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Introduction: The current study aimed to expand current knowledge on cat-related guilt beyond work cat conflict and guilt about cat parenting to determine the influence of owner’s personality traits, choices regarding their cat’s lifestyle, and cat-related guilt factors. Additionally, we sought to assess potential predictors of anxiety and depression to determine the contributions of cat-related guilt, owner personality traits, and social compensatory behaviors, while controlling for owner demographics. Methods: An online, anonymous, cross-sectional survey was disseminated between October 18 and 28, 2023. Survey respondents (n = 531) were adults who resided in the United States and were the primary caretakers of a cat they had owned for at least 6 months. Descriptive statistics captured cat owner demographics. Multiple linear regression was used to predict guilt about cat parenting, work cat conflict, anxiety, and depression. Results: Significant predictors of guilt about cat parenting included guilt factors, time away, indoor, and attention. Significant predictors of work cat conflict included gender and cat guilt factors, time away, and attention. Work cat conflict and personality traits (extraversion, agreeableness, conscientiousness, and neuroticism) significantly predicted depression scores. Lastly, anxiety scores were significantly predicted by work cat conflict, neuroticism, and social compensatory behaviors. Discussion: Findings from this study extend understanding of cat owner’s guilt and illuminate how their personality traits, compensatory behaviors, and lifestyle choices for their pets influence how they perceive and internalize feelings about their cat parenting practices. The nuanced nature of parenting guilt receives limited social recognition, leaving owners isolated in their disenfranchised guilt which significantly influences feelings of anxiety and depression. Our findings underscore the imperative for research and public education about beneficial ways to integrate social contact and enrichment activities to foster both human and animal wellbeing.

Numerous studies have found pets to have a beneficial effect on people’s psychological well-being, yet a growing body of research suggests that the positive impact of pet ownership is more complex than once thought and does not always lead to improved owner physical and mental health. One potential drawback to pet ownership is pet-related guilt. Research pertaining to work-family conflict and parental guilt has traditionally focused on human family members, yet the majority of pet owners consider their pets to be family members. Similar to parental guilt, dog-related guilt has been found to be associated with feelings of anxiety, depression, and reduced psychological health. The current study was designed to expand on dog-related guilt research by assessing cat owners. An online, anonymous, cross-sectional survey was distributed through Prolific and resulted in 604 responses for analysis. Multiple linear regression was used to predict owner depression. Gender, age, social compensatory techniques, and two guilt factors (Attention and Veterinary-related) significantly predicted depression scores. Participants’ anxiety scores, assessed with multiple linear regression, were predicted by gender, age, social compensatory techniques, and three guilt factors (Attention, Veterinary-related, and Lifestyle). Our results suggest that cat-related guilt, analogous to parental guilt, is a significant predictor of anxiety and depression. It is imperative that society recognize cat owners’ guilt, often disenfranchised; unrecognized; and unacknowledged, and help support owners’ efforts to mitigate this guilt in healthy ways.

Pets are often an integral part of the family structure, with many people viewing their pets as children and thinking of themselves as “pet parents”. Pets have been shown to provide an array of psychological and physical health benefits, but some research suggests that the effects of pet ownership are more nuanced than once thought. One common negative aspect of pet ownership is guilt. Drawing from research pertaining to the transition to siblinghood, this study explored pet owner guilt as a result of adding a child to a dog-owning family. It also measured changes in dogs’ behaviors and their impact on owners’ depression and anxiety levels. Results suggest that many parents feel dog-related guilt and struggle with the resultant changes in household dynamics with the arrival of a child. Suggestions to help improve the chances of a successful transition include awareness, preparation, and self-compassion. Planning and preparing can help minimize negative dog behaviors and, as a result, levels of parental depression and anxiety. Parents are encouraged to help their dogs succeed by taking the time to prepare beforehand, thereby minimizing their own guilt and decreasing the potential of a severed human–dog bond.

ABSTRACT The Central England Temperature (CET) series is one of the longest instrumental climate records in the world. The CET record from 1659 represents a roughly triangular area of England extending from the Lancashire plain in the north, to London in the south‐east and south‐west of the Midlands of England. HadCET is a composite series produced by the Met Office Hadley Centre, using data from a succession of observing sites for which the data have been adjusted to remove inhomogeneities to be consistent with the original long running series and be updated in near real time. This paper documents a technical update to the HadCET which is referred to as HadCET version 2 (v2), and at time of publication v2.1.0.0 is the latest available version.

