Academic success has been the primary criterion for admission to many nursing programs. However, academic success as an admission criterion may have limited predictive value for success in noncognitive skills. Adding situational judgment tests, such as Casper, to admissions procedures may be one strategy to strengthen decisions and address the limited predictive value of academic admission criteria. In 2021, admissions processes were modified to include Casper based on concerns identified with noncognitive skills.This study aims to (1) assess the incremental validity of Casper scores in predicting nursing student performance at years 1, 2, 3, and 4 and on the National Council Licensing Examination (NCLEX) performance; and (2) examine faculty members’ perceptions of student performance and influences related to communication, professionalism, empathy, and problem-solving.We will use a multistage evaluation mixed methods design with 5 phases. At the end of each year, students will complete questionnaires related to empathy and professionalism and have their performance assessed for communication and problem-solving in psychomotor laboratory sessions. The final phase will assess graduate performance on the NCLEX. Each phase also includes qualitative data collection . The goal of the focus groups is to help explain the quantitative findings (explanatory phase) as well as inform data collection  in the subsequent phase (exploratory sequence). All students enrolled in the first year of the nursing program in 2021 were asked to participate (n=290). Faculty will be asked to participate in the focus groups at the end of each year of the program. Hierarchical multiple regression will be conducted for each outcome of interest  to determine the extent to which scores on Casper with admission grades, compared to admission grades alone, predict nursing student performance at years 1-4 of the program and success on the national exam. Thematic analysis of focus group transcripts will be conducted using interpretive description. The quantitative and qualitative data will be integrated after each phase is complete and at the end of the study.This study was funded in September 2021, and data collection began in March 2022. Year 1 data collection and analysis are complete. Year 2 data collection is complete, and data analysis is in progress.At the end of the study, we will provide the results of a comprehensive analysis to determine the extent to which the addition of scores on Casper compared to admission grades alone predicts nursing student performance at years 1-4 of the program and on the NCLEX exam.RR1-10.2196/48672 There is an increased demand for registered nurses (RNs) with the increasingly complex health care system and aging population . The strAdmission criteria that accurately predict student success related to the performance of cognitive and noncognitive skills can help admit applicants with the prerequisites to develop nursing competencies. This can also help reduce the loss of invested resources from failure or attrition . CognitiCognitive skillsAcademic achievementsAbility to understand complex ideas, learn from experience, and reason Noncognitive skillsPersonal traits, attitudes, and motivation  Involve mental processes Situational judgment tests (SJTs)A methodology for assessing decisions in relation to underlying knowledge, skill, traits, and other attributes CasperA web-based SJT (90-110 minutes) that assesses noncognitive skillsTest-takers respond to scenarios concerning what they would do and whyTrained raters score the testInterrater reliability and intraclass correlations range from 0.84 to 0.94 [Applicants who have appropriate decision-making skills that reflect capabilities related to noncognitive skills may be more suitable for the nursing profession. Noncognitive skills related to areas such as communication, empathy, problem-solving, and professionalism are essential to assume the roles of an RN  and deliver competent care to often complex patients and families across the life span in different settings .There is strong evidence that cognitive ability predicts program success, but there is limited evidence related to noncognitive skills. The authors of a 2020 systematic review of 16 cohort studies explored preadmission criteria that predicted student success in undergraduate nursing programs in the United States. These authors reported that it was well established that cognitive predictors such as admission grade point average (GPA) predicted program success. Although not used as admission criteria, age, gender, and ethnicity also predicted success. Other possible predictors included grades on standardized tests, such as the Test of Essential Academic Skills. It is important to note that the definition of success used by most studies varied and was related to academic success, passing the licensure exam, attrition, program completion, and GPA in nursing and science courses. These authors contend that it is difficult to isolate a single variable as the best predictor of student performance, and it would be more reliable to use a combination of variables .P<.001) [R2 of regression models with and without SJTs differed by 5-10 percentage points). This suggests that there is value to adding SJTs, but SJTs alone cannot account for the outcomes assessed. The authors point out that this is a modest relationship but was considered in the context of medical school admissions, where many applicants are strong. Therefore, detecting slight differences is difficult [One possible approach for nursing admissions is using situational judgment tests (SJTs) to measure noncognitive skills, combining these results with cognitive criteria. SJTs are defined as “a methodology for assessing how an individual’s underlying knowledge, skills, traits, and other attributes are expressed when making decisions about job-related scenarios” . The useP<.001) . A totalifficult .The authors of a 2020 scoping review reported that no research was identified between 2006 and 2019 concerning using SJT for nursing school admissions . A literaccelerated option. Over 600 applicants per year apply for 291 seats at 3 sites. Historically, admission decisions were primarily based on academic performance, but starting in 2021, the admissions process was modified to include Casper, a SJT that assesses noncognitive skills. The Casper score, the applicants’ academic average, and references were used in the admissions decisions.The BScN (Collaborative) program at Memorial University of Newfoundland (MUN) is a competitive program composed of 2 admission options: the 4-year option and the z score, is sent to the program the applicant applied to. Casper assesses for the following noncognitive skills: collaboration, communication, empathy, equity, ethics, motivation, problem-solving, professionalism, resilience, and self-awareness. As noted above, these noncognitive skills are essential for nursing practice. The interrater reliability of Casper is strong, with intraclass correlations ranging from 0.84 to 0.94 across 55,988 applicants , which raised concerns about recent graduates’ performance in the clinical area with professionalism, empathy, communication, and problem-solving. These concerns were also highlighted in discussion with the College of Registered Nurses of Newfoundland and Labrador, the admissions committee, and faculty members.This study proposes a mixed methods research (MMR) study to address and add to the knowledge related to predictors of success in a nursing program concerning noncognitive skills and program success. In particular, the predictive nature of Casper will be