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Given the complexity of teaching, continuing teacher professional development (CPD) is essential for maintaining and enhancing teaching effectiveness, and bridging the gap between ever-evolving theory and practice. Technological advancements have opened new opportunities for digital tools to support CPD. However, the successful integration of such digital tools into practice poses challenges. It requires adherence to CPD prerequisites and acknowledgment of the complexity of the professional development process. This study explored the applicability of the developed digital PE teacher professional development TARGET-tool in a secondary school PE context. We examined the perceived usability of this tool and gained insights into the process of teachers' professional development as a result of using the tool. Ten PE teachers from different schools implemented the TARGET-tool within their PE context for a period of 4 to 6 weeks. Individual semi-structured interviews and the System Usability Scale provided insights into the perceived usability and the process of teacher professional development. The TARGET-tool demonstrated its potential as an effective tool for supporting teachers' professional development. Future tool improvements were identified to further optimize the perceived usability, such as simplifying complex features, providing additional support and resources, and improving (data) presentations. Using the Interconnected Model of Professional Growth as a theoretical basis, it was demonstrated how the use of the TARGET-tool engages teachers as active and reflective participants in their professional development and induces changes within the external domain, the domain of practice, the domain of consequences, and the personal domain.

Abstract Recent research highlights the abundance of floccule (flocs) in rivers, formed by aggregation of clay particles with organic matter. These flocs affect the transport and the eventual fate of clay. Flocs exhibit distinct behaviour from the unflocculated sedimentary counterparts: they can deform and break, and have higher settling velocities, which may in turn cause flocs to deposit and possibly interact with the riverbed. Here, we conducted systematic experiments in a laboratory flume to identify the mechanisms by which flocs and bedforms interact. Flocs showed a saltating (bouncing) behaviour, and were incorporated in the sediment bed as single flocs, clusters, or strings, via deposition and burial in the lee of a dune. Dune geometry was negligibly impacted by the presence of flocs. In natural systems, the burial of flocculated clay particles can affect contaminant spreading, aquatic ecology, the interpretation of deposition patterns, and clay transport.

Abstract In a recent work, we calculated all three-loop diagrams contributing to the decay amplitude for b → sγ where none of the gluons touch the b-leg. In the present paper, we complete the calculation by working out all remaining three-loop diagrams (of order α s 2 $$ {\alpha}_s^2 $$ ) associated with the current-current operators O 1 and O 2 at the physical value of the charm-quark mass m c . Using the programs AMFlow and DiffExp to solve the differential equations for the master integrals, we obtained precise numerical results at 23 values for z = m c 2 / m b 2 $$ z={m}_c^2/{m}_b^2 $$ , ranging from z = 1/1000 to z = 1/5, along with asymptotic expansions around z = 0. For certain diagrams, the asymptotic expansion breaks down in the physical z-range, necessitating a Taylor expansion (which we do around z = 1/10). In all expansions, we retained power terms up to z 20 and included the accompanying log(z) terms to all powers for asymptotic expansions. Numerical results for the sum of all diagrams (including those calculated in the previous paper) are presented in tabular form, while the mentioned expansions of individual diagram classes are provided electronically. We note that our results for the asymptotic expansions around z = 0 are in good agreement with those recently published by Fael et al. and Czaja et al.

Given the long response time of ice sheets, simulations of the Greenland ice sheet typically exceed the availability of input climate data to reliably simulate the fast processes underlying surface mass balance. Strong feedback processes are known to make the mass balance sensitive to inter- and intra-annual variability. Even simulations with climate models do not always cover the full period of interest, motivating bridging these gaps using relatively coarsely resolved climate reconstructions or temporal interpolation methods. However, both of these approaches usually only provide information about the climatological average but not variability. We investigate how this simplification impacts the surface mass balance using the BErgen Snow SImulator. The model was run for up to 500 years using the same atmospheric climatology but different synthetic variabilities. While changing inter-annual variations has an impact of less than 5 % on the surface mass balance of the Greenland ice sheet, neglecting intra-annual variability by using a daily climatology causes a 40 % change in mass balance. Decomposing the total effect into contributions from different input variables, the biggest contributor is precipitation followed by temperature. Using a daily climatology, a small amount of snowfall every day overestimates the albedo and thus surface mass balance (SMB). We propose a correction that re-captures the effect of intermittent precipitation, reducing the SMB overestimation to 15 %–25 %. We conclude that simulations of the Greenland surface mass and energy balance should be forced with a transient climate, in particular for models that are calibrated with transient data.