Summary: T cell-redirecting bispecific antibodies (bsAbs) to treat advanced stage solid tumors are gaining interest after recent clinical successes. The immune checkpoint human leukocyte antigen G (HLA-G) is expressed in several tumor types while in normal tissues expression is limited. Here, we describe JNJ-78306358, a T cell-redirecting bispecific antibody (bsAb) to treat advanced stage solid tumors. JNJ-78306358 binds with high affinity to the α3 subunit of HLA-G on cancer cells and with purposely engineered weaker affinity to CD3ε on T cells. JNJ-78306358 induced potent T cell-mediated cytotoxicity of HLA-G-expressing solid tumors in vitro and in vivo. JNJ-78306358 also blocked the interaction of HLA-G with its receptors in vitro, indicating that immune checkpoint blocking may contribute to its anti-tumor activity. These results suggest that T cell-redirection against HLA-G could be a potent and effective treatment for a wide range of solid tumor indications.

Parental guilt, one common subtype of guilt often associated with work-family conflict (WFC), has been found to be associated with depression and anxiety. Because many people view their pets as family members and even children, the current study was designed to explore dog owners’ dog-related guilt and its relationship with depression and anxiety. Through an online anonymous survey, the results of our study suggest that dog owners’ guilt and dog-related WFC are at comparable levels to those reported in human family studies. They are also both significant predictors of depression and anxiety. It is important for mental health professionals to be aware of this disenfranchised guilt and help clients cope in positive ways. Guidance related to self-compassion is offered as one strategy to help pet owners struggling with this common, but often trivialized, source of guilt.

Climate change is increasing the frequency and severity of extreme precipitation events, requiring new ways of managing stormwater, particularly in urban areas. Nature-based solutions (NBS) have become increasingly popular to provide distributed stormwater storage while supporting urban biodiversity and access to nature. However, long-term monitoring of the hydrological performance of NBS is limited. To date most literature has focused on monitoring methodologies for specific sites and types of NBS, use of remote sensing and modeling for large-scale assessments, or measuring benefits of NBS for urban heat mitigation. More comprehensive and consistent measurement strategies are needed to understand the effects of distributed NBS on urban hydrology at the regional scale, and improve the design, maintenance, and adoption for community-centered stormwater management. To address these gaps, we review available literature on measurement methods, summarize these methods and provide specific recommendations for instrumentation and in situ monitoring of common types and scales of urban NBS. Based on our findings on performance monitoring for individual NBS sites, we extend recommendations for consistent hydrological assessment of distributed NBS at regional scale and the efficacy of NBS in reducing community flooding impacts. These recommendations are particularly applicable for municipalities, researchers and community-based organizations who are now leading the planning and implementation of community-centered NBS systems in many areas.

Abstract Introduction: The current study aimed to expand current knowledge on cat-related guilt beyond work cat conflict and guilt about cat parenting to determine the influence of owner’s personality traits, choices regarding their cat’s lifestyle, and cat-related guilt factors. Additionally, we sought to assess potential predictors of anxiety and depression to determine the contributions of cat-related guilt, owner personality traits, and social compensatory behaviors, while controlling for owner demographics. Methods: An online, anonymous, cross-sectional survey was disseminated between October 18 and 28, 2023. Survey respondents (n = 531) were adults who resided in the United States and were the primary caretakers of a cat they had owned for at least 6 months. Descriptive statistics captured cat owner demographics. Multiple linear regression was used to predict guilt about cat parenting, work cat conflict, anxiety, and depression. Results: Significant predictors of guilt about cat parenting included guilt factors, time away, indoor, and attention. Significant predictors of work cat conflict included gender and cat guilt factors, time away, and attention. Work cat conflict and personality traits (extraversion, agreeableness, conscientiousness, and neuroticism) significantly predicted depression scores. Lastly, anxiety scores were significantly predicted by work cat conflict, neuroticism, and social compensatory behaviors. Discussion: Findings from this study extend understanding of cat owner’s guilt and illuminate how their personality traits, compensatory behaviors, and lifestyle choices for their pets influence how they perceive and internalize feelings about their cat parenting practices. The nuanced nature of parenting guilt receives limited social recognition, leaving owners isolated in their disenfranchised guilt which significantly influences feelings of anxiety and depression. Our findings underscore the imperative for research and public education about beneficial ways to integrate social contact and enrichment activities to foster both human and animal wellbeing.

