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There is continuing uncertainty about the nature of teacher professional learning using social networking websites (SNWs) and how using these platforms influences teacher practice. Findings from the authors' small-scale, qualitative study in Australia into English teacher use of one global SNW for professional learning showed participant innovative and organic engagement with this social media for self-directed, personally relevant, practice-informing learning. Thematic data analysis revealed detail about teachers using the SNW's features and spaces for curating eclectic content gathered through personal and professional interactions. Engaging with varied colleagues, ideas and resources, participants developed individually specific ways of capturing transient learning opportunities for informing practice and reconceptualising understandings of professional learning and teacher roles. Emergent knowledge about teachers accessing, transforming and applying reconstructed knowledge to practice enabled generation of a model representing teacher knowledge transfer using one SNW. The study findings suggest cause for recognising the potential for using this SNW in effective teacher professional learning. [ABSTRACT FROM AUTHOR]

The objective of this narrative study was to explore experiences and assigned meanings in stories about self-directed weight loss (WL) maintenance after severe obesity (SO). In-depth interviews were conducted with eight women and two men, aged 27 to 59 years, who had carried out self-directed WL from SO for 5 years or more. fear of weight-regain, and food and emotion. We performed a case-based narrative analysis of especially rich interviews that illustrate these. Results pointed to persistently cultivating new competencies, establishing new eating habits, re-establishing old physical-training habits, and forming new relational bonds. Participants reinvented themselves and their lives. However, the stories are not all about transformation, but also about new and old health problems. The study directs attention to 'different obesities', not only to initial weight from which WL takes place, but also linked to the experiential horizons that the persons embody from childhood on. Furthermore, there was no way back in the present stories, always haunted in the wake of the lost weight. A double burden imposed on the person with obesity related to meta-stories in society deepens the understanding of this imperative: being vulnerable health-wise and exposed to stigmatization. [ABSTRACT FROM AUTHOR]

Despite the promising outcome of modular distance learning, its implementation is challenging. Thus, this study aimed to examine the usefulness and challenges of the implemented clustered self-directed learning modules in entrepreneurship for senior high school distance learning amidst the emerging pandemic using the descriptive-survey research method. This study was conducted at Espiritu Santo Parochial School of Manila, Inc., during the school year 2021-2022, among Grade 12 students using a stratified proportional random sampling technique. The study used both quantitative and qualitative methods of analyzing the data, including descriptive statistics and thematic analysis. As a result, all the modules were inferred to be very effective and very useful in terms of their usefulness for distance learning. On the other hand, there were six emergent themes from twenty-five challenges, as follows: (a) difficulties and limitations in theoretical and practical processes; (b) concerns about time constraints and academic workloads; (c) technical issues in learning modules; (d) problems with communication, lessons, and instructions; (e) issues with online learning, connectivity, and learning management systems; and (f) external and personal challenges as a student. These challenges were the basis in framing the recommendations of the students in addressing the aforementioned emergent themes. [ABSTRACT FROM AUTHOR]

Online Parent Training in Early Behavioral Intervention (OPT-In-Early) is a self-directed resource for caregivers of autistic children. Sixty-three parent–child dyads from three states in were randomized to the OPT-In-Early or treatment as usual group. Parents in both groups completed baseline and post-treatment visits, which were targeted for 4 months apart but allowed to go up to 6 months. Compared to parents in the treatment as usual group, parents randomized to OPT-In-Early learned more evidence-based intervention principles from baseline to post-treatment and were rated by observers blind to group and time as increasing their use of these strategies during brief semi-structured interactions with their children. Parent participation in OPT-In-Early did not significantly influence children's social communication as coded from one observation session. Results suggest that parents acquired knowledge and skills in intervention techniques from OPT-In-Early. Longer trials may be needed for gains in child behavior. Early intervention can help children learn language and improve social communication. However, many barriers, including the expense of services and an insufficient number of providers, prohibit families from accessing services when their children are young. We developed a comprehensive online program for caregivers of autistic children. The program, Online Parent Training in Early Behavioral Intervention (OPT-In-Early), uses text and video demonstrations to teach caregivers effective methods for improving their children's language, social, and adaptive skills (e.g. using utensils, toilet training), and reducing their children's disruptive behavior. Sixty-three parents from three states participated in the study. Half of the parents received access to the OPT-In-Early program. After 4 months, parents who had access to the OPT-In-Early program learned more effective intervention strategies, and started using these strategies during interactions with their children, than parents who did not receive access to the program. Parent participation in OPT-In-Early did not significantly influence children's social communication compared to children whose parents did not have access to OPT-In-Early. A longer duration of parents using learned intervention skills with their children may be needed for children's social communication skills to improve. [ABSTRACT FROM AUTHOR]

Background: Literature shows there are multiple areas where nursing students could be more efficient in developing Critical Thinking in Student Nurses (CTS). Methods: A systematic search of five databases, PubMed, CINAHL, ERIC, the Texas Woman's University Library resources, and Google Scholar, were conducted to identify articles describing critical thinking in student nurses. The inclusion criteria were articles published on CTS of student nurses published between 2011 to 2021, and the exclusion criteria were all the new and experienced professional nurses, and the articles were published prior to 2011. Results: A total of 35 articles describing critical thinking in student nurses were identified from 17,800 articles for this paper. Conclusion: In synthesizing critical thinking literature in student nurses during the academic periods, critical thinking components look different in every setting based on the students, education methods, critical thinking model, and the tools used. [ABSTRACT FROM AUTHOR]

