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Fragile X syndrome (FXS), the leading heritable cause of intellectual disability, has a co-occurrence rate of autism spectrum disorder (ASD) estimated at ~60%. The onset and rates of motor development in FXS are slower relative to neurotypical development, and even more so in the context of co-occurring FXS + ASD. Extant evidence suggests these differences are likely to affect communication, yet this developmental process or how it varies in the context of co-occurring ASD remains unknown in FXS. We aimed to delineate developmental associations between early motor abilities and their rate of development from 9 to 60 months of age on communication outcomes in 51 children with FXS, 28 of whom had co-occurring ASD. We also aimed to identify variation in these developmental associations in the context of co-occurring ASD. Results captured within-syndrome variability in these developmental associations as a function of co-occurring ASD. Fine motor proved to be a robust predictor of receptive communication regardless of co-occurring ASD, but we identified differences between FXS with and without ASD in the association between aspects of motor development and expressive outcomes. Findings provide evidence for differential developmental processes in the context of co-occurring ASD with implications for timely developmental intervention.

Background: The ability of outdoor educators and their participants to be present with each other and the natural and cultural histories of places can impact the realisation of learning outcomes and safety. Purpose: In this paper, we combine the findings of two separate research studies regarding the potential for digital technology to both distract and enhance the presence that both facilitators and their learners may experience in outdoor education programs. Methodology/Approach: Research Study One used a naturalistic inquiry to collect data via surveys and online interviews with 185 outdoor educators from 14 different countries. Research Study Two used a collective case study involving undergraduate outdoor education programs in Norway. Data were collected from 12 educators and 12 learners using semi-structured interviews and focus group interviews. Findings/Conclusions: Decisions on inclusion or exclusion of digital technology in outdoor education should be intentional, systematic, and evidence-based. The use of mobile technologies can pose barriers to learners' and educators' presence, their social interactions, and their experience of place. Implications: Digital technology can enhance or detract the experience of presence in outdoor education programs depending on how that technology is used, and the way the technology is managed.

INTRODUCTION: Across specialties, surgeons over-prescribe opioids to patients after surgery. We aimed to develop and implement an evidence-based calculator to inform post-discharge opioid prescription size for gynecologic oncology patients after laparotomy. METHODS: In 2021, open surgical gynecologic oncology patients were called 2-4 weeks after surgery to ask about their home opioid use. This data was used to develop a calculator for post-discharge opioid prescription size using two factors: 1) age of the patient, 2) oral morphine equivalents (OME) used by patients the day before hospital discharge. The calculator was implemented on the inpatient service from 8/21/22 and patients were contacted 2-4 weeks after surgery to again assess their opioid use at home. RESULTS: Data from 95 surveys were used to develop the opioid prescription size calculator and are compared to 95 post-intervention surveys. There was no difference pre- to post-intervention in demographic data, surgical procedure, or immediate postoperative recovery. The median opioid prescription size decreased from 150 to 37.5 OME (p

BACKGROUND: Racial and ethnic disparities in pain management are well documented. Differences in pain assessment and management by language have not been studied in the postoperative setting in gynecologic surgery. OBJECTIVE: This study aimed to investigate the association between language and immediate postoperative pain management by comparing pain assessments and perioperative opioid use in non-English speakers and English speakers. STUDY DESIGN: This was a retrospective cohort study comparing perioperative outcomes between non-English-speaking patients and English-speaking patients who had undergone a gynecologic oncology open surgery between July 2012 and December 2020. The primary language was extracted from the electronic medical record. Opioid use is expressed in oral morphine equivalents. Proportions are compared using chi-square tests, and mean values are compared using 2-sample t tests. Although interpreter services are widely available in our institution, the use of interpreters for any given inpatient-provider interaction is not documented. RESULTS: Between 2012 and 2020, 1203 gynecologic oncology patients underwent open surgery, of whom 181 (15.1%) were non-English speakers and 1018 (84.9%) were English speakers. There was no difference between the 2 cohorts concerning body mass index, surgical risk score, or preoperative opioid use. Compared with the English-speaking group, the non-English-speaking group was younger (57 vs 54 years old, respectively; P