Schools are placing a heavy focus on providing a safe learning environment. Part of that safe environment is for the school to be a bully-free zone. In order for a school to be bully-free, staff must be able to identify bullying when it happens in order to make appropriate referrals. This article looks at the ability of pre-service teachers to identify bullying, their knowledge about bullying, and their perception of how to help. It is clear from the results of this survey, more attention needs to be spent helping pre-service teachers identify bullying as a means of keeping the school building and the students within it safe.

Background: Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it. Aims: This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England. Methods & Procedures: Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post-recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift. Outcomes & Results: Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials. Conclusions & Implications: Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long-term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined.

Eliglustat, an oral substrate reduction therapy, is approved for eligible adults with Gaucher disease type 1. In the Phase 3 ENGAGE trial of previously untreated adults with Gaucher disease type 1, eliglustat-treated patients had statistically significant improvements in organ volumes and hematologic parameters compared with placebo in the 9-month primary analysis. We report final outcomes by time on eliglustat among all patients who participated in the ENGAGE trial and extension. No patient deteriorated clinically or withdrew due to adverse events; 39/40 patients entered the open-label extension period and 34/40 (85%) remained in the trial until completion or switching to commercial eliglustat after its approval (2.3-6 years). Clinically meaningful improvements in Gaucher disease manifestations were seen in all patients concomitant with reductions in pathological lipid substrate levels (glucosylceramide and glucosylsphingosine). Among patients with 4.5 years of eliglustat exposure, mean spleen volume decreased by 66% (from 17.1 to 5.8 multiples of normal [MN], n = 13), mean liver volume decreased by 23% (from 1.5 to 1.1 MN, n = 13), mean hemoglobin increased 1.4 g/dl (from 11.9 to 13.4 g/dl, n = 12), mean platelet count increased by 87% (from 67.6 to 122.6 × 109 /L, n = 12), median chitotriosidase decreased by 82% (from 13 394 to 2312 nmol/h/ml, n = 11), median glucosylceramide decreased by 79% (from 11.5 to 2.4 μg/ml, n = 11), median glucosylsphingosine decreased by 84% (from 518.5 to 72.1 ng/ml, n = 10), and mean spine T-score increased from -1.07 (osteopenia) to -0.53 (normal) (n = 9). The magnitude of improvement in Gaucher disease manifestations and biomarkers over time was similar among the full trial cohort. Eliglustat was well-tolerated and led to clinically significant improvements in previously untreated patients with Gaucher disease type 1 during 4.5 years of treatment.

Purpose: This study investigated the complexity of stuttering behavior. It described and classified the complexity of stuttering behavior in relation to age, behavioral treatment outcomes, stuttering severity, anxiety-related mental health, impact of stuttering, and gender. Method: For this study, a taxonomy was developed--LBDL-C7--which was based on the Lidcombe Behavioral Data Language of stuttering. It was used by five experienced judges to analyze the complexity of stuttering behavior for 84 adults and adolescents before and after speech restructuring treatment. Data were 3,100 stuttering moments, which were analyzed with nominal logistic regression. Results: The complexity of stuttering behavior appears not to change as a result of treatment, but it does appear to change with advancing age. Complexity of stuttering behavior was found to be independently associated with clinician stuttering severity scores but not with percentage of syllables stuttered or self-reported stuttering severity. Complexity of stuttering behavior was not associated with gender, anxiety, or impact of stuttering. Conclusion: Clinical and research applications of these findings are discussed.