Background: The expeditious changes of the world today present massive challenges and demand rapid modifications in our education system. Focusing on concept-based learning and core understanding of topics for practical application is the cornerstone for a better outcome. Didactic Lectures (DL) are the most widely used method; however, in the current changing face of our education system, newer techniques like Self-directed Learning (SDL), SDL with Focussed Discussion (SDL-FD) and Problem- based Learning (PBL), which encourage active participation by the learner are being increasingly employed for better understanding of the subject. Aim and Objectives: To examine the effect of transition from traditional to newer methods on student performance. Material and Methods: We conducted a retrospective study involving 409 students, over two years, to evaluate the scores attained in examinations among topics delivered by different modalities namely DL, SDL, PBL and SDL-FD. Results: The scores achieved were higher among topics delivered by DL when compared with SDL and PBL approach which were statistically significant. The score of DL when compared with SDL-FD was higher, however did not have statistical significance. Conclusion: DL may help the learner immensely in a scenario of an examination-oriented evaluation. However, it may limit the learners' ability to question and ponder over the subject matter, mindlessly clinging to facts dissipated in class room. We recommend that a unified approach along with activities of self-learning and discussions, may tremendously improve the outcome. [ABSTRACT FROM AUTHOR]

This research aimed to evaluate how students respond to feedback offered by their English lecturers and how, after receiving such information, they subsequently self-regulate their learning processes. The qualitative method was used, which included 10 English for specific purposes students who were studying English as a foreign language at the National Institute of Technology for the academic year (2022-2023). The research was conducted face to face semi-structured interview questions. After that, the data were transcribed, and a thematic analysis was conducted to identify how students understood the statements made by instructors and how they directed their education. This was done to find out how students directed their education. According to the results, the pupils could distinguish between positive and negative feedback offered by the lecturers. The outcomes of this research advise educators and English instructors interested in improving the overall quality of the comments they provide during English classroom assessments.

Abstract Objective Analyze efficacy of self‐directed resident microvascular training versus a mentor‐led course. Study Design Randomized, single‐blinded cohort study. Setting Academic tertiary care center. Methods Sixteen resident and fellow participants were randomized into two groups stratified by training year. Group A completed a self‐directed microvascular course with instructional videos and self‐directed lab sessions. Group B completed a traditional mentor‐led microvascular course. Both groups spent equal time in the lab. Video recorded pre and post‐course microsurgical skill assessments were performed to assess the efficacy of the training. Two microsurgeons, blinded to participant identity, evaluated the recordings and inspected each microvascular anastomosis (MVA). Videos were scored using an objective‐structured assessment of technical skills (OSATS), a global rating scale (GRS), and quality of anastomosis scoring (QoA). Results The pre‐course assessment identified that the groups were well matched with only “Economy of Motion” on the GRS favoring the mentor led group (p = .02). This difference remained significant on the post assessment (p = .02) Both groups significantly improved in OSATS and GRS scoring (p .99). Time to completion of MVA significantly improved overall by a mean of 8 min and 9 s (p = .005) with no significant difference between post training times to complete (p = .63). Conclusion Different microsurgical training models have previously been validated as effective methods for improved MVA performance. Our findings indicate that a self‐directed microsurgical training model is an effective alternative to a traditional mentor driven models. Level of Evidence Level 2.

This study investigated the preparedness and experience of students for the fast-paced convergence of ICT and higher education. Overall, 366 distance students with a history of self-directed learning through correspondence courses were profiled using structured text-based online interviews. Twelve students' attributes on ICT material possession and competencies and experience of Open Distance and Open Learning (ODeL) were collected and analysed. The findings show that the majority of students (72%) who had prior knowledge about the basic concepts of ODeL modalities indicated satisfaction with the e-learning environment while the learning mode is challenging for traditional students (28%). Statistically significant positive correlations (ρ = 0.00) were observed between ICT competencies or preparedness: the level of prior academic qualifications (HAQ: r2 = 0.35); key challenge faced (KC: r2 = 0.26); and the convenience of ODeL (C.ODeL: r2 = 0.18). To ensure that students are not left behind with the proliferation of ICT in distance education, principal component analysis revealed that having prior knowledge about the ODeL modalities is an important attribute that contributes to students' preparedness for the e-learning environment, thus bridging the variance between the expected expectations and the actual expectations. [ABSTRACT FROM AUTHOR]

This research aimed to evaluate how students respond to feedback offered by their English lecturers and how, after receiving such information, they subsequently self-regulate their learning processes. The qualitative method was used, which included 10 English for specific purposes students who were studying English as a foreign language at the National Institute of Technology for the academic year (2022-2023). The research was conducted face to face semi-structured interview questions. After that, the data were transcribed, and a thematic analysis was conducted to identify how students understood the statements made by instructors and how they directed their education. This was done to find out how students directed their education. According to the results, the pupils could distinguish between positive and negative feedback offered by the lecturers. The outcomes of this research advise educators and English instructors interested in improving the overall quality of the comments they provide during English classroom assessments. [ABSTRACT FROM AUTHOR]

Objective: Analyze efficacy of self‐directed resident microvascular training versus a mentor‐led course. Study Design: Randomized, single‐blinded cohort study. Setting: Academic tertiary care center. Methods: Sixteen resident and fellow participants were randomized into two groups stratified by training year. Group A completed a self‐directed microvascular course with instructional videos and self‐directed lab sessions. Group B completed a traditional mentor‐led microvascular course. Both groups spent equal time in the lab. Video recorded pre and post‐course microsurgical skill assessments were performed to assess the efficacy of the training. Two microsurgeons, blinded to participant identity, evaluated the recordings and inspected each microvascular anastomosis (MVA). Videos were scored using an objective‐structured assessment of technical skills (OSATS), a global rating scale (GRS), and quality of anastomosis scoring (QoA). Results: The pre‐course assessment identified that the groups were well matched with only "Economy of Motion" on the GRS favoring the mentor led group (p =.02). This difference remained significant on the post assessment (p =.02) Both groups significantly improved in OSATS and GRS scoring (p <.05). There was no significant difference in OSATS improvement between the two groups (p =.36) or improvement in MVA quality between groups (p >.99). Time to completion of MVA significantly improved overall by a mean of 8 min and 9 s (p =.005) with no significant difference between post training times to complete (p =.63). Conclusion: Different microsurgical training models have previously been validated as effective methods for improved MVA performance. Our findings indicate that a self‐directed microsurgical training model is an effective alternative to a traditional mentor driven models. Level of Evidence: Level 2. We designed a randomized, single‐blinded cohort study to analyze the efficacy of self‐directed resident microvascular training compared to a mentor‐led course. Our results suggest that a self‐directed microsurgical training model is an effective alternative to more traditional models. [ABSTRACT FROM AUTHOR]

