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BackgroundUniversal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent’s commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves. ObjectiveTo assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program’s implementation. MethodsA mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included. ResultsThe study was approved by the Umeå Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021. ConclusionsMethodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080 International Registered Report Identifier (IRRID)DERR1-10.2196/21100

This study investigates how Swedish learners make sense of and perceive English instruction and the process of foreign language learning in a target language-only primary school classroom. In small group discussions, 26 learners aged 9-10 were audio recorded while discussing questions related to their language learner beliefs and their classroom experiences. Learners expressed a strong consensus about the importance of both the teacher's extensive target language input and the learners' oral engagement, in alignment with the beliefs of the teacher. However, the analysis identified three mismatches among high anxiety learners in this context, related to incomprehensible teacher talk, social fear of making mistakes and classroom organization. As their voiced beliefs were at odds with their emotionally guided behavior of refraining from asking questions or volunteering to speak, their sense of agency was reduced. In this context, the target language-only approach appeared to have a negative impact on the emotional, organizational and instructional dimensions of foreign language instruction for many of the young learners. The findings illustrate the interrelated dynamics of beliefs, emotions and classroom context, and contribute to our understanding of learners' foreign language anxiety and sense of agency in the primary foreign language classroom.

Introduction: The gerontological literature suggests that external housing-related control beliefs (HCB) influence activities of daily living (ADL) among older people, but knowledge is scarce for people with Parkinson's disease (PD). This longitudinal study aimed to explore the directions of the relationship between external HCB and ADL among people with PD. Methods: Baseline (T1) and 3-year follow-up data (T2) were collected from 154 people with PD (mean age = 68 years, T1). Two regression analyses were applied, where dependent (T2 values) and independent (T1 values) variables—external HCB score and PD specific ADL (PADLS)—were switched, adjusting for age, disease severity, cognitive functioning, and accessibility problems. Results: There was a significant effect of ADL on external HCB (β = 3.07, p <.001, CI [1.28, 4.85]), but no effect in the reverse direction. The proportion with moderate-extreme ADL difficulties increased over time (from 20.8% to 32.5%, p =.006). Discussion: ADL difficulties seem to lead to higher external HCB, but not the other way around, which contradicts assumptions in environmental gerontology theories. This new knowledge can promote theory development. While additional studies are required to verify whether this is a disease-specific finding, this indicates the importance of targeting ADL if the purpose is to influence external HCB among people with PD. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the optic disc and macula in a large cohort of patients with different severity of optic nerve hypoplasia (ONH) using high‐resolution spectral domain optical coherence tomography (SD‐OCT). Methods: In total, 36 patients (52 ONH eyes and 17 fellow eyes in unilateral cases) and 45 healthy right eyes from 45 controls were evaluated. All patients underwent an examination to confirm the diagnosis. SD‐OCT images of the disc and macula were obtained and analysed both quantitatively and qualitatively. Results: OCT in ONH eyes demonstrated a shorter disc diameter (1061 ± 375 μm vs. 1751 ± 221 μm, p < 0.001), shallower mean cup depth (427 ± 171 μm vs. 551 ± 152 μm, p = 0.01), thinner ganglion cell complex (GCC) perifoveally (47.3 ± 13.0 μm, 60.8 ± 6.0 μm, p < 0.001) and reduced foveal depth (61 ± 36 μm, 119 ± 19 μm, p < 0.001) compared to control eyes. Qualitative analysis showed that 1/3rd of ONH eyes lacked signs of an optic cup, and 2/3rd had reduced or no sign of a foveal pit. Fellow eyes had shorter disc diameter (1446 ± 404 μm vs. 1751 ± 221 μm, p = 0.004) and reduced foveal depth (93 ± 27 μm vs. 119 ± 19 μm, p < 0.001) but similar GCC thickness (60.8 ± 7.1 μm vs. 60.8 ± 6.0 μm, p = 0.738) compared to controls. Disc diameter showed the best correlation with visual acuity in ONH eyes (ρ = 0.517, p < 0.001). Conclusion: ONH eyes have reduced GCC thickness and reduced or no foveal pit. Fellow eyes in presumed unilateral cases have a smaller disc diameter and reduced foveal depth compared to controls, suggesting the possibility of subclinical/mild disease. However, GCC thickness was normal. The correlation between structure and visual function is not always straightforward. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to describe nurse managers' perceptions of the provision of mentoring for newly graduated registered nurses (NGRNs) and its contribution to the work environment in a hospital setting. Background: Nurse managers are responsible for the work environment and for supporting the staff's professional development, which includes giving NGRNs organizational support during their introduction to the workplace. Mentorship is one common way to provide support, but there is a lack of knowledge about how nurse managers view this support. Design/Method: This was a qualitative descriptive study, using a semi‐structured interview guide. Fifteen individual interviews with nurse managers were performed in hospital settings. The interview transcripts were analysed using qualitative content analysis. The COREQ guidelines and checklist were used. Results: The results describe the nurse managers' perceptions of the provision of mentoring in three themes: Ensuring and sustaining mentoring for new nurses' needs is a struggle in the harsh reality of healthcare, Identifying mentors who are willing and possess the necessary competence for the assignment and Promoting a secure and attractive workplace by mentoring new nurses. Conclusions: Our study confirms that nurse managers are important in the provision of mentoring for NGRNs' learning and professional development. Mentoring has a positive spillover effect on the entire unit as a sustainable approach to securing and improving the work environment. Our study also identifies challenges for nurse managers to structure mentoring provision. Implications for the profession and/or patient care: This study highlights the importance of investment in mentoring for the NGRNs' professional development and for patient care. Support is needed from the top level of the organization, but how mentoring should be structured and facilitated needs to be investigated further. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence. Research aim: This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic. Research design: This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and analysed thematically. Participants and research context: Healthcare teachers (n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated. Ethical considerations: This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research. Findings: Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students' ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone's needs, and who gets my time? Conclusions: This study highlights the importance of healthcare teachers' continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers. [ABSTRACT FROM AUTHOR]