examined concerning optimizing admission decisions and admitting applicants with the greatest potential of completing the program, meeting the competencies of the nursing profession, and passing the NCLEX.The purpose of this multiphase MMR study is to assess the effectiveness of Casper as part of the admission decisions in the BScN (Collaborative) program in predicting student performance in years 1, 2, 3, and 4 of the program, and on the NCLEX, compared to academic performance alone. Overall academic success will be evaluated, as well as performance in psychomotor skills laboratory sessions and clinical settings. Problem-solving, empathy, and other skills are expectations in both types of settings, and all are expected to improve as students progress through the program.The overarching MMR research question is, What is the effectiveness of the addition of Casper to admission decisions in predicting student success across the curriculum? The objectives of the quantitative and qualitative analysis and the integration of both are as follows:To assess the incremental validity of Casper scores in predicting student performance with communication and problem-solving and student behavior related to professionalism and empathy at years 1, 2, 3, and 4 of the program, and on NCLEX performance, compared to academic ranking alone.To examine clinical and laboratory faculty members’ perceptions of student performance, challenges, and influences related to professionalism, empathy, communication, and problem-solving in psychomotor skills laboratory sessions and the clinical area.We obtained ethical approval (20222324) from the Newfoundland and Labrador Health Research Ethics Authority in February 2022, and this approval was renewed in January 2023.This study will use a multistage evaluation MMR study design with 5 phases and 2 embedded sequences . An inteIn each study phase, there is an embedded explanatory sequence whereby quantitative data collection  will be followed by qualitative data collection (focus groups). The goal of the qualitative interviews is to help explain the quantitative findings and gain a more robust understanding of student performance concerning professionalism, empathy, communication, and problem-solving. The other embedded sequence is an exploratory sequence, whereby what is learned in each phase will inform focus group questions in the subsequent phase.In March 2022, all first-year students in the 4-year option and accelerated option at all 3 sites were invited to participate. These students were admitted in 2021 and were the first cohort to complete Casper as part of the admission process. Students who chose to participate will be followed through their program to the completion of the NCLEX exam. A faculty member at each site not associated with the study acted as an intermediary and introduced the study using a script. If students were interested, an investigator came to the class to further explain the study, and an information letter was provided to students. At that time, informed consent was obtained from students wanting to enroll, and the first set of questionnaires was completed. Students who chose not to enroll at that time were told that if they decided they would like to enroll, they could contact the research assistant within 1 week. It was explained to students in the consent form that participation (or not) would not affect any courses that they take in the nursing program; there were no known risks to participating in the study; all identifying information would be kept confidential; study data would be anonymized and safely stored using a secured drive; and only the research team would have access to the data.A demographic profile was completed for each student . The student’s Casper score and admission GPA for those who had completed university courses, or the high school average, were obtained through the Nursing Admissions Office. To access these data, a conditional agreement was reached between the university and the researchers.Focus groups with clinical and laboratory faculty will be conducted at the end of each year of the program at a mutually convenient location and time. Recruitment is done by email using purposive convenience sampling. Emails will be sent to clinical and laboratory faculty that taught this group of students in the previous year. During the focus groups, we explore faculty perceptions of student performance, challenges, and influencing factors related to noncognitive skills in the laboratory and clinical settings. Written informed consent is obtained from participants in the focus groups. It is explained in the consent form that all information that identifies participants will be kept confidential, and only the research team has access to the data. As well, it is explained that there may be potential risks, including being uncomfortable sharing experiences in the context with others in the focus group. Every effort is made by the researchers to ensure participant comfort as well as safety during the focus group .R2 of regression models, with and without SJTs, are compared to see if the addition of the SJT explains more of the variance found. The sample size of this study was calculated using the findings of a previous study [R2 analysis. In it, researchers examined the incremental validity of adding SJTs to the use of a clinical problem-solving tool (CPST) for predicting performance in workplace simulation exercises as part of the selection process for postgraduate medical training. The researchers found that a regression model with CPST but not SJT explained 35% of variance (R2=.35) whereas a model with both CPST and SJT explained 57% of the variance (R2=.57) seen in the simulation scores. Their sample size of 135 was sufficient to detect this difference. Our target sample size is, therefore, 135, assuming we will see similar differences for the addition of SJT to admission grades (instead of CPST) on different outcomes. Few of the other studies reported in the systematic review by Webster et al [To assess incremental validity, the us study  that asser et al  assessedThis study has 5 phases, with quantitative data collection occurring in appropriate psychomotor skills courses during each academic year and at the end of each phase . The following outcomes, identified as concerns related to graduate performance and entry-level competencies of RNs, will measure nursing student performance: communication, problem-solving, empathy, professionalism, GPA and grades, and NCLEX success.Communication is being evaluated during psychomotor testing in a nursing skills laboratory session using a tool developed for the study. One specific course was chosen for each year of the program. In these courses, students learn and practice foundational skills  and complex psychomotor skills . Nursing skills laboratory session testing is scenario-based and requires students to demonstrate effective communication skills . Laboratory faculty who evaluate students during the psychomotor testing, use consistent rubrics for that course, and complete these tools based on the student’s performance related to communication. The communication tool assesses whether students introduce themselves, use appropriate language, and complete appropriate documentation. There are additional criteria to assess if the testing involves a real person . The possible range of scores for this assessment tool is 0-14, with higher scores indicating strong communication skills. Face validity was established by having faculty who have extensive experience conducting psychomotor assessments with nursing students review the tool to ensure the