Abstract Objectives While flipped classroom instruction has repeatedly shown efficacy in undergraduate medical education, evidence for its utility in procedural domains remains sparse. This holds particular significance for surgical subspecialties such as otolaryngology, which have limited time in undergraduate medical curricula. We designed a novel airway management skills simulation course with a flipped classroom approach and evaluated its efficacy in a pilot study. Methods A simulation course was designed to provide instruction in seven airway management skills: bag valve mask ventilation, laryngoscopy, intubation, cricothyroidotomy, tracheotomy, and tracheostomy care. Publicly available YouTube videos were selected as pre-learning materials. Participating students completed surveys before the pre-learning assignment and after completion of the simulation center workshop. Results Sixteen students participated in the workshop, and data was collected from 14 participants. Learners reported significant improvements in knowledge regarding all covered skills except tracheotomy; mean self-rated knowledge improved from 2.9 to 5.8 (p

We provide a detailed description of the ice-sheet layer age tracer Englacial Layer Simulation Architecture (ELSA) – a model that uses a straightforward method to simulate the englacial stratification of large ice sheets – as an alternative to Eulerian or Lagrangian tracer schemes. ELSA's vertical axis is time, and individual layers of accumulation are modeled explicitly and are isochronal. ELSA is not a standalone ice-sheet model but requires unidirectional coupling to another model providing ice physics and dynamics (the “host model”). Via ELSA's layer tracing, the host model’s output can be evaluated throughout the interior using ice core or radiostratigraphy data. We describe the stability and resolution dependence of this coupled modeling system using simulations of the last glacial cycle of the Greenland ice sheet using one specific host model. Key questions concern ELSA's design to maximize usability, which includes making it computationally efficient enough for ensemble runs, as well as exploring the requirements for offline forcing of ELSA with output from a range of existing ice-sheet models. ELSA is an open source and collaborative project, and this work provides the foundation for a well-documented, flexible, and easily adaptable model code to effectively force ELSA with (any) existing full ice-sheet model via a clear interface.

Abstract This paper introduces three novel approaches to size geothermal energy piles in a MILP, offering fresh perspectives and potential solutions. The research overlooks MILP models that incorporate the sizing of a geothermal borefield. Therefore, this paper presents a new model utilizing a g-function model to regulate the power limits. Geothermal energy is an essential renewable source, particularly for heating and cooling. Complex energy systems, with their diverse sources of heating and cooling and intricate interactions, are crucial for a climate-neutral energy system. This work significantly contributes to the integration of geothermal energy as a vital energy source into the modelling of such complex systems. Borehole heat exchangers help generate heat in low-temperature energy systems. However, optimizing these exchangers using mixed-integer-linear programming (MILP), which only allows for linear equations, is complex. The current research only uses R-C, reservoir, or g-function models for pre-sized borefields. As a result, borehole heat exchangers are often represented by linear factors such as 50 W/m for extraction or injection limits. A breakthrough in the accuracy of borehole heat exchanger sizing has been achieved with the development of a new model, which has been rigorously compared to two simpler models. The geothermal system was configured for three energy systems with varying ground and bore field parameters. The results were then compared with existing geothermal system tools. The new model provides more accurate depth sizing with an error of less than 5 % compared to simpler models with an error higher than 50 %, although it requires more calculation time. The new model can lead to more accurate borefield sizing in MILP applications to optimize energy systems. This new model is especially beneficial for large-scale projects that are highly dependent on borefield size.

Young people's room for autonomy and independent life choices is challenged by intensive parenting practices and ambiguous ideals underpinning the youth-parent relationship. In this article, we explore how young people make sense of and relate to parental influence as they are about to make choices of higher education. Through Foucauldian discourse analyses of interviews with 23 young men and women (19 years) in Oslo, Norway, this study sheds light on how the youth reconciled ideals of self-expression and self-determination with perceived parental influence. We demonstrate how their 'autonomous self' is portrayed as 'accountable' and 'malleable', to allow for parent's influence through their subject positions as 'advisor' and 'socialising agent'. These subject positions overlap with discourses of intensive parenting previously described as disciplining the modern parent. We discuss whether youth contribute to the cultivation of 'the intensive parent', and the potential the ideal of autonomy holds for conformity to normalizing powers.