Artikel ini menganalisis definisi konseptual dan pengembangan pengukuran sikap karier protean. Beragam definisi dan alat ukur yang diperkenalkan para peneliti sering kali menimbulkan kebingungan. Akibatnya pemahaman dan kebijakan yang dikembangkan terkait karier protean menimbulkan kerancuan. Masing-masing definisi dan alat ukur fokus pada bidang tertentu, sehingga meninggalkan lubang yang harus mendapat perhatian dari peneliti lainnya. Artikel ini menawarkan alternatif definisi karier protean yang lebih komprehensif berdasarkan studi literatur atas 118 artikel. Studi literatur secara sistematis dan komprehensif menghasilkan 34 artikel konseptual yang mengerucut pada tiga pendekatan pengukuran karier protean, yaitu orientasi, sikap, dan konsep karier protean. Penulis merumuskan definisi konseptual karier protean sebagai sikap individu terhadap karier yang melibatkan nilai-nilai diri individu sebagai komponen kognitif dan perilaku pengarahan diri sendiri sebagai komponen perilaku. Artikel ini menawarkan pengembangan pengukuran sikap karier protean, yang mengeksplorasi kecintaan terhadap pekerjaan sebagai bagian dari proses afeksi. Ketiadaan komponen afeksi dalam mendefinisikan dan mengukur sikap karier protean yang selama ini terjadi dapat menyesatkan dan memberikan arah kebijakan operasional yang keliru. Teori kognisi social karier menjadi dasar analisis literatur untuk menyusun artikel ini. Penelitian mendatang perlu mengeksplorasi pengembangan pengukuran dengan menguji kegunaan sikap karier protean dalam kaitannya dengan faktor penentu dan konsekuensi sikap karier protean.

The optimization algorithm of monotonous improvement of strategy in reinforcement learning is a current research hotspot,and it has achieved good performance in both discrete and continuous control tasks.Proximal policy optimization(PPO)algorithm is a classic strategy monotonic promotion algorithm,but it is an on-policy algorithm with low sample utilization.To solve this problem,an algorithm named proximal policy optimization based on self-directed action selection(SDAS-PPO)is proposed.The SDAS-PPO algorithm not only uses the sample experience according to the importance sampling weight,but also adds a synchronously updated experience pool to store its own excellent sample experience,and uses the self-directed network learned from the experience pool to guide the choice of actions.The SDAS-PPO algorithm greatly improves the sample utilization rate and ensures that the intelligent body can learn quickly and effectively when training the network model.In order to verify the effectiveness of the SDAS-PPO algorithm,the SDAS-PPO algorithm and the TRPO algorithm,PPO algorithm and PPO-AMBER algorithm are used in the continuous control task Mujoco simulation platform for comparative experiments.Experimental results show that this method has better performance in most environments.

Purpose: In the Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, dietary intervention significantly reduced breast cancer mortality (P = 0.02). In observational studies, physical activity is associated with lower breast cancer incidence. Currently, dietary intervention influence on other health-related behaviors is unknown. Therefore, we evaluated whether the WHI dietary intervention influenced self-directed physical activity. Methods: Of 48,835 postmenopausal women, 19,541 were randomized to dietary intervention (18 nutritionist-led group sessions first year, then quarterly sessions throughout 8.5 years [median] intervention) and 29,294 to a usual diet comparison (written health-related materials only). Neither randomization group received specific or ongoing instructions to increase physical activity. Episodes per week of moderate or vigorous recreational physical activity (MVPA) were serially reported. Marginal longitudinal logistic regression models were used to assess physically inactive (MVPA = 0) or physically active (MVPA > 0) participants by randomization group. Marginal Poisson regression models estimated mean weekly MVPA. Results: At entry, 45.6% of all participants reported physical inactivity (MVPA = 0). In 43,760 women with MVPA information, throughout 15.9 years (median) cumulative follow-up, dietary intervention group participation was associated with 7% lower physical inactivity rate (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.91, 0.95, P < 0.001) and a 4% higher mean MVPA (ratio of means [RM] 1.04 95% CI 1.02, 1.06, P < 0.001), relative to the comparison group. Conclusion: In a randomized trial setting, a low-fat dietary pattern intervention was associated with a long-term, favorable influence on self-directed recreational physical activity. Trial registration: NCT00000611. [ABSTRACT FROM AUTHOR]

IntroductionThe Badges Program is a self-directed supplement to a program's research curriculum. This step-by-step resource helps medical residents to understand the resources needed to conduct their own research project and fulfill the Accreditation Council for Graduate Medical Education requirements for scholarly activity.MethodsThe curriculum is completed over varying amounts of time depending on the intricacy of scholastic activities. Simple case reports may take as little as 1-2 weeks whereas months to years may be required if residents are completing more intricate and elaborate projects. Associated materials include a guide organized by topic followed by sequentially completed task assignments demonstrating the user has gained a basic understanding of the corresponding objective. Upon completing a task, the user obtains its educational badge, a virtual certificate of completion the program can then track with a simple checklist for progress. Several supplementary online articles review core concepts or provide examples and web-based tutorials for becoming proficient with using reference software. No faculty training is necessary. Residents go through the steps necessary to perform research so as to gain familiarity with the process.ResultsQualitative feedback obtained by informally surveying residents who have completed the Badges Program has been very positive, with residents reporting that the guide was easy to follow and the knowledge gained will help tremendously with future projects.DiscussionWe hope that with feedback, this resource will be expanded and refined so every resident will be able to use the Badges Program regardless of previous skills, experience, and publications.