content was appropriate and relevant. The interrater reliability score was 100%. Laboratory faculty received training on how to complete the tool .Problem-solving is being evaluated during psychomotor testing in a nursing skills laboratory session using a tool developed for the study. One specific course has been chosen for each year of the program. Nursing skills laboratory session testing is scenario-based and requires students to demonstrate effective problem-solving skills. Laboratory faculty who evaluate students during the psychomotor testing, using consistent rubrics for that course, will complete this tool based on the student’s performance related to problem-solving. The problem-solving tool evaluates whether the student recognizes the problem, attempts to address the problem, and takes appropriate action to address the problem. The possible range of scores for this assessment tool is 0-6, with a higher score indicating strong problem-solving skills. Face validity was established by having faculty who have extensive experience conducting psychomotor assessments with nursing students review the tool to ensure the content was appropriate and relevant. The interrater reliability score was 94%. Laboratory faculty received training on how to complete the tool .Empathy will be measured with the Jefferson Scale of Empathy . This 20-item self-report scale takes approximately 10 minutes to complete and measures 3 constructs: “perspective taking,” “compassionate care,” and “standing in a patient’s shoes.” Each item is answered using a 7-item Likert scale (1=strongly agree and 7=strongly disagree). The scores can range from 20 to 140, with higher scores indicating stronger empathy .Professionalism will be measured with an adapted Nurses Professional Values Scale-Three . This measurement is a 28-item self-report scale. The demographics questions were removed as the questions were either not appropriate for our context or the information would be obtained from the MUN Registrar’s Office. Professional nursing values are evaluated using a 5-item Likert scale: not important (A), somewhat important (B), important (C), very important (D), and most important (E). Numeric values were assigned to each letter and added together to get the total score. The scores can range from 28 to 140. A higher score indicates a stronger nurse’s professional value orientation .For GPA and grades, GPA (yearly and cumulative) and marks in academic nursing courses will be obtained at the end of the academic year from the registrar’s office.For NCLEX success, data will be obtained from the College of Registered Nurses of Newfoundland and Labrador (CRNNL) regarding NCLEX success in terms of pass or fail. If available, as NCLEX scoring is changing, the overall performance (logit score) and performance on individual test categories (logit score) will be obtained. The CRNNL is the regulatory body and professional association for all RNs and nurse practitioners and the custodian for the National Council of State Boards of Nursing data. An agreement was signed between the researchers, MUN, and CRNNL to access the data.Data will be collected on several predictor variables. Admission grades and Casper scores are the predictor variables of interest . The other variables will be assessed and controlled for as potential confounders.Admission grades: the admission GPA will be obtained for students who had some postsecondary education before admission; the admission high school average will be obtained for students admitted directly from high school. These data will be obtained from the registrar’s office.Admission Casper score: students complete Casper as part of their admissions application. Results will be obtained from the nursing admission office.Demographics: age, gender, province, and program of study  and program site, as the BScN (Collaborative) program is offered at 3 sites. These data will be obtained from the nursing admissions office.At the end of each year of the program, the research assistant or researchers will meet with the students to complete the 2 pen and paper questionnaires: the Jefferson Scale of Empathy and the NPVS-3. The research assistant has been trained in data collection and the use of measurement tools. Students are monitored to ensure they are not talking to each other. As a thank-you for participating, students are given a CAD $10 (US $7.32) coffee card at each phase of data collection. The completed problem-solving and communication tools will be obtained directly from the laboratory instructors.Completed questionnaires and tools at the sites are placed in a sealed envelope and sent to the MUN Faculty of Nursing Research Unit by courier. If there is a delay in sending the completed questionnaires by courier, the questionnaires are stored in a locked filing cabinet in one of the researcher’s offices. Data will be obtained from the Registrar’s Office, Nursing Admissions Office, and CRNNL at the appropriate times, using procedures established with each source.Qualitative data collection will occur at the end of each academic year. Faculty focus group questionsTell me about your experiences with students this past year in the clinical setting concerning communication, professionalism, empathy, and problem-solving.Tell me about your experiences with students this past year in the laboratory setting concerning communication, professionalism, empathy, and problem-solving.Did you experience any challenges related to communication, professionalism, empathy, and problem-solving?What do you think influenced their performance in relation to communication, professionalism, empathy, and problem-solving?Descriptive statistics , as appropriate for the data, will be used to describe the characteristics of the participants, including their GPAs and their scores on the different outcome measures. Stata  will be used to analyze the data. The data will be checked for the amount of missing data; if they are missing completely at random, and if warranted, multiple imputation will be used. Different analyses will be conducted to address each research objective, as described below.For objective 1 (phases 1-5), hierarchical multiple linear regression will be conducted to determine if Casper is a significant predictor of each outcome  and if a model with both Casper and admission grade explains more of the variance for the outcome than a model without Casper . Each model assessed will contain both the Casper score and the admission average and include potential predictors and confounders . Modeling will be conducted separately for students who entered directly from high school (admission grade=high school average) and those who had some postsecondary education before admission (admission grade=GPA for the postsecondary courses). The modeling will be repeated at the end of each year (years 1-4) for each of the yearly outcomes : communication, problem-solving, empathy, professionalism, and GPA. The measures used will be the scores for that year.P value (P>.05) will be dropped, and the model without this variable will be tested. The second model will be compared to the previous model using the likelihood ratio (LR) test. If the LR test is not significant (P>.05), the variable is not a predictor and needs to be assessed for confounding before being removed from the model. To assess confounding, the coefficient for the main exposure of interest is assessed to see if it changes when the potential confounder is taken out of the model. If it did, that variable would be considered a confounding variable and would be kept in the model. If the coefficient did not change, the variable is not