Purpose: This study was designed to answer three questions: (a) Does percentage of syllables stuttered (%SS) differ between standard and challenge phone calls; (b) Does anxiety differ between standard and challenge phone calls; and (c) Is there a relationship between %SS and anxiety during standard and challenge phone calls? Method: Participants were 230 adults diagnosed with stuttering, who were participants from five clinical trials. Each participant received two 10-min phone calls at pretreatment and a further two phone calls 6 months or 20 weeks postrandomization. One phone call was standard, and the other presented challenge: occasionally disagreeing with, interrupting, and talking over participants, or asking for clarification of their views. Results: Statistically significant, but clinically minor, increases of %SS and anxiety occurred during the challenge phone calls. There was a statistically significant association between %SS and anxiety. Conclusions: Variable phone call procedures to assess stuttering severity in clinical trials are not likely to spuriously inflate or deflate treatment outcomes to a clinically important extent. Regardless, the present results suggest that there is statistical merit in controlling the nature of phone calls during clinical trials with the simple and replicable method developed in this report. Additionally, there is procedural merit in the challenge phone call procedure; it is a more valid representation of the challenges of everyday speech than the standard procedure. However, a disadvantage of the challenge phone call procedure is the practical issues associated with its use. The clinical and theoretical applications of the results are discussed.

Abstract Numerous studies have found pets to have a beneficial effect on people’s psychological well-being, yet a growing body of research suggests that the positive impact of pet ownership is more complex than once thought and does not always lead to improved owner physical and mental health. One potential drawback to pet ownership is pet-related guilt. Research pertaining to work-family conflict and parental guilt has traditionally focused on human family members, yet the majority of pet owners consider their pets to be family members. Similar to parental guilt, dog-related guilt has been found to be associated with feelings of anxiety, depression, and reduced psychological health. The current study was designed to expand on dog-related guilt research by assessing cat owners. An online, anonymous, cross-sectional survey was distributed through Prolific and resulted in 604 responses for analysis. Multiple linear regression was used to predict owner depression. Gender, age, social compensatory techniques, and two guilt factors (Attention and Veterinary-related) significantly predicted depression scores. Participants’ anxiety scores, assessed with multiple linear regression, were predicted by gender, age, social compensatory techniques, and three guilt factors (Attention, Veterinary-related, and Lifestyle). Our results suggest that cat-related guilt, analogous to parental guilt, is a significant predictor of anxiety and depression. It is imperative that society recognize cat owners’ guilt, often disenfranchised; unrecognized; and unacknowledged, and help support owners’ efforts to mitigate this guilt in healthy ways.

This study reports a user evaluation of a DVD-based social simulator, developed for people who stutter to potentially gain confidence in using a learned fluency technique. The aim was to examine and evaluate the pilot of the DVD-based social simulator, Scenari-Aid, to inform the development of an online version of the program. Thirty-seven adults who were stuttering were recruited to the study from non-professional groups in Australia. The DVD comprised scenarios with actors in real-life settings that were designed to elicit verbal responses. Participants worked through the scenarios at their own rate and then completed an online survey. The survey comprised 29 statements requiring responses on a 5-point Likert scale and provided information about users’ perceptions of participating in the social simulations. There was high positive agreement among the participants on all statements, the most important being that they perceived the scenarios represented in everyday speaking situations and that they felt immersed in them. Participants also agreed that both their fluency and confidence increased in everyday speaking situations as a result of working through the DVD scenarios. The developers were satisfied that, despite the subjective nature of the findings, the study provided sufficient support for constructing the online version, which is now available to the public free of charge. Further research is needed to provide empirical evidence of the contribution it can make to the efficacy of speech programs for adults who stutter.

Abstract Hyporheic exchange (HE), fine particle deposition and clogging are tightly coupled processes that control ecosystem services in rivers. While HE is assumed to be induced primarily by riverbed topography, surface flow turbulence also drives significant exchange. We show that turbulence‐driven HE produces large interfacial fluxes and drives long‐term feedback between HE and fine suspended particles via bed clogging. Turbulence significantly increases total HE fluxes as it rapidly delivers suspended particles into porewater over the entire interface, whereas advective pumping exchange only delivers particles into focused downwelling regions on the upstream side of bedforms. While turbulence is associated with rapid fluctuations and shallow HE, it is key on longer‐timescale outcomes, namely bed clogging. However, beyond the general effect of clogging in attenuating HE, turbulence‐driven HE will also be important for other river‐borne materials that are retained and transformed within hyporheic zones, such as nutrients and organic pollutants.