Abstract Background The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems. Methods An innovative CBT mobile app, based on Deakin University’s GamblingLess online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant’s language and their name (e.g. Kia ora Tāne) and by creating personalized feedback. A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention. Discussion If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services. Ethics approval NZ Health and Disability Ethics Committee (Ref: 19/STH/204) Trial registration Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019.

Early intervention with parent participation is important for facilitating skill development in children with Autism Spectrum Disorder (ASD). However, many barriers delay or prohibit families from accessing care. We describe the development and acceptability of a novel, comprehensive, self-directed online program for caregivers of children with ASD. Program effectiveness will be presented in a subsequent manuscript. The program is based on behavioral, naturalistic, and developmental principles, and teaches caregivers to use evidence-based interventions to teach developmentally appropriate targets. Approximately two-thirds of enrolled parents completed all 14 modules; barriers to completion for the additional families are described. Parents reported that the program was clear, enjoyable, and useful in teaching them interventions and in improving their children's skills and behavior. [ABSTRACT FROM AUTHOR]

Two behavioral change-based strategies for promoting adherence to physical activity (PA) suggested to have the greatest potential are the pedometer and Motivational Interviewing (MI). However, there are no comparisons between these two strategies identifying which one is more effective for improving PA adherence. This systematic review and meta-analysis aimed to determine which PA motivation strategy is more effective for promoting adherence to self-directed PA in female breast cancer survivors. Studies implementing self-directed PA which used a step tracker and/or MI for motivation in female breast cancer survivors were identified from the following databases at two timepoints, September 2019 and June 2020: CENTRAL, PubMed, CINAHL, PsycINFO, and Sportdiscuss. Sixteen randomized controlled trials (RCTs) were selected for data extraction, whereas ten RCTs were included in meta-analysis. Meta-analysis was performed on pooled data to estimate the standardized mean differences in PA duration and step count, and 95% confidence intervals. The number of participants meeting PA recommendations was also analyzed. Subgroup analysis was performed for three motivational strategies (pedometer combined with counselling, with print material or with motivational interviewing). Meta-analysis showed that pedometer combined with another intervention has a small effect on step count (p = 0.03) and a moderate effect on duration of moderate-vigorous physical activity (MVPA) (p = <0.0001) compared to controls. Additionally, motivational strategies increase the number of participants who meet a PA goal (p = 0.005). The findings of this review endorse the use of a step tracker combined with counselling, print material or MI based on behavioral change theory. This approach provided the most consistent positive effect on adherence to self-directed PA among breast cancer survivors. Future studies should evaluate differences between measures of adherence to self-directed PA, to identify the best motivation strategy for improving patient adherence and health outcomes. Systematic review registration: PROSPERO Registration number CRD42020148542. [ABSTRACT FROM AUTHOR]

The online classroom is self-directed, where students decide when and how often they access their course material. Even in the traditional classroom, students have shown a propensity to shift their time allocation to the last minute, so it is not clear what happens when they have full control over their learning schedules. Our interest is whether this self-directed learning environment produces similar harmful binge behavior as observed with online television, where memory and satisfaction with the experience decrease over time. With access to clickstream data from an online e-educator, we found 62% of the sample binged their learning by concentrating their studies within the semester rather than distributing their online activity throughout. Two types of binge learning emerged as significant: Front-bingers, who accessed the majority of their education early, performed more similarly over time to those who spaced their learning activities. Back-bingers, who accessed the majority of their material late in the semester, did not perform as well. To help us better understand these findings, we used a relatively new measure of behavior called "clumpiness" to summarize their overall online activity. We discuss our findings and their implications for online education and marketing course design. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate the effect of the flipped learning model on nursing students' asepsis knowledge and learning skills. The flipped learning model enables students to pursue their learning with online support whenever and wherever they want. Students have the responsibility for their learning activities. The flipped learning model is an effective method to improve nursing students' knowledge and skills related to the principles of asepsis with online innovative approaches. This study has a pre-test post-test open-label, randomized controlled design. The study sample consisted of 107 first-year nursing students randomized into experimental (n = 53) and control (n = 54) groups. The experimental group students were trained utilizing the flipped learning model. The data were collected through the "Descriptive Characteristics Form of Nursing Students ", the "Principles of Asepsis Knowledge Test" and the " Self-directed Learning Skills Scale". It was determined that the post-test knowledge score of the experimental group was statistically significantly higher (p=0.000) than the control group and the median of the retention test knowledge score was statistically significantly higher (p=0.000) than the control group. There was a statistically significant increase (p<0.05) in the median score of the self-directed learning skills scale "self-control" sub-dimension of the experimental group. Flipped learning increased nursing students' knowledge related to the principles of asepsis and enabled them to take responsibility for learning. This model had a positive effect on students' higher order thinking skills such as critical organization and decision making. It is recommended to use the flipped learning within the scope of nursing education and especially in gaining basic skills. A success in today's education; flipped learning [ABSTRACT FROM AUTHOR]