a confounder and will be removed from the model. This process will be repeated, comparing it with the previous model, until all of the variables are tested and the final model has been established. To determine the incremental validity, the R2  for the final model and the R2 for that model without the Casper score will be compared.For the first model that is tested, all the predictor variables will be entered into the model. The predictor variable with the highest A similar analysis will be conducted in 2025 using logistic regression to determine if Casper is a significant predictor of NCLEX success  and if a model with both Casper and admission grade explains more of the variance for NCLEX success than a model without Casper .For objective 2 (phases 1-5), under the direction of the methodological approach of interpretive description, the analytical framework, the three Cs  will be used to conduct a thematic analysis of the data. The following 6 steps are used in this iterative process: initial coding, revisiting initial coding, developing categories, revising the initial list of categories based on additional review of the data, reviewing categories and subcategories, and developing themes  . The PIsThe integration will occur after each phase is complete and at the end of the study.Explanatory sequences (end of phases 1-5): integration with this design aims to use the qualitative results to explain the quantitative data . Each daExploratory sequences (end of phases 1-3): the goal of integration in an exploratory sequence is to build from one database to another . In thisThis study was funded in September 2021. In March 2022, a total of 144 first-year students enrolled in the research, who will be followed throughout the nursing program to the completion of the NCLEX exam in 2026. A total of 3 focus groups with clinical and laboratory faculty were conducted in May 2022. Data analysis of year 1 data is complete, and data analysis of year 2 data has begun. STROBE  guidelines for cross-sectional research and COREQ  guidelines for qualitative research will be followed when results are presented ,26. The The results of this study may provide evidence to support the use of the SJT, Casper, to guide nursing admissions to optimize the selection of applicants who have the greatest potential of completing the nursing program and meeting the competencies of the nursing profession. Specifically, the results will show if Casper helps predict the performance of the 4 noncognitive skills that were measured  and success on the NCLEX. Identifying and selecting applicants who perform well in these areas will mean that individuals are selected who are a good fit for nursing and therefore may be more likely to remain in the program and be licensed to practice as an RN. This will, in turn, potentially improve the quality of the nursing workforce and patient care.These findings will have implications for nursing education and administration concerning admissions procedures and whether the use, or continued use, of SJTs is warranted based on the available evidence. As well, the results of this study will hold implications for nurse researchers to further evaluate the use of SJTs such as CASPER. Consideration should be given to conducting a multisite study across several university schools of nursing and comparing student cohorts on outcomes measured by Casper  before and after the implementation of Casper.There are several notable strengths. This is the first study to report on the predictive ability of situational judgment testing as part of nursing admission criteria. The recruitment of students at 3 nursing schools ensured that participants were representative of the target population. Also, using a multiphase MMR approach and integrating or merging quantitative and qualitative data allows for a more comprehensive answer to the research questions . ConcernThere may be some possible limitations to this study. The first is the attrition of participants throughout the study. We anticipate that there will be some attrition from the study with student failure and withdrawal from the study or program throughout the 5-year study timeline. The COVID-19 pandemic has greatly influenced this cohort, and this may be found to be a contributing factor to attrition and student performance. The second limitation concerns variables that are measured with self-report . Although the tools used are valid and reliable, there is a potential for social desirability bias with these measures. Additionally, while focus groups for data collection are considered a strength, there is the possibility of power imbalances within the group, thus limiting the breadth and depth of the data ,28. ThisThe addition of a SJT such as Casper may be a strategy that could support admissions committees as they endeavor to admit students that have both the cognitive and noncognitive skills to be successful in a nursing program. SJTs have been widely used for medical education, but there is limited literature on their usefulness for nursing programs. This multistage evaluation mixed methods study will add to the literature about the predictive ability and incremental validity of the SJT Casper. The findings of this study will have implications for nursing education and research.


The use of assistive robotic systems in care is intended to relieve nursing staff. Differentiated and literature-based findings on current application possibilities, technological developments and empirical findings are necessary to enable a goal-oriented and participatory development of assistive robotic systems of care. The aim of this review was to identify assistive robotic systems and their areas of application in nursing settings. Furthermore, an overview of existing social and nursing science findings from the research field of assistive robotic systems will be described.A systematic literature search was performed based on the JBI scoping review methodology. During the period from May to August 2020, the databases MEDLINE via PubMed, CINAHL, Cochrane Library, Web of Science, and IEEE Xplore Digital Library were searched. In order to reflect current developments and evidence in the present literature work, a supplementary search with these same requirements was conducted in January 2022.The 47 included publications are divided into 15 studies, 23 technical articles and nine opinion-based articles (text-opinion). A total of 39 different assistive robotic systems were identified. There were 55% in the testing phase and 29% of the systems in the development phase. Assistive robotic systems can be divided into six fields of application: Information and patient data processing, assistance with activities of daily living, fetch and bring activities, telepresence and communication, monitoring, safety and navigation, and complex assistance systems. The description of the study findings is divided into "integration of technology and impact on practice" and "attitude and acceptance of elderly people towards assistive robotic systems".The results of the research show that the use of assistive robotic systems in care mainly take place in the context of development and testing phases. In addition to usability and acceptance issues, implementation factors must be integrated into theory-driven research projects. Under the conditions of demographic change and epidemiological developments, Western society is challenged to provide high-quality care that can be financed in the long term . Under tInnovative technologies for caregiving are generally hoped to relieve the burden on formal and informal caregivers. However, the development of these