Purpose: Recent research has shown that some school-age children who stutter may have speech-related anxiety. Given this, speech-language pathologists require robust measures to assess the psychological effects of stuttering during the school-age years. Accordingly, this systematic review aimed to explore available measures for assessing the psychological impacts of stuttering in young school-age children and to examine their measurement properties. Method: The systematic search protocol was registered with PROSPERO (ID: 163181). Seven online databases, in addition to manual searching and screening of reference lists, were used to identify appropriate measures for the population of children who stutter aged 7-12 years. The first two authors independently assessed the measures using the quality appraisal tool described by Terwee et al. (2007). Results: Despite the comprehensive search strategy, only six measures were identified for quality appraisal. No assessment tool was found to possess adequate measurement properties for the eight assessed domains: content validity, internal consistency, construct validity, reproducibility, reliability, responsiveness, floor and ceiling effects, and interpretability. No measure had clear evidence of responsiveness to clinical change. Based on the criterion defined by the Terwee et al. (2007) appraisal tool, the Communication Attitude Test and the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children received the highest number of ratings in support of their measurement properties. Conclusions: The results highlight a lack of available measures in this domain and poor practices in developing and testing measurement instruments. To ensure that clinicians and researchers are equipped with sound measures to meet the mental health needs of this vulnerable population, further research to establish resources is needed.

While most bacterial and archaeal taxa living in surface soils remain undescribed, this problem is exacerbated in deeper soils, owing to the unique oligotrophic conditions found in the subsurface. Additionally, previous studies of soil microbiomes have focused almost exclusively on surface soils, even though the microbes living in deeper soils also play critical roles in a wide range of biogeochemical processes. We examined soils collected from 20 distinct profiles across the United States to characterize the bacterial and archaeal communities that live in subsurface soils and to determine whether there are consistent changes in soil microbial communities with depth across a wide range of soil and environmental conditions. We found that bacterial and archaeal diversity generally decreased with depth, as did the degree of similarity of microbial communities to those found in surface horizons. We observed five phyla that consistently increased in relative abundance with depth across our soil profiles: Chloroflexi, Nitrospirae, Euryarchaeota, and candidate phyla GAL15 and Dormibacteraeota (formerly AD3). Leveraging the unusually high abundance of Dormibacteraeota at depth, we assembled genomes representative of this candidate phylum and identified traits that are likely to be beneficial in low-nutrient environments, including the synthesis and storage of carbohydrates, the potential to use carbon monoxide (CO) as a supplemental energy source, and the ability to form spores. Together these attributes likely allow members of the candidate phylum Dormibacteraeota to flourish in deeper soils and provide insight into the survival and growth strategies employed by the microbes that thrive in oligotrophic soil environments.IMPORTANCE Soil profiles are rarely homogeneous. Resource availability and microbial abundances typically decrease with soil depth, but microbes found in deeper horizons are still important components of terrestrial ecosystems. By studying 20 soil profiles across the United States, we documented consistent changes in soil bacterial and archaeal communities with depth. Deeper soils harbored communities distinct from those of the more commonly studied surface horizons. Most notably, we found that the candidate phylum Dormibacteraeota (formerly AD3) was often dominant in subsurface soils, and we used genomes from uncultivated members of this group to identify why these taxa are able to thrive in such resource-limited environments. Simply digging deeper into soil can reveal a surprising number of novel microbes with unique adaptations to oligotrophic subsurface conditions.