Background: Clinical trials examining lifestyle interventions for weight loss in cancer survivors have been demonstrated to be safe, feasible, and effective. However, scalable weight loss programs are needed to support their widespread implementation. The ASPIRE trial was designed to evaluate real-world, lifestyle-based, weight loss programs for cancer survivors throughout Maryland., Objective: The objectives of this protocol paper are to describe the design of a nonrandomized pragmatic trial, study recruitment, and baseline characteristics of participants., Methods: Participants were aged ≥18 years, residing in Maryland, with a BMI ≥25 kg/m 2 , who reported a diagnosis of a malignant solid tumor, completed curative treatment, and had no ongoing or planned cancer treatment. Enrollment criteria were minimized to increase generalizability. The primary recruitment source was the Johns Hopkins Health System electronic health records (EHRs). Participants selected 1 of 3 remotely delivered weight loss programs: self-directed, app-supported, or coach-supported program., Results: Participants were recruited across all 5 geographic regions of Maryland. Targeted invitations using EHRs accounted for 287 (84.4%) of the 340 participants enrolled. Of the 5644 patients invited through EHR, 5.1% (287/5644) enrolled. Participants had a mean age of 60.7 (SD 10.8) years, 74.7% (254/340) were female, 55.9% (190/340) identified as non-Hispanic Black, 58.5% (199/340) had a bachelor's degree, and the average BMI was 34.1 kg/m 2 (SD 5.9 kg/m 2 ). The most common types of cancers were breast (168/340, 49.4%), prostate (72/340, 21.2%), and thyroid (39/340, 8.5%). The self-directed weight loss program (n=91) included 25 participants who agreed to provide weights through a study scale; the app-supported program (n=142) included 108 individuals who agreed to provide their weight measurements; and the coach-supported weight loss program included 107 participants. We anticipate final analysis will take place in the fall of 2024., Conclusions: Using EHR-based recruitment efforts, this study took a pragmatic approach to reach and enroll cancer survivors into remotely delivered weight loss programs., Trial Registration: ClinicalTrials.gov NCT04534309; https://clinicaltrials.gov/study/NCT04534309., International Registered Report Identifier (irrid): DERR1-10.2196/54126., (©Gerald J Jerome, Lawrence J Appel, Linda Bunyard, Arlene T Dalcin, Nowella Durkin, Jeanne B Charleston, Norma F Kanarek, Michael A Carducci, Nae-Yuh Wang, Hsin-Chieh Yeh. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 12.06.2024.)

Background: In the wake of challenges brought by the COVID-19 pandemic to conventional medical education, the demand for innovative teaching methods has surged. Nurse training, with its focus on hands-on practice and self-directed learning, encountered significant hurdles with conventional approaches. Augmented reality (AR) offers a potential solution to addressing this issue., Objective: The aim of this study was to develop, introduce, and evaluate an AR-based educational program designed for nurses, focusing on its potential to facilitate hands-on practice and self-directed learning., Methods: An AR-based educational program for nursing was developed anchored by the Kern six-step framework. First, we identified challenges in conventional teaching methods through interviews and literature reviews. Interviews highlighted the need for hands-on practice and on-site self-directed learning with feedback from a remote site. The training goals of the platform were established by expert trainers and researchers, focusing on the utilization of a ventilator and extracorporeal membrane oxygenation system. Intensive care nurses were enrolled to evaluate AR education. We then assessed usability and acceptability of the AR training using the System Usability Scale and Technology Acceptance Model with intensive care nurses who agreed to test the new platform. Additionally, selected participants provided deeper insights through semistructured interviews., Results: This study highlights feasibility and key considerations for implementing an AR-based educational program for intensive care unit nurses, focusing on training objectives of the platform. Implemented over 2 months using Microsoft Dynamics 365 Guides and HoloLens 2, 28 participants were trained. Feedback gathered through interviews with the trainers and trainees indicated a positive reception. In particular, the trainees mentioned finding AR particularly useful for hands-on learning, appreciating its realism and the ability for repetitive practice. However, some challenges such as difficulty in adapting to the new technology were expressed. Overall, AR exhibits potential as a supplementary tool in nurse education., Conclusions: To our knowledge, this is the first study to substitute conventional methods with AR in this specific area of critical care nursing. These results indicate the multiple principal factors to take into consideration when adopting AR education in hospitals. AR is effective in promoting self-directed learning and hands-on practice, with participants displaying active engagement and enhanced skill acquisition., Trial Registration: ClinicalTrials.gov NCT05629663; https://clinicaltrials.gov/study/NCT05629663., (©Suyoung Yoo, Sejin Heo, Soojin Song, Aeyoung Park, Hyunchung Cho, Yuna Kim, Won Chul Cha, Kyeongsug Kim, Meong Hi Son. Originally published in JMIR Serious Games (https://games.jmir.org), 23.05.2024.)

Introduction The interpretation of electrocardiograms (ECGs) is a critical competency for internal medicine trainees, yet time and resources to foster proficiency are limited. Methods This resident-authored ECG email curriculum for first-year residents involved 129 first-year internal medicine residents at three major academic university hospitals. Residents either received the resident-authored ECG email curriculum (intervention group) or continued standard training (control group). The curriculum involved 10 multiple-choice ECG cases emailed biweekly over the 6-month study period. All participants were asked to complete a pre- and postintervention test to assess ECG interpretation competency and attitudes. The primary outcome was improvement in ECG test performance. Results Among the 129 first-year residents participating, 21 of the 65 (32%) randomized to the intervention group and 13 of the 64 (20%) randomized to the control group completed both the pre- and posttests for analysis. While all participants’ ECG test scores improved over the study period (p < .001), improvement did not differ between groups (p = .860). We found that the effect of the intervention on ECG test performance varied significantly by the number of cardiology rotations an intern experienced (p = .031), benefiting naïve learners the most. All intervention group participants who completed the posttest reported they would recommend it to a colleague. Discussion While it did not improve resident performance on an ECG posttest, this resident-authored ECG email curriculum offers a scalable way to provide trainees additional practice with ECG interpretation, with particular benefit to trainees who have not yet rotated on cardiology.