In the acute care setting, we often ask families to make challenging decisions regarding their loved ones’ preferences and choices for end of life care when these individuals can no longer make those decisions themselves. This already stressful situation can be exacerbated by medical jargon and conflicting messaging from various well-meaning health care practitioners. Some of this ambiguity likely stems from medical providers’ lack of familiarity with end-of-life policies and their obligations as providers. Further, there can be discomfort for many families and clinicians about speaking about end of life, alongside varying cultural norms and expectations around death and dying. In this analysis, we aim to outline fundamental concepts and misconceptions surrounding cardiopulmonary resuscitation (“CPR”), the administration and withdrawal of life-sustaining therapies, and the framework provided by regulatory bodies for medical professionals to approach these situations. As legal and ethical principles may vary nationally between jurisdictions, our discussion will be based on Ontario policy and law. However, we believe that a similar approach would help hospitals and health care bodies provide clarity to clinicians, patients and families alike, and could be easily adapted into medical education materials.

IntroductionAs life expectancy and expected years in retirement rise and family structures change, the need for personal financial protections, such as long term care (LTC) insurance, in managing financial risks associated with later life is expected to increase. Roughly half of American households are at risk of not being able to maintain their present standards of living post-retirement. Because both public and private health insurance programs typically do not cover LTC needs, which are associated with significant costs, the potential demand for LTC further exacerbates the retirement savings crisis.MethodsUsing an original survey experiment, in this high-powered study (N = 1,450), we examine the impact of a 2×3 framing intervention on participants' attitudes, emotions, and behavioral intentions toward LTC insurance.ResultsResults indicated that direct framing effects were present for people's reported emotions: those who received a loss frame (compared to a gain frame) were more likely to report anxiety-related emotions, and those who were exposed to a care choice narrative frame (compared to a family or a financial frame) were more likely to report calmness-related emotions. There were no significant interaction effects between loss/gain and narrative frames. A mediation analysis suggested that the framing impacts acted through these two different emotional pathways to yield more positive attitudes toward and behavioral intentions around LTC.ImplicationsThe study results underscore the need to examine how different frames affect emotional arousal as a potential pathway to impacting attitudes and behaviors. We found that both a loss framing and a narrative framing, operating through different emotional pathways, have the potential to be helpful to nudge people to hedge against a financial risk associated with older age.

ObjectiveTo determine the relationship between success at peak performance age and quantity of within-sport distance variety and compare the dose-time-effect between swimming and track running by determining probability of becoming an international-class female athlete based on the number of different race distances the athletes compete in each year throughout their development process.MethodsRace times of female Tier 2 to Tier 5 freestyle pool swimmers (n = 2,778) and track runners (n = 9,945) were included in the present study. All athletes were ranked according to their personal best at peak performance age. Subsequently, number of different race distances during each year were retrospectively extracted from peak performance to early junior age. Personal best performance points at peak performance age were correlated with the number of different race distances across the various age categories. Poisson distribution determined the dose-time-effect of becoming an international-class athlete based on the number of different swimming strokes.ResultsAt peak performance age, correlation analysis showed a larger within-sport distance variety for higher ranked athletes, particularly for track runners (r ≤ 0.35, P

Policy perspectives on sustainability, particularly those dominating an era, can have long-lasting effects and shape the context in which decisions are made. Historical analyses of sustainability perspectives applied in policymaking can enrich our understanding of the sources contributing to decision-making processes. Through an in-depth analysis of policy documents published between 1986 and 2022 and interviews with former and current policymakers, we have studied the development of the Dutch regional government of Flevoland’s perspectives on sustainability in the agricultural sector. We developed a framework to guide our analysis of the concepts and rhetoric used and the assumptions made about social-ecological relationships, nature values, and structure and agency. Our findings show a gradual evolution of policy perspectives on sustainability, moving from an economic focus to recognising ecological value and the agricultural sector’s role in addressing environmental and social issues. However, aspects of social sustainability remain narrowly addressed, focusing on business aspects while overlooking farmers’ multifaceted roles and challenges. Moreover, despite encouraging farmer-led sustainability initiatives, the Province struggles to clarify its sustainability strategy and implement concrete measures. These insights can help challenge previously unquestioned or unknown assumptions and be instrumental in crafting better integrated and effective policy measures aimed at addressing sustainability challenges.