Studies on music reading have provided insights into the cognitive processes in sight singing. However, there has been limited research on sight singing in a group setting. This study aims to assess how choral singers approach music reading as they perform previously unfamiliar choral scores together. We addressed (1) how singers’ gaze direction is distributed over staff systems, and (2) how their gaze behaviour is influenced by note density and repeated practice. Four quartets, a total of sixteen experienced singers, performed eight Baroque music excerpts three times, while the singers’ eye movements were recorded. Eye-movement measures were analysed in conjunction with the singers’ views regarding their music reading, obtained through questionnaires and group discussions. Results reveal that besides reading their own voice lines, singers typically inspected the neighbouring lines, seeking visual cues to coordinate the performance. The results of a generalised linear mixed model analysis underscore the substantial influence of note density on fixation durations on one’s own lines, but not on other voices’ lines. Practice, on the other hand, exhibited effects only on average fixation duration for one’s own lines, with no significant impact observed on other lines. The study provides evidence of coordination between an actual sight-reading process and a parallel information-gathering process that helps singers relate their parts to the overall musical structure. [ABSTRACT FROM AUTHOR]

Background: Optic pathway glioma (OPG) is a feared complication to neurofibromatosis type 1 (NF1) since it can cause visual impairment in young children. The main goal of screening is to detect symptomatic OPGs that require treatment. Optical coherence tomography (OCT) has been suggested as a tool for detection of neuro-retinal damage. Aims: To investigate whether the ganglion cell layer assessed by OCT is a reliable measure to identify and detect relapses of symptomatic OPGs in children with NF1. Methods: Children (3–6 years) with NF1, with and without known OPG and children with sporadic OPG (S-OPG) resident in the Stockholm area, were invited and followed in a prospective study during a three-year period. Brain magnetic resonance tomography (MRI) had been performed in children with symptoms of OPG. Outcome measures were VA in logMAR, visual field index (VFI), average thicknesses of the ganglion cell-inner plexiform layer (GC-IPL), and peripapillary retinal nerve fiber layer (pRNFL). Results: There were 25 children with MRI-verified OPG and 52 with NF1 without symptomatic OPG. Eyes from NF1 patients without symptoms of OPG showed significantly better results in all four analyzed parameters compared to eyes with NF1-associated OPG. Mean GC-IPL measurements seemed stable and reliable, significantly correlated to pRNFL (correlation coefficient (r) = 0.662, confidence interval (CI) =.507 to.773 p<0.001), VA (r = -0.661, CI = -7.45 to -.551, p<0.001) and VFI (r = 0.644, CI =.452 to.774, p<0.001). GC-IPL measurements were easy to obtain and acquired at considerably younger age than pRNFL (5.6±1.5 vs 6.8±1.3; p<0.001). Conclusions: The mean GC-IPL thickness could distinguish well between eyes with OPG and eyes without symptomatic OPG in children with NF1. As thinning of GC-IPL assessed with OCT could indicate underlying OPG, it should be included in the screening protocol of children with questionable VA measurements and in particular in children with NF1. [ABSTRACT FROM AUTHOR]