technologies is still in its infancy, highlighting the need for fundamental research –13. DiffRegarding the state of research, a first orienting search identified reviews that dealt with the topic of robotic systems in nursing with corresponding foci. In the scoping review by Buhtz et al. , the posFor which fields of activity and application are assistive robotic systems being developed in nursing settings?What social and nursing science findings are available in the field of assistive robotic systems?The aim of this review was to identify assistive robotic systems and their application areas and possibilities in nursing settings, as well as potential users. Furthermore, an overview of existing social and nursing science findings from the research field of assistive robotic systems will be described. For this purpose, the following research questions were guiding:A systematic literature search was conducted using the PRISMA statement for scoping reviews. For this, the recommendations of the JBI were methodologically followed. This form of systematic literature review was chosen to provide an orientation to the current state of the research literature, to delineate areas of work and topics, and to map key concepts in the research and development field of assistive robotic systems in nursing , 18. ThePopulation: in addition to caregivers, individuals in need of care and relatives were included as users. This heterogeneous composition was chosen in order to be able to make a differentiated statement about the target groups in the field of assistive robotic systems for care.Concept: For this review, the term assistive robotic systems was used according to Schraft & Volz  and GrafContext: In order to comply with the sensitive search principle, the context of the literature search refers not only to the acute inpatient sector, but also to the outpatient and inpatient care sector.The PCC scheme  was used to define and differentiate the search components :PopulatiBased on the methodological guidance for scoping reviews (JBI methodology) , the seaIn the first step of the literature search, a general search on the topic of assistive robotic systems for nursing care was conducted in the databases CINAHL and MEDLINE via PubMed. The articles found were analyzed with regard to relevant keywords and key terms (keywords) in the title and abstract. On this basis, the search strategy Table  for the After duplicates were excluded, double-blinded title abstract screening and full-text screening were performed by two independent reviewers . For this purpose, the support tool Rayyan QCRI web app from Qatar Computing Research Institute was used . ArticleState of technological development: a distinction was made here between development, test phase (testing in the laboratory or in the field), and use in practice.Setting: Based on the PCC scheme, it was documented in which nursing setting  the assistive robotic system was used or will be used.User: Based on the PCC scheme, it was documented who is the direct user of the assistive robotic system: nurse, person in need of care, relatives, other professional groups.Application scenario: The application possibilities and fields of activity of the assistive robotic systems were summarized descriptively. Furthermore, it was noted how the interaction between user and robotic system is defined (e.g. via voice input or tablet).Descriptive of application opportunities & research findings: The data were tabulated in a word document. The publication related data of the hits were recorded in the form of an Excel spreadsheet. The extracted data of the application areas were categorized for better overview. The categories were formed inductively using content structuring qualitative content analysis following Kuckartz .The following criteria were established in advance for data extraction. First, publication-related data were extracted: Author, publication year, title, country, and publication type. The assistive robotic systems and their possible applications were documented using the following criteria:A total of 4,938 publications were included via database search and an additional 10 via hand search. After excluding duplicates, a total of 3,869 articles were subjected to title abstract screening. Of these, 112 qualified for full text screening. In the end, 47 articles were included in the analysis . The 15 studies include two systematic reviews , four qualitative and four quantitative studies, and five studies with a mixed-method approach. The 23 technology articles are divided into 16 conference papers, seven journal articles, and one online publication. The nine opinion-based contributions are divided into four journal articles, two edited volumes, one monograph, one conference paper, and one final project brochure.The publications originate from 25 different countries and were published between 1998 and 2022.A total of 39 different assistive robotic systems were identified. Some of the robotic systems were developed for more than one setting or user group. Furthermore, there were the same systems described in different publications in different development phases. There were 55% in the testing phase and 29% of the systems in the development phase. For the clinical setting 56% of the assistive robotic systems were developed. At 48%, just under half were developed for persons in need of care. A differentiated breakdown is shown in Table Assistive robotic systems can be divided into the following six fields of applications: Information and patient data processing, assistance with activities of daily living, fetch and bring activities, telepresence and communication, monitoring, safety and navigation, and complex assistance systems.With the help of the assistive robotic systems Table  in Song Assistive robotic systems to support activities of daily living Table  were devThe assistive robotic systems for pick-up and delivery activities could be divided into the following four sub-areas: Assistive systems for food and beverage service, for medication delivery, for contact reduction in infections, and user-related delivery services.Assistive robotic systems for food and beverage service Table  deliver Some assistive robotic systems deliver medications directly to patients Table  28, 29,, 36–38. The goal of these assistive robotic systems is to minimize physical contact between patients and staff, both to prevent infection and to reduce the workload of health care professionals. In light of current events, the systems were developed and tested for the clinical care of COVID-19 patients Table . The autIn addition to delivering food, beverages, or medications, assistive robotic systems are also used to deliver and transport laboratory materials, documents and further undefined objects Table  48–53].