Introduction Sex differences in blood pressure (BP), hypertension and hypertension mediated cardiovascular complications have become an increasingly important focus of attention. This narrative review gives an overview of current studies on this topic, with the aim to provide a deeper understanding of the sex-based disparities in hypertension with essential insights for refining prevention and management strategies for both men and women.Methods and results We searched Medline, Embase and the Cochrane libray on sex differences in BP-trajectories and hypertension prevalence. In the past decade various population-based studies have revealed substantial sex-disparities in BP-trajectories throughout life with women having a larger increase in hypertension prevalence after 30 years of age and a stronger association between BP and cardiovascular disease (CVD). In general, the effects of antihypertensive treatment appear to be consistent across sexes in different populations, although there remains uncertainty about differences in the efficacy of BP lowering drugs below 55 years of age.Conclusion The current uniform approach to the diagnosis and management of hypertension in both sexes neglects the distinctions in hypertension, while the differences underscore the need for sex-specific recommendations, particularly for younger individuals. A major limitation hampering insights into sex differences in BP-related outcomes is the lack of sex-stratified analyses or an adequate representation of women. Additional large-scale, longitudinal studies are imperative.

Introduction: Rural physician engagement in continuous quality improvement (CQI) activities is vital to improving quality of care, patient safety, and healthcare delivery efficiencies. However, there is a lack of evidence surrounding the barriers and facilitators to CQI uptake across rural medical practices. This study aimed to explore enablers and barriers to CQI implementation and identify ways to foster greater engagement of rural physicians. Methods: A mixed-methods triangulation study design was undertaken encompassing a survey and focus group interviews with physicians practising in rural communities of British Columbia, Canada. Results: The survey was distributed to 1584 rural physicians, and 299 responses were received (response rate of 19%). Seven focus groups were conducted with 33 participants. Survey respondents indicated strong support towards CQI and the benefits of improved patient outcomes and practice quality. Less than half (47%) of respondents had participated in a CQI initiative within the previous 2 years. Key barriers to CQI engagement included time constraints, limited knowledge of CQI principles, and a lack of understanding of accessing and using relevant data. Key motivators for CQI engagement were opportunities for peer collaboration and receiving practice improvement feedback. Key enablers included more usable and accessible data and appropriate staffing resources to assist with undertaking CQI activities. Conclusion: Given rural physicians' time demands, better support systems are required to enhance rural physician engagement in systematic CQI activities. Specific support areas include dedicated CQI staff resources and better practice data systems and processes to support CQI initiatives.

Summary: Background: Surviving sepsis can lead to chronic physical, psychological and cognitive impairments, which affect millions of patients worldwide, including survivors after COVID-19 viral sepsis. We aimed to characterize the magnitude and trajectory of functional dependence and new impairments post-sepsis. Methods: We conducted a prospective cohort study including sepsis survivors who had been discharged from five German intensive care units (ICUs), until 36 months post-discharge. Primary outcome was functional dependence, defined as ≥1 impaired activity of daily living (ADL; 10-item ADL score

In the United States, early childhood programs inclusive of nature experiences for young children vary widely in terms of time spent outdoors; purpose of the program, approaches to use of the environment, curricular aims and support of young children's development. A commonality across many of these early childhood programs available in the United States is their focus on nature as a context for learning and play, some with an intentional approach to teaching about the environment, and, less commonly, to overtly engage with early childhood education for sustainability (ECEfS). The early childhood years are seen as a critically important time for learning, as well as for development of pro-environment behaviors and dispositions (Chawla & Derr, 2012), underscoring the importance of nature-based early learning.

Abstract Viruses are core components of the human microbiome, impacting health through interactions with gut bacteria and the immune system. Most human microbiome viruses are bacteriophages, which exclusively infect bacteria. Until recently, most gut virome studies focused on low taxonomic resolution (e.g., viral operational taxonomic units), hampering population-level analyses. We previously identified an expansive and widespread bacteriophage lineage in inhabitants of Amsterdam, the Netherlands. Here, we study their biodiversity and evolution in various human populations. Based on a phylogeny using sequences from six viral genome databases, we propose the Candidatus order Heliusvirales. We identify heliusviruses in 82% of 5441 individuals across 39 studies, and in nine metagenomes from humans that lived in Europe and North America between 1000 and 5000 years ago. We show that a large lineage started to diversify when Homo sapiens first appeared some 300,000 years ago. Ancient peoples and modern hunter-gatherers have distinct Ca. Heliusvirales populations with lower richness than modern urbanized people. Urbanized people suffering from type 1 and type 2 diabetes, as well as inflammatory bowel disease, have higher Ca. Heliusvirales richness than healthy controls. We thus conclude that these ancient core members of the human gut virome have thrived with increasingly westernized lifestyles.