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Aim: The aim of this study was to explore communication apprehension and communication self-efficacy in undergraduate nursing students and identify factors that contribute to communication apprehension and communication self-efficacy., Background: Communication education and skills training is often incorporated into undergraduate nursing curricula; however, communication competence continues to be a problem for novice nurses. Communication apprehension is a concept that has been only minimally researched in nursing education and can have a negative impact on student communication readiness., Design: This study employed a cross-sectional design and surveyed a national sample of undergraduate nursing students between October 2022 and March 2023., Methods: An online survey was sent out to undergraduate nursing student members of the National Student Nurses Association as well as nursing education programs in 8 states and the District of Columbia. The survey was comprised of demographic questions, the Personal Report of Communication Apprehension, and the communication subscale of the Nursing Student Self-Efficacy Survey., Results: Approximately 22.1 % of the students had high communication apprehension, with the highest communication apprehension in public speaking and classroom communication. Communication self-efficacy scores ranged from 12 to 40, with a mean of 31.65 (SD = 6.28). Communication apprehension and communication self-efficacy were significantly negatively correlated. Positive and negative affect were significant predictors of communication apprehension. Affect, as well as current healthcare employment were significant predictors of communication self-efficacy. When controlling for all demographic, educational, and psychological variables, communication apprehension was a significant predictor of communication self-efficacy., Conclusions: This study is one of the few to explore communication apprehension in undergraduate nursing students. Data demonstrated that communication apprehension is a prevalent problem for many nursing students. Communication apprehension was also found to be a significant predictor of communication self-efficacy after controlling for all other variables. Progression through nursing education did not show a correlation with a decrease in the students' communication apprehension or increase in communication self-efficacy. Given these findings, educational efforts aimed at reducing communication apprehension and enhancing students' school-related affect could contribute to an improvement in communication self-efficacy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The Antarctic Circumpolar Current (ACC) represents the world's largest ocean-current system and affects global ocean circulation, climate and Antarctic ice-sheet stability 1-3 . Today, ACC dynamics are controlled by atmospheric forcing, oceanic density gradients and eddy activity 4 . Whereas palaeoceanographic reconstructions exhibit regional heterogeneity in ACC position and strength over Pleistocene glacial-interglacial cycles 5-8 , the long-term evolution of the ACC is poorly known. Here we document changes in ACC strength from sediment cores in the Pacific Southern Ocean. We find no linear long-term trend in ACC flow since 5.3 million years ago (Ma), in contrast to global cooling 9 and increasing global ice volume 10 . Instead, we observe a reversal on a million-year timescale, from increasing ACC strength during Pliocene global cooling to a subsequent decrease with further Early Pleistocene cooling. This shift in the ACC regime coincided with a Southern Ocean reconfiguration that altered the sensitivity of the ACC to atmospheric and oceanic forcings 11-13 . We find ACC strength changes to be closely linked to 400,000-year eccentricity cycles, probably originating from modulation of precessional changes in the South Pacific jet stream linked to tropical Pacific temperature variability 14 . A persistent link between weaker ACC flow, equatorward-shifted opal deposition and reduced atmospheric CO 2 during glacial periods first emerged during the Mid-Pleistocene Transition (MPT). The strongest ACC flow occurred during warmer-than-present intervals of the Plio-Pleistocene, providing evidence of potentially increasing ACC flow with future climate warming., (© 2024. The Author(s).)

Parents self-medicating their children with antibiotics (SMA) without consulting healthcare professionals is a common practice in China. Previous research has focused primarily on examining the socioeconomic factors that contribute to the prevalence of SMA. This study adopts and extends the theory of planned behavior to understand the cognitive and emotional factors that are associated with parental SMA in China. The responses to an online survey were collected from 961 parents of children aged 6-12 years old, primarily from Gansu, Shandong, and Shaanxi provinces. More than half of the participants (66.5%) engaged in parental SMA. Amoxicillin, Cephradine, and Azithromycin were the most frequently selected antibiotics used for children. Structural equation modeling showed that uncertainty was positively associated with negative emotions, which were in turn positively associated with attitude toward SMA. Uncertainty was also negatively associated with perceived behavioral control (PBC), but the association between PBC and SMA behavior was not significant. Attitude and subjective norm were both positively associated with SMA behavior. The relationship between subjective norm and attitude was also positive. Understanding the psychological factors driving parental SMA may inform tailored interventions to promote responsible antibiotic use among parents.

Background: Early detection is a critical part of reducing the burden of breast cancer and breast selfexamination (BSE) has been found to be an especially important early detection strategy in low and middle income countries such as Malaysia. Although reports indicate that Malaysian women report an increase in BSE activity in recent years, additional research is needed to explore factors that may help to increase this behavior among Southeastern Asian women., Objective: This study is the first of its kind to explore how the predicting variables of self-efficacy, perceived barriers, and body image factors correlate with self-reports of past BSE, and intention to conduct future breast self-exams among female students in Malaysia., Materials and Methods: Through the analysis of data collected from a prior study of female students from nine Malaysian universities (n=842), this study found that self-efficacy, perceived barriers and specific body image sub-constructs (MBSRQ-Appearance Scales) were correlated with, and at times predicted, both the likelihood of past BSE and the intention to conduct breast self-exams in the future., Results: Self-efficacy (SE) positively predicted the likelihood of past self-exam behavior, and intention to conduct future breast self-exams. Perceived barriers (BR) negatively predicted past behavior and future intention of breast self-exams. The body image sub-constructs of appearance evaluation (AE) and overweight preoccupation (OWP) predicted the likelihood of past behavior but did not predict intention for future behavior. Appearance orientation (AO) had a somewhat opposite effect: AO did not correlate with or predict past behavior but did correlate with intention to conduct breast self-exams in the future. The body image sub-constructs of body area satisfaction (BASS) and self-classified weight (SCW) showed no correlation with the subjects' past breast self-exam behavior nor with their intention to conduct breast self-exams in the future., Conclusions: Findings from this study indicate that both self-efficacy and perceived barriers to BSE are significant psychosocial factors that influence BSE behavior. These results suggest that health promotion interventions that help enhance self-efficacy and reduce perceived barriers have the potential to increase the intentions of Malaysian women to perform breast self-exams, which can promote early detection of breast cancers. Future research should evaluate targeted communication interventions for addressing self-efficacy and perceived barriers to breast self-exams with at-risk Malaysian women. and further explore the relationship between BSE and body image.