–53.48–53A key feature of the systems described in Table One function of this category Table  is the mThe function of navigation belongs to this category, as these systems support the safe mobility of individuals. The ARNA robot accompanies patients. It serves as a walking aid and thus provides stability , 50. TheComplex assistive robotic systems for assistance Table  perform integration and impact on practice and attitude and acceptance of older people towards assistive robotic systems.The second aim of the review was to describe an overview of existing social and nursing science findings. The included publications were analyzed with regard to common research foci and summarized by content analysis. The descriptive description of the study findings is divided into Results were summarized from four studies. Two of the studies followed a qualitative research approach and one study each followed a quantitative and mixed-method approach.Mutlu & Forlizzi  used a qFurthermore, in Mutlu & Forlizzi  the cultResults were summarized from two studies. One study followed a qualitative approach and the other a mixed method approach. Acceptance of and attitudes toward assistive robotic systems in home care can be described as heterogeneous. Wang et al.  investigThe results of this systematic literature review show that assistive robotic systems in nursing care perform a variety of tasks in a wide range of settings. From the 47 included publications, 39 different systems could be identified. Almost one third of the systems were in the development phase and more than half in the test phase. Only 7 systems were already in use in nursing practice at the time of the search. With regard to the settings of use, it became apparent that more than half of the systems were developed for use in clinical care. The focus of the users is on persons in need of care and nursing professionals. Relatives, who often take over essential responsibilities in the care of persons in need of care, still play a subordinate role in this research field.A look at the literature shows that there are different categories and definitions of robotic systems in nursing. In their systematic literature review, Maalouf et al.  subdividThe evaluation of the scientific evidence showed that social science studies are largely concerned with issues of acceptance toward assistive robotic systems, in addition to the question of integration into practice. The studies show that acceptance is related to the individually perceived need for care. On the one hand, assistive robotic systems may increase loneliness and dehumanization. On the other hand, it has been noted that assistive robotic systems can provide relief within care situations , 65. TheIn the publications, some of the robotic systems were described briefly and exemplarily, others in great detail. Therefore it was not always possible to guarantee a detailed description of the technical systems and their possible applications in the results section. The definition of assistive robotic system chosen at the outset may have led to technical systems and relevant study results being disregarded. Despite the extensive and supplementary database research, it must be acknowledged that relevant sources of information were overlooked, as the research was only conducted in German and English. The heterogeneous and partly qualitatively poor studies focused for the most part only on technical and application-related questions, so that nursing science and care-related issues could hardly be addressed.The results illustrate that the transfer of assistive robotic systems into nursing care is still in its beginnings. Nursing professionals and people in need of care are already involved in the development and testing of assistive robotic systems. This participation has to take place again in the case of implementation in a real practice environment. The literature review clarifies that relatives are hardly involved in technology development and testing. However, they are an important part of home care and should be more integrated into technology development and nursing science. This can be realized by co-creative and participatory research approaches. In this context, qualitative and especially ethnographic methods prove their worth, because in interdisciplinary projects, mutual understanding and empathy for the other party is a basic requirement for technology development and practice transfer. The identified applications for assistive robotic systems are diverse and targeted to different settings and groups of people. The assistive robotic systems are often developed to take over a highly specialized activity. This fact reduces the fear that in the near future nursing professionals and complex nursing activities can be replaced by assistive robotic systems. However, they have an impact on nursing care situations, which is why ethical and social issues must be taken into account during development. There is also a need for research to determine the impact on nursing practice, as well as facilitating and inhibiting factors for implementation. To achieve this, projects must be evaluated and become the subject of research. In addition, technology development and transfer must be discussed at the political and legal level, because the transfer of technical systems to standard care is only possible with their support.


Patient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development.A systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched . The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles.We included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups , and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards.More research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups. DepressPatient decision aids (PDAs) are important tools for facilitating and achieving this aim. PDAs are evidence-based tools that inform patients about treatment options and go beyond mere informational materials by helping patients elicit their preferences, and thus preparing them for a consultation with a healthcare professional to engage in a shared decision making (SDM) process –17. PDAsPDAs can be designed as stand-alone tools, as facilitators during the SDM process, or as a combination of both. There are several types of PDAs: they can be either developed in analog forms, e.g., as fact sheets, or in a digital format, such as websites or applications. Best practice standards for developing PDAs have been defined in the International Patient Decision Aid Standards , 21.As in many other areas, novel IT technologies hold many promises also in the health care sector. This does not only apply to diagnostic tools or treatment options but also to decision making. Digitalization offers the opportunity to design PDAs in an interactive, personalized, and possibly more effective way to better engage patients and facilitate SDM for decisions regarding current and future care –24. HencPrevious research on PDAs has mainly focused on somatic conditions , 25, 26.To follow the current development driven by digital revolution and its potential, the aim of this scoping review was to characterize and compare digital and analog PDAs for patients with major depressive disorders by portraying both qualitative and quantitative evidence of their main advantages and disadvantages. Thereby, we define digital PDAs as tools that can be used with computers, mobile devices, or other digital devices. Analog PDAs are tools that are not in digital electronic formats. Instead, they typically use paper-based materials, such as flyers or booklets. This evidence synthesis provides a comprehensive understanding of the role of PDAs for patients' decision making as well as recommendations for further research and development.2.As we intended to portray the existing literature on key characteristics of PDAs in depression , scoping review methodology was most appropriate for our study . As stanThe articles were selected in a two-step process guided by predefined inclusion and exclusion criteria see . To broaData extraction was aligned with the aims of the study: summarizing advantages and disadvantages of using PDAs in general and digital vs. analog PDAs. During the extraction process, it became clear that it was not possible to differentiate between benefits and advantages or risks, challenges, and disadvantages, because the included articles did not differentiate clearly between this terminology. Besides, the terminology used in the