While most bacterial and archaeal taxa living in surface soils remain undescribed, this problem is exacerbated in deeper soils, owing to the unique oligotrophic conditions found in the subsurface. Additionally, previous studies of soil microbiomes have focused almost exclusively on surface soils, even though the microbes living in deeper soils also play critical roles in a wide range of biogeochemical processes. We examined soils collected from 20 distinct profiles across the United States to characterize the bacterial and archaeal communities that live in subsurface soils and to determine whether there are consistent changes in soil microbial communities with depth across a wide range of soil and environmental conditions. We found that bacterial and archaeal diversity generally decreased with depth, as did the degree of similarity of microbial communities to those found in surface horizons. We observed five phyla that consistently increased in relative abundance with depth across our soil profiles: Chloroflexi, Nitrospirae, Euryarchaeota, and candidate phyla GAL15 and Dormibacteraeota (formerly AD3). Leveraging the unusually high abundance of Dormibacteraeota at depth, we assembled genomes representative of this candidate phylum and identified traits that are likely to be beneficial in low-nutrient environments, including the synthesis and storage of carbohydrates, the potential to use carbon monoxide (CO) as a supplemental energy source, and the ability to form spores. Together these attributes likely allow members of the candidate phylum Dormibacteraeota to flourish in deeper soils and provide insight into the survival and growth strategies employed by the microbes that thrive in oligotrophic soil environments.IMPORTANCE Soil profiles are rarely homogeneous. Resource availability and microbial abundances typically decrease with soil depth, but microbes found in deeper horizons are still important components of terrestrial ecosystems. By studying 20 soil profiles across the United States, we documented consistent changes in soil bacterial and archaeal communities with depth. Deeper soils harbored communities distinct from those of the more commonly studied surface horizons. Most notably, we found that the candidate phylum Dormibacteraeota (formerly AD3) was often dominant in subsurface soils, and we used genomes from uncultivated members of this group to identify why these taxa are able to thrive in such resource-limited environments. Simply digging deeper into soil can reveal a surprising number of novel microbes with unique adaptations to oligotrophic subsurface conditions.

Purpose: The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method: We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results: The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions: The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

Background: Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis. Aims: To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277). Methods & Procedures: A total of 32 variables were used as predictors in regression analyses of short- and medium-term Lidcombe Program outcome, and of treatment dropout. Outcomes & Results: Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity. Conclusions & Implications: Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop-out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions.

Purpose: In a companion paper, we found no statistical reason to favor percentage syllables stuttered (%SS) over parent-reported stuttering severity as a primary outcome measure for clinical trials of early stuttering. Hence, considering the logistical advantages of the latter measure, we recommended parent-reported stuttering severity for use as an outcome measure. The present report extends the prior analysis to a comparison of %SS with self-reported stuttering severity (SRSS) for use as an outcome measure in clinical trials of stuttering treatments for adults. Method: We analyzed data from four randomized clinical trials for adults that incorporated %SS and SRSS data at prerandomization and at 6 months post randomization. We analyzed the distributions associated with the two measures, their agreement, and their estimates of effect sizes. Results: The positively skewed distribution of %SS warrants much reservation about its value as a clinical trial outcome measure. This skew causes inherent instability because of spurious data associated with low scores, which occur commonly at the low end of such a distribution. This inherent instability is compounded by inherent problems with absolute reliability of %SS measures. These problems are reduced with the much more normal distribution of SRSS. Conclusions: The logistical arguments in favor of SRSS apply similarly to adults as they do when parents report the stuttering severity of their children. However, there are statistical reasons to favor SRSS over %SS measures as a primary outcome of clinical trials with adult participants: SRSS has acceptable discriminant validity and a normal distribution, and it is less error prone than %SS. We recommend SRSS as a primary outcome for clinical trials of adults with stuttering.

Objectives Respiratory protective equipment is critical to protect healthcare workers from COVID-19 infection, which includes filtering facepiece respirators (FFP3). There are reports of fitting issues within healthcare workers, although the factors affecting fitting outcomes are largely unknown. This study aimed to evaluate factors affecting respirator fitting outcomes.Design This is a retrospective evaluation study. We conducted a secondary analysis of a national database of fit testing outcomes in England between July and August 2020.Settings The study involves National Health Service (NHS) hospitals in England.Participants A total of 9592 observations regarding fit test outcomes from 5604 healthcare workers were included in the analysis.Intervention Fit testing of FFP3 on a cohort of healthcare workers in England, working in the NHS.Primary and secondary outcome measures Primary outcome measure was the fit testing result, that is, pass or fail with a specific respirator. Key demographics, including age, gender, ethnicity and face measurements of 5604 healthcare workers, were used to compare fitting outcomes.Results A total of 9592 observations from 5604 healthcare workers were included in the analysis. A mixed-effects logistic regression model was used to determine the factors which affected fit testing outcome. Results showed that males experienced a significantly (p