Background: 'Snack writing' is a term coined to describe regular short bursts of writing on a larger academic writing task. There is extensive research on academic writing, but research on 'snack writing' is limited. Moreover, the idea of 'snack writing' in an online environment is not evident in the literature. Objectives: The study objectives were: (1) to evaluate the effectiveness of an online 'snack writing' group; and (2) to identify what might enable or constrain productive academic writing amongst group members. Method: A reflective evaluation approach was used, in which participant researchers studied online chat data over a 6-month period. The study was framed by Activity Theory, in which digitally connected writing is understood as a new mediational means within an academic writing system. Results: 'Snack writing' in a digital environment was found to be effective when the writing task was focused, appropriate to the time available, and connected to a larger writing task. Goal setting, debriefing, and reflecting kept writers focused, while seeing a writing task develop over time enhanced confidence. Including writers with different levels of experience was effective for developing and sharing writing practices. Conclusion: Regular participation in digitally connected 'snack writing' is effective as it builds a supportive writing culture. Contribution: The study contributes to an understanding of how short bursts of writing in a digitally connected space could benefit academic tasks. The findings are therefore of use to postgraduate scholars, academics, and all those who want to progress an academic writing task when time is limited.

One teacher preparation program worked toward improving teacher preparation by strengthening the network of support among teacher candidates, mentor teachers, and teacher educators. Drawing on third-generation cultural historical activity theory, we modeled activity systems framing the experiences of teacher candidates and contradictions within and between activity systems. Using cycles of learning over one year, we learned 1) how direct and indirect activity systems interact and 2) how meaningful and influential contradictions erupt between two systems. Contradictions included the theory-practice divide alongside the implementation of equity supports, the teacher candidates' navigation of their role, and shifting rules during the transition to distance learning across contexts during COVID-19. This study has implications for enacting dynamic, program-wide change in teacher education programs.

Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.

BACKGROUND: The efficacy of simvastatin in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. METHODS: In an ongoing international, multifactorial, adaptive platform, randomized, controlled trial, we evaluated simvastatin (80 mg daily) as compared with no statin (control) in critically ill patients with Covid-19 who were not receiving statins at baseline. The primary outcome was respiratory and cardiovascular organ support-free days, assessed on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support through day 21 in survivors; the analyis used a Bayesian hierarchical ordinal model. The adaptive design included prespecified statistical stopping criteria for superiority (>99% posterior probability that the odds ratio was >1) and futility (>95% posterior probability that the odds ratio was

Abstract Background Patients with kidney failure often lack robust evidence because they are excluded from randomized trials. Trial emulation provides an alternative approach to derive treatment effect estimates when randomized trials cannot be conducted. Critical questions about the comparative efficacy and safety of interventions in kidney failure are now being answered using this approach or parts of it. However, variations and inconsistencies in reporting cast doubt on the reliability and validity of effect estimates not derived from randomized trials. The aim of this methodological systematic review is to understand the extent to which the target study approach is used in kidney failure and the appropriateness of this approach. By identifying and evaluating studies that qualify as emulating a target trial, compared with studies that did not apply the principles. We aim to provide more specific methodological guidance to increase the clarity and reliability of reporting treatment effect estimates when running a trial in kidney failure is not feasible. Methods This protocol is developed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P) statement. MEDLINE, Embase, and reference lists (backwards citation chasing) will be searched up until 1st July 2023 and the search updated prior to publication to identify all studies evaluating patient outcomes in late-stage kidney disease and failure that use target trial emulation as the primary approach for analysis. Two authors (A. A., P. K.) will select articles based on title and abstract and then full text, with a third reviewer settling disagreements (J. P.). The prespecified variables will be extracted, and the risk of bias will be assessed by at least two authors (A. A., P. K., A. N.) using prespecified data forms. This will enable the determination of the robustness of the methodological quality of observational studies in using the whole or elements of the target trial approach. We will thereby assess their ability to reliably report treatment effect estimates. Discussion We will provide specific methodological recommendations on how to design target trials and model assumptions for emulation to get reliable treatment effect estimates for therapeutic interventions in kidney failure. Methodological systematic review registration Open Science Framework: Identifier https://doi.org/10.17605/OSF.IO/Z4Y29 .