The present study was motivated by theoretical considerations in cognitive linguistics associated with the concept projection as well as by theories in cognitive science related to self-directed learning on computers, to apply them in developing Japanese learners' knowledge of the different degrees of sureness attached to certain, probable, and possible items. It evaluated the relative effects of cognitive and non-cognitive approaches and of self- and teacher-directed approaches on computers. The cognitive approach involved concept projection, a process through which the participants understand an abstract concept, namely the degree of certainty, in terms of the spatial concept of distance, whereas the non-cognitive approach involved rote learning of a list of target expressions related to the degree of certainty. The results of the present study demonstrated that the cognitive approach groups outperformed the non-cognitive approach and control groups in writing, comparison, and categorization tests, and further demonstrated that the cognitive approach is effective as a mnemonic device generating long-term memory encoding. The results of the present study also showed that the self-directed approaches were no less effective than the teacher-directed approaches, and the difference between self-directed and teacher-directed learning did not seem to have had a major impact on the overall performance of the self- and teacher-directed groups. [ABSTRACT FROM AUTHOR]

Background: The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems.Methods: An innovative CBT mobile app, based on Deakin University's GAMBLINGLESS online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant's language and their name (e.g. Kia ora Tāne) and by creating personalized feedback. A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention.Discussion: If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services.Ethics Approval: NZ Health and Disability Ethics Committee (Ref: 19/STH/204) TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019. [ABSTRACT FROM AUTHOR]

Object manipulation and tool use by nonhuman primates have received considerable attention from primatologists and anthropologists, because of their broad implications for understanding the evolution of tool use in humans. To date, however, most of the studies on this topic have focused on apes, given their close evolutionary relationship with humans. In contrast, fewer studies on tool use and object manipulation have been conducted on monkeys. Documenting and studying object manipulation and tool use in species that are more distantly related to humans can provide a broader perspective on the evolutionary origins of this behavior. We present a detailed description of tool-aided behaviors and object manipulation by Nicobar long-tailed macaques (Macaca fascicularis umbrosus) living along the coastlines of Great Nicobar Island. We made observations from December 2018 to March 2019, using ad libitum and focal sampling methods. We observed behaviors related to object manipulation and tool use in six different behavioral contexts (foraging, hygiene, communication, play, self-directed and self-hygiene behavior) involving eight different types of objects: resonance rod, play object, rolling platform, scraping tool, dental groom, pounding substrate, leaves as grip pads and wipers, and stimulation tool. We observed that males were involved in tool use and object manipulation more frequently than females. Our results add to existing records of object manipulation, tool-use behavior, and tool variants displayed by nonhuman primates, showing that Nicobar macaques perform multiple and diverse tool-aided behaviors. [ABSTRACT FROM AUTHOR]

In this article author outlines five characteristics of adult learning and eight pillars of mature learning (Knowles et. al, 2005) that can be applied to learning music, particularly in secondary schools and communities. Using pedagogy, andragogy, and heutagogy as a progression toward lifelong learning, author suggests learning approaches specific to adolescent and adult learners that increase learner autonomy with the eventual goal of self-determined, heutogogical learning. In order to broadly apply a learning arc from pedagogy toward heutagogy, teachers' roles remain flexible, incorporating both pedagogical and andragogical principles, while eyeing the potential for eventual heutogogy and showing a demonstrated value for it. Author purposefully avoids recommending specific teaching techniques, in favor of broad principles that can be adapted to any music teaching and learning scenario, as is appropriate with heutagogical learning. The focus of this paper is to discuss purposes and possibilities of fostering self-directed and self-determined learning among adolescent and adult music learners. [ABSTRACT FROM AUTHOR]

This research is aimed to develop biology learning materials in Junior High School for plants movement topic to increase students’ achievement and self-directed through Science Process Skill approach. This is development research refers to Kemp’s development model. The learning kit is taught in SMPN 1 Blega Bangkalan Madura for 28 students grade VIII employing science process skill approach. The research design uses One Group Pretest-Posttest and data is analyzed with the qualitative descriptive method. This research reveals that the implementation of learning kit is 83%, dominant student’s activities in 1st and 2nd learning process are observing (22% - 24%), most of the students have positive responses which are indicated by 99% of students expressing their like, the result of students’ learning mastery satisfies the classical criteria for 86%, the rate of students self-directed varies from 55,56% to 83,32%. Based on the data analysis, it can be concluded that the Development of Biology Learning Kit is feasible.

Teaching practice is one among many programs in teachers training which focuses on having a professional preparation for work. In this program, student-teachers are asked to improve their skills through teaching actual students and engaging with school environment. Moreover, they are also building their own knowledge based on the improved teaching and learning process. It is crucial for them as pre-service teachers to encounter such experience. This meaningful theory and experience-based insights are possible to obtain if the student-teachers possess the commitment of self-reflection. There is likely a big chance that this action will be perpetual because of this personal initiative. This study aims to analyze the use of reflective journal as pre-service teachers’ professional development tool, their attitude towards reflective journal, as well as the strength and challenges arise related to the use of reflective journal during their teaching practice. The type of the research is a qualitative case study research. The data collection techniques being used are questionnaire and Focus Group Discussion (FGD). Moreover, the technique of analyzing the data was Miles and Huberman concept of data reduction, data presentation, and conclusion drawing. The results of this research will be presented in a descriptive-narrative manner by describing and discussing the data of the research.