selected articles was not unified. That is why we decided to use general terms of advantages and disadvantages to refer to the potential positive and negative aspects of the use of digital and analog PDAs. The method of narrative synthesis  was chosd was chosen because it is appropriately widely used for continuous outcomes  independent of the scale on which the outcome was measured   , and froDiMatteo . For preo Morris .3.After two-step screening and applying our inclusion and exclusion criteria, 40 articles remained see in  that wer3.1.3.1.1.The mentioned advantages of PDAs and positive roles that PDAs can have for patients seeking treatment of depression were increased knowledge , 75, 77,3.1.2.A variety of advantages or positive aspects specific to digital PDAs for the treatment of depression were discussed: digital PDAs are effective, easy and quick to use and access , 54, 67.Finally, from the clinicians’ perspective, a great advantage of digital PDAs used in SDM settings is the possibility to link them with electronic health systems, e.g., electronic health records or screening assessment tools . This wi3.1.3.The only mentioned advantages specific to analog PDAs for the treatment of depression were that printed materials are important for patients without access to computers or the internet , 51, and3.2.3.2.1.The challenges, which were discussed either in the general context of PDAs or for both digital and analog PDAs for the treatment of depression, were mainly related to the information provided in the PDAs. Both clinicians and patients raised concerns about PDAs that appeared to be too technical and too overwhelming, for example, in terms of content or wording that they provide , 51, 68.3.2.2.The common challenges discussed with digital PDAs for the treatment of depression were mainly connected with PDAs integration and implementation in the clinicians' workflow , 51. PDA3.2.3.In analog PDAs for the treatment of depression, it might be particularly challenging to regularly update evidence about the treatment . This ch3.3.3.3.1.In the papers included in this analysis, several recommendations have been identified, which relate to both analog and digital PDAs for the treatment of depression , 54, 57.In terms of the content of PDAs for the treatment of depression, it was suggested to include both pharmacological as well as psychotherapeutic treatment options , and to Tailoring PDAs to the needs of the target group was another recurring topic , 51, 60.In terms of research, it was also recommended to include a variety of population groups as well as considerations of factors related to age and involvement of caregivers . Future In terms of use of PDAs for the treatment of depression, it was recommended to make PDAs interactive, use them on a regular basis , make th3.3.2.Recommendations specific to digital PDAs for the treatment of depression mainly concerned their implementation in the clinical workflow , 54, 68:4.This scoping review aimed at comparing digital and analog PDAs for patients with major depressive disorder by collecting evidence and information regarding advantages and disadvantages of their use as well as recommendations for their development. The main finding was that analog and digital PDAs increased the patients' satisfaction with the tool, enhanced knowledge, reduced decisional conflict and better preparation for SDM. There was only one advantage specific to the analog PDAs, namely that these PDAs are more suitable for people without access to technology such as computers or smartphones. Digital PDAs were deemed to be more efficient, flexible, more easily accessible and with the opportunity of personalization. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. Furthermore, there is more research needed to study which forms of PDAs are most appropriate for various patient groups , and to identify the most effective ways of PDAs' integration in the clinical workflow.The findings from our review could be well aligned with the International Patient Decision Aids Standards , 21 thatThe review of the literature documents the growing interest in digital PDAs for patients with depression. These patients deem it important to be more involved in the decision-making process and have more information about the available treatment options , 26, 32.4.1.In general, more research is needed to systematically study the clinical effectiveness and possibly adverse effects of digital PDAs for the treatment of depression. The present review shows a high level of heterogeneity of approaches and measures of digital PDAs. Some studies were designed with a narrow focus on a specific patient group; other studies had a broad focus on PDAs from both clinicians' and patients' perspective. In addition, many studies used unvalidated instruments to measure the impact of the intervention, such as treatment adherence, patient knowledge, and goal concordance of care. This is in part explained by a lack of validated measurement instruments, e.g., for concordance of care with patient preferences and values . AnotherIn the present scoping review, only 40 articles qualified for inclusion, although inclusion criteria were deliberately broad. This is a small number given the impact of depression on public health as well as on patients, who often wish to be included to a greater extent in the decision-making process about their treatment. This research gap is accentuated by the fact that half of the articles had to be excluded because the main (or the only) focus was on the use of decision aids by clinicians see . Even thThe development, challenges and research of PDAs for patients with depression can gain from taking inspiration from research on PDAs for somatic conditions such as osteoarthritis and cancer and for other mental disorders such as schizophrenia . ResearcThe implementation challenges might be approached by the following strategies. Clinicians need training on how to effectively use PDAs with patients in the SDM process , 88. In In future studies, it is of importance to further improve the inclusion of preferences, values, and experiences of patients with depression in PDAs and SDM. More scientific studies, particularly qualitative studies, are needed to learn about patients' views, experience, and factors influencing acceptance and implementation of PDAs . Further4.2.Strengths of this review are the systematic literature search with broad inclusion criteria, capturing the full scope of scholarly articles on advantages and disadvantages of PDAs for the treatment of depression. However, this review did not include research on self-help groups, online fora, or patient versions of clinical guidelines, that are probably often used as PDA although not meeting our PDA definition. Also, while we did not exclude articles based on the age of the target group of the respective PDA, due to differences in diagnostic categories between child and adolescent and adult mental health care, our search strategy was likely less sensitive towards articles on child and adolescent depression. The final limitation is that even though we included articles in German, we did not specifically search for articles in German databases.5.The present scoping review suggests that in the field of PDAs for the treatment of patients with depression, more systematic and comprehensive research is needed to study the role of PDAs in the SDM process and to address the potential benefits as well as challenges that digitalized PDAs can offer. More research is also needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical and equity issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.


