experimental investigation, participants with no epileptic or balance disorder history completed a four-week progressive stroboscopic vision training protocol. To assess sensorimotor feedback participants were instructed to walk a 27.5 m straight line while blindfolded. PRE and POST blind-folded straight line walk tests were completed and deviations from endpoint were measured. A paired-samples t-test was used to analyze the calculated deviation angles. Results: Significant difference was noted from PRE (14.48 ± 5.95) to POST (11.60 ± 6.78) deviation angles (t(36) = 2.71, p = 0.01). Conclusions: This is the first study to examine the effects of stroboscopic training on a vision restricted walking task, which demands feedback re-weighting. These findings may be valuable for clinical settings or performance where reliance on non-visual systems may be beneficial.