Objective: To evaluate the feasibility of a multicentre, observer-blind, pilot randomized controlled trial (RCT) of a wristband accelerometer with activity-dependent vibration alerts to prompt impaired arm use after stroke. Design: Parallel-group pilot RCT. Setting: Four English stroke services. Participants: Patients 0–3 months post stroke with a new arm deficit. Intervention: Participants were randomized to wear a prompting or 'sham' wristband during a four-week self-directed therapy programme with twice-weekly therapy review. Main outcomes: Recruitment, retention and adherence rates, safety and completion of assessments were reported. Arm recovery was measured by Action Research Arm Test (ARAT) and Motor Activity Log (MAL) without statistical comparison. Results: In total, 33 patients were recruited (0.6 per month/site; median time post stroke: 26 days (interquartile range (IQR):15.5–45)). Baseline, four-week and eight-week median (IQR) ARAT for the control group (n = 19) were 15 (2–35), 35 (15–26) and 31 (21–55) and those for the intervention group (n = 14) were 37 (16–45), 57 (29–57) and 57 (37–57), respectively; for MAL Amount of Use, the corresponding values in the control group were 0.2 (0.0–1.2), 1.1 (0.3–2.9) and 1.2 (0.7–2.9) and in the intervention group were 1.4 (0.5–2.6), 3.8 (1.9–4.5) and 3.7 (2.1–4.3). Four participants withdrew from the study. Wristbands were worn for 79% of the recommended time. The intervention and control group participants received a median of 6.0 (IQR: 4.3–8.0) and 7.5 (IQR: 6.8–8.0) therapy reviews. A median of 8 (IQR: 6–10) prompts were delivered per intervention participant/day. Research assessments were completed for 28/29 and 25/28 patients at four and eight weeks. Eight serious adverse events were reported, all unrelated to the intervention. Conclusion: A multicentre RCT of wristband accelerometers to prompt arm activity early after stroke is feasible. A total sample of 108 participants would be required. [ABSTRACT FROM AUTHOR]

Objective: Bibliotherapy refers to psychological self-help interventions that utilize treatment books to improve psychological well-being. Research supports bibliotherapy as an efficacious intervention for a variety of mental health problems. Yet, few studies have investigated bibliotherapy in psychosocial oncology. The objective of this randomized controlled trial was to examine the efficacy of the NuCare intervention, delivered as a self-directed workbook, for enhancing empowerment, coping, and quality of life and reducing distress in patients with cancer.Methods: Eighty-nine adult patients with cancer were randomized to receive the workbook for 6 weeks or the control condition, usual care. Participants completed questionnaires at baseline, 6 weeks post-baseline, and 10 weeks post-baseline.Results: The increase of empowerment (main outcome) and quality of life and the decrease of distress in the NuCare group from pre-intervention to follow-up assessment differed significantly from the respective difference scores in the control group.Conclusions: The self-administered NuCare workbook is a potentially cost-effective, minimal intervention addressing psychosocial needs of patients with cancer.Practice Implications: Evidence-based bibliotherapy can empower patients and has the promise of reducing the burden on the healthcare system while enhancing the immediacy of psychosocial support. [ABSTRACT FROM AUTHOR]

Children of all ages who have the opportunities, time, and materials to explore science content in a self-directed manner will develop higher level understandings, and demonstrate more sophisticated approaches to science. A vast and growing body of research supports the academic benefits of self-directed or authentic scientific inquiry, which is defined as a line of questioning that belongs to the individual (Llewellyn, 2011; Akerson, Hanson, & Cullen, 2007; Cacciamani, 2010; Eick, Meadows, and Balkcom, 2005). Embedded within a child’s distinctive ownership of the inquiry process is a highly beneficial, yet often overlooked aspect, and that is the child’s choice to engage in play. Playing around in science presents children with opportunities to think creatively and divergently, to solve problems in innovative ways, and to develop a unique scientific identity. Llewellyn (2011) states that children learn about the world through exploration, “play, creativity, curiosity, and wonderment” (p. 63). Play in science extends far beyond promoting academic understandings. In fact, when a child engages in play activities while simultaneously undertaking inquiry processes, the child can also choose to participate in social/collaborative scientific endeavors. Furthermore, emotional development and connections can be made when children play around with science content. Also, since play activities typically involve movement, children are actively occupied in physical representations that can also make concepts concrete for better understanding. Play in science promotes comprehension, but it also provides opportunities for children to become socially, physically, emotionally, and even culturally involved. This article will discuss the benefits of play in science to the whole child as well as some of the obstacles that diminish or extinguish play behaviors and scientific exploration.

Introduction: The advent of consoles that deliver both interactive games and therapy may augment rehabilitation options in burn patients. The Jintronix software combines therapy-specific software and interactive gaming as a form of coaching and records patient performance on the Kinect® platform. Our objective was to determine the feasibility of a set of Jintronix games and therapy modules in hospitalized adult burn patients.Methods: We conducted a prospective single center feasibility study from August through October 2016. The study enrolled subjects to conduct 1 supervised session with 6 Jintronix modules targeting their burned areas of the body, with an acceptability survey and a safety analysis. We also performed qualitative analysis to detect major themes from free-text responses.Results: We enrolled 20 participants. Eleven (55%) completed all the modules; reasons for incompletion included baseline shoulder abduction pain and poor balance. Participants responded that the activity was comfortable (90%), safe (100%), easy to understand (95%), and improved strength/range of motion (100%). Mean module completion time was 43±10min. Mean pain score was 3.8±2.8 (out of 10) and localized to burned areas. The wall climbing module had 4 episodes of temporary imbalance. Eight (40%) participants recorded fatigue at completion and noted "sweating" or "feeling stretched". Qualitative analysis highlighted that the activity was "fun/cool" and a "good challenge". Negative themes included "inaccurate depth" sensing and "too lengthy" on a specific module.Conclusions: A Jintronix-based therapy demonstrated good acceptability and safety in hospitalized burn patients. Feedback from this study led to software modifications implemented by the Jintronix company. This feasibility study has informed the design of a prospective randomized controlled trial to determine whether a virtual-environment home rehabilitation strategy improves functional outcomes after burn injury. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self‐directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own. Methods: Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants' weight‐loss experiences were explored using semi‐ structured interviews to elicit in‐depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self‐directed weight loss identified by participants. Results: Most characteristics of those who successfully self‐managed their weight loss were in line with those reported by successful weight losers participating in professional‐led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight‐loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self‐directed weight loss by participants of the present study. Conclusions: Overweight or obese individuals with strong internal motivation, problem‐solving skills and self‐reliance are more likely to be successful at achieving self‐directed weight loss. The patients identified with these characteristics could be encouraged to self‐manage their weight‐loss process, leaving the places available in more resource‐intensive professional‐led programmes to those individuals unlikely to succeed on their own. [ABSTRACT FROM AUTHOR]