Abstract Background While several validated sports nutrition knowledge questionnaires exist, none are specifically designed to assess the sports nutrition knowledge (SNK) of Sri Lankan track and field athletes. This study aims to validate the Sri Lankan Sports Nutrition Knowledge Questionnaire (SLn-SNKQ), tailored for this athlete group, to provide more accurate and meaningful insights for research and practice. This will enable health professionals and coaches to confidently assess athletes’ nutrition knowledge, which directly influences their food choices. Methods The validity of the questionnaire was established through a multi-step approach. Content validity was achieved via ratings from nutrition experts, all of whom had specialized training in human nutrition and experience of working with athletes. Face validity was evaluated through in-depth telephone interviews with elite or highly trained athletes, using a retrospective think-out-loud protocol to gather feedback on the clarity and relevance of the questions. Construct validity involved nutrition-trained doctors (NTG), non-nutrition-trained professionals (NNTG), and elite-level athletes’ groups (AG). Internal consistency was assessed using Cronbach’s alpha, and test-retest reliability was evaluated. Results The final tool comprised 123 individual statements or prompts (items) that were organized into 32 broader questions, spanning 12 sub-sections. Content validity was confirmed by fully integrating 49 out of 70 comments and partially integrating four comments received from nutrition experts for each sub-section. Face validity was established by fully integrating 33 out of 40 comments received from 16 elite and highly trained athletes. Construct validity was confirmed, indicating significant differences in the total scores achieved as a percentage of the SLn-SNKQ among the NTG (462.5, 92.5%), NNTG (223.5, 44.7%), and AG (235, 47.0%; p 0.7). Conclusions The SLn-SNKQ has been validated and demonstrates robust psychometric properties, offering a reliable tool for assessing SNK among Sri Lankan track and field athletes.

Abstract Background Diabetes in pregnancy is associated with short and long-term adverse health outcomes for mothers and babies. The condition disproportionately impacts Pacific, Maaori, and Indian pregnancies. Those with diabetes are offered intensive support during pregnancy, but in many centres, no additional support following birth beyond routine care. The aim of this study was to determine the postpartum needs for mothers and whaanau (family) impacted by diabetes in pregnancy, to inform co-design of a new service to improve metabolic and developmental outcomes for infants. Methods Pregnancies complicated by diabetes were identified using a local diabetes registry. Mothers with a diagnosis of GDM or T2DM and gave birth between January 2022 -June 2022 were eligible for the study. A total of 19 parents (18 mothers, 1 father) were interviewed. Participants primarily identified as Maaori (6), Pacific (6), Indian (3), Asian (2), and New Zealand European (2). Interviews took place between December 2022 and February 2023, between 5-13 months post-pregnancy. Interviews facilitated by an externally contracted local Pacific mother, with a professional background in social work were conducted using Koorero and Talanoa, Maaori and Pacific methods of qualitative data collection, to capture the lived experiences of participants. A multidisciplinary group reviewed and coded interview transcripts. Themes were presented back to participants and stakeholders for feedback and refinement. Four over-arching themes were illustrated with exemplar quotes. Results Four themes described the importance of 1) Finding a balance between what is “best practice” and what is best for me, my baby and my whaanau, 2) The need for individualised and culturally appropriate care, 3) Centrality of whaanau and family to the pregnancy and postpartum journey, 4) The pervasive negative impact of diabetes on taha hinegaro (well-being) beyond childbirth. Conclusion People who are affected by diabetes in pregnancy have ongoing physical, psychological, and social needs. A holistic, whaanau-centred approach is required to ensure optimal health and well-being outcomes of mothers, infants and whaanau. The findings of this study will inform a new targeted model of care for infants and whaanau affected by diabetes in pregnancy.

This paper draws on a webinar on digital technology and networked spaces in outdoor education, where three researchers presented their work through responses to two discussion statements: First, 'the use of digital technology in outdoor education is fundamentally contrary to all its values.' Second, 'if we accept that digital technology is embedded in outdoor education, what do we know about its potential? And what are key areas to explore more deeply?.' Despite there being no advance planning to produce a research output from the webinar, the organisers' basic analysis of the webinar's frontchannel and backchannel revealed areas of the conversation that may merit targeted empirical attention. Three principal themes emerged from participants' responses during the webinar: the need to move beyond binary thinking; the importance of considering digital technology in regard to specific learning objectives and contexts; and to inform oneself about the affordances of digital technology, while thinking critically about its applications.

This is a composite article which brings together the international perspectives of the editorial board of the Journal of Adventure Education and Outdoor Learning to explore the impacts of artificial intelligence (AI) on the field of adventure education and outdoor learning (AE/OL). Building on the AE/OL profession's response to the impacts of COVID-19 on outdoor and environmental education in 2020, this article includes authors from 10 countries including Australia, Brazil, Canada, England, Japan, Kenya, the Netherlands, New Zealand, Norway, and Wales. The statements discuss the impacts and opportunities of AI for the AE/OL professions, researchers, the nature of being in and with the outdoors, and Indigenous knowledges. The intention of this article is not to present a definitive summary of the state of the profession, but to provide examples of the ways in which diverse people are responding to the challenges and opportunities of AI. By sharing these views, and identifying some commonalities, we hope that AE/OL educators, practitioners, researchers and managers can creatively and cautiously seize the opportunities of this technological revolution.