Chronic diseases are common among adults. A healthy diet may be beneficial for managing the consequences of such conditions. The purpose of this study was to evaluate the effects of a self-directed nutrition program on dietary behaviors among adults with chronic health conditions. As part of a larger trial examining the effects of a self-directed exercise program, participants with arthritis were randomized to a 12-week self-directed exercise or nutrition intervention. Self-reported fruit and vegetable consumption, fat- and fiber-related behaviors were assessed at baseline, 12 weeks, and 9 months. Repeated measures analyses of covariance examined Group × Time changes in dietary behaviors. Effect sizes were computed. Participants (n = 321) were, on average, 56.5 ± 10.5 years old, had a mean body mass index of 32.9 ± 8.3 kg/m2, and had 2.0 ± 1.0 chronic health conditions; 88% were female, 65% White, 88% had at least some college education, and 62% married. There were significant Group × Time interactions favoring the nutrition group at 12 weeks for all dietary behaviors (p < .05) but not at 9 months. Between-group effect sizes were small at 12 weeks and decreased at 9 months. Within-group effect sizes were larger for the nutrition group (small to medium) than the exercise group (none to small) at both time points. A self-directed nutrition intervention can result in meaningful improvements in dietary behaviors among adults with chronic health conditions in the short term. [ABSTRACT FROM AUTHOR]

Men with prostate cancer are not routinely offered psychosocial support despite strong evidence that being diagnosed with prostate cancer poses significant quality of life concerns and places the patient at elevated risk of developing a range of mental health disorders. The objective of this study was to develop an online psychological intervention for men with prostate cancer and to pilot test the feasibility and acceptability of the intervention. Development of the intervention involved a multidisciplinary collaboration, adapting face-to-face and group intervention strategies for an online format. The full online intervention and moderated forum were pilot tested with 64 participants who were recruited from urology practices in Melbourne, Victoria, Australia. After consenting to participate and creating a personal account in the online programme, participants completed baseline demographic questionnaires. Participants were provided access to the programme for 6–12 weeks. After completing the programme participants completed an online survey to assess intervention and forum utilisation and satisfaction, as well as suggest intervention refinements following their use of the intervention. Patient satisfaction was calculated using mean responses to the satisfaction questionnaire. The intervention was received positively with 47.82% of participants highly satisfied with the programme, and 78.26% said they would recommend it to a friend. Participants' qualitative feedback indicated good acceptability of the online intervention. A number of technical and participant engagement issues were identified and changes recommended as a result of the feasibility testing.

Computer module intervention is the process of exposing students to a series of discrete exercises for the purpose of strengthening students' familiarity with conceptual material. The method has been suggested as a remedy to student under-preparedness. This study was conducted to determine the effectiveness of module intervention in improving and equalizing students' module assessment and comprehensive final exam grade outcomes in a pharmacy calculations course. Pharmacy students encountered computer module exercises in a self-directed manner. Computer module and grade data were analyzed with respect to academic preparation and class cohort. Computer module scoring performance did not differ among students with respect to academic preparation. A difference in course final exam outcome was observed with respect to class cohort despite the use of module intervention. Despite similar performance on computer module exercises regardless of student academic background, computer module intervention did not result in an equalization of comprehensive final examination outcomes in pharmacy calculations. Consideration of instructional organization and potential constraints to self-directed learning are important to maximizing performance outcomes when using technology enhanced active learning methods. [ABSTRACT FROM AUTHOR]

Objective: People with cancer can experience psychological distress but do not always desire, or engage with, professional support to assist with managing distress. Interventions that are self-directed or guided by patients may hold promise as they allow patients to engage with interventions as they need. The objective of this review is to describe and appraise the evidence for effectiveness of self-guided interventions that aim to manage psychological distress in people with cancer.Methods: A systematic search of Medline, PsychInfo and CINAHL identified 15 relevant papers, reporting on 14 studies.Results: Of the interventions, three studies comprised hard-copy workbooks, six studies used resource packs, four were online resources and one was a brief multimedia resource. One study was adequately powered and demonstrated a positive effect. Almost all interventions required some level of facilitation. Distressed participants may benefit more from interventions.Conclusion: Self-guided interventions represent a potentially efficient way of delivering support for people affected by cancer, however evidence supporting them is lacking.Practice Implications: There is a need to generate evidence to understand the impact of self-guided interventions for: i) the ideal delivery point in the disease trajectory, ii) patient groups, iii) intervention content and iv) type and mode of delivery. [ABSTRACT FROM AUTHOR]

Objective To describe a novel setting and method for self-directed introductory pharmacy practice experiences (SD IPPE). Methods Students presented health care information relative to the plot of a production at a local community theater throughout the season. Students developed a poster and handout that were presented in the theater lobby prior to each production. Assessment A six-question survey was provided to students after each presentation that identified their perceived benefit to play patrons and their overall experience using a 5-point Likert scale. Implications Completing SD IPPE in a theater is a novel and innovative concept. Data suggest that students prefer presenting information in non-traditional settings. Students felt their work enhanced the theatrical experience of patrons. Results demonstrate that the theater is a viable setting for future presentations that benefit both students and public. [ABSTRACT FROM AUTHOR]