The proportions of global populations that are over 65 years of age are growing rapidly. In Japan there are now 2.5 times more diapers sold for adults than for children. Because the neurodegenerative disorders Alzheimer's, Parkinson's and amyotrophic lateral sclerosis (ALS) are all linked to aging the number of cases with these conditions are expanding greatly. It is estimated that there are 55 million people currently with dementia in the world and it is projected that there will be 139 million globally with dementia by 2050. Despite intense efforts by scientists and drug companies worldwide there is still no disease modifying therapy for Alzheimer's disease (AD), the most common cause of dementia.On June 16, 2022, it was announced that an anti-amyloid antibody, Crenezumab, failed in a large clinical trial. This result followed the complex story of another anti-amyloid antibody, Aducanumab. In June 2021, the US Food and Drug Administration (FDA) granted accelerated approval to Aducanumab, developed by Biogen, for the treatment of AD. Randomized placebo-controlled studies had shown that the antibody removed amyloid deposits in the brain. These plaques of aggregated molecules have been an important finding in AD for over 120 years. Despite this encouraging development, the drug did not provide clinically meaningful cognitive benefit. And disturbingly, over 40% of subjects experienced potentially hazardous side effects involving brain swelling. Because of these findings an FDA scientific advisory panel had recommended in November 2021, by a vote of 10 to 0 (with one voting “uncertain”), that the antibody should not be approved.Responses to the FDA's approval of the Aducanumab have been overwhelmingly negative. Three members of the FDA's advisory panel which recommended against approval resigned following the FDA's decision to approve the antibody. Biogen was criticized for the cost of $56,000 for 1 year of treatment, and they have lowered the cost to $28,000. In response to the high cost and lack of efficacy the European Medicines Agency has refused marketing authorization for Aducanumab and the US Centers for Medicare and Medicaid Services will pay for the antibody only for patients enrolled in qualifying clinical trials . The number of our own cells is similar to the number of these partner organisms and they contain over a hundred times more genetic information than does our own DNA. They are with us at every moment of our lives, beginning shortly after birth. All of our ancestors going back 1 billion years also had microbial companions. This co-evolution is key to understanding their importance in our lives. The microbiota evolved the capacity to enhance the tolerance of our immune system to their presence. This acceptance allows them to thrive without causing an aggressive immune response from the host which would be damaging. At the same time, our immune system evolved the capacity to monitor the presence of our microbial communities and control our immune responses, so that a symbiotic relationship, which benefits us both, can be maintained. It has been shown that the microbiota are key to the healthy development of the immune system. They also play important roles in metabolism nutrition learning memory and protection from disease causing organisms , and ALS has been recently demonstrated (Klann et al., Li et al., Shen et al., this issue, hyperlinks, Kurlawala et al., in vitro (Perov et al., Escherichia coli and other bacteria colocalized with neuronal amyloid inside neurons, promoted aggregation though cross-seeding and promoted disease in worm models of AD, ALS and Huntington's.Microbes in the gut, including the nose, mouth, and intestines make functional bacterial amyloid proteins which have been shown to cause templated cross-seeding of neuronal proteins in the brain, accelerating cerebral amyloid deposition in neurodegenerative disease models (Sampson et al., Furthermore, functional bacterial amyloids proteins in the gut are recognized as pathogen associated molecular patterns by the innate immune system, which has been shown to increase the immune response to neuronal amyloids in the brain and worsen functional deficit (Chen et al., An exciting feature of this work is that our microbial partners are relatively easy to adjust. They are our captives and must eat what we give them. Studies show that a change in diet in humans in as little as 2 weeks can significantly change the nature of bacterial populations in the intestine with beneficial effects on health (O'Keefe et al., Furthermore, considerable effort is being extended globally to develop agents which will affect the gut microbiota and their metabolic products with benefits for our health and fitness . It is cFrontier of Aging Neuroscience provide good reasons to believe that new approaches based on microbial mechanisms will powerfully influence the critical primary pathways of disease development with powerful effect (Tetz, Ninety to ninety-nine percent of cases of neurodegenerative diseases are not caused by genes. The microbiota may be a major environmental factor influencing the course of their development. The amyloid deposits in the brain, which anti-amyloid treatments remove, are a biomarker of AD, not the disease itself. The papers in a recent special issue of ct Tetz, .All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


Concreteness effects have been found at both the brain and the behavioral levels, but they may vary depending on the constraints of the context and task demands. In this study, we collected concreteness norms for English and Italian words presented in different context sentences to allow better control and manipulation of concreteness in future psycholinguistic research. First, we observed high split-half correlations and Cronbach’s alpha coefficients, suggesting that our ratings were highly reliable and can be used in Italian- and English-speaking populations. Second, our data indicate that the concreteness ratings are related to the lexical density and accessibility of the sentence in both English and Italian. We also found that the concreteness of words in isolation was highly correlated with that of words in context. Finally, we analyzed differences between nouns and verbs in concreteness ratings without significant effects. Our new concreteness norms of words in context are a valuable source of information for future research in both the English and Italian language. The complete database is available on the Open Science Framework (doi:  Word concreteness–the degree to which a word refers to an entity that can be perceived through our senses –has attrThis ontological distinction is reflected in their different representations in the human brain. In fact, a growing body of evidence from functional neuroimaging studies supports the idea that the brain areas of the distributed semantic network respond differently to the processing of concrete and abstract words . Theconcreteness effect emerged in a variety of studies of many different cognitive processes. There are hundreds of experimental reports that show that concrete words are processed more quickly and accurately than abstract words. For example, compared to abstract words, concrete words are responded to more quickly in lexical decision tasks [Differences can also be observed at the behavioral level. Since Paivio et al.  publisheon tasks , are eason tasks , 27, areon tasks , and areon tasks .’Physics is Alice’s research field’, ’The magnetic field attracts iron’, and ’In summer the wheat field is yellow’, the word field has different meanings with three different degrees of concreteness depending on the context in which it appears: in this perspective, each meaning is associated with a given concreteness content. Thus, shades of meaning could be mirrored by subtle differences in the concreteness dimension of words. Indeed, concreteness is not a dichotomous dimension, but rather a continuous dimension of semantic representation, and no clear boundary can be drawn between abstract and concrete words [The relative effects of the concreteness dimension in predicting the performance of participants in different cognitive tasks can also vary depending on the constraints of the context and the demands of the task . For exate words , 30.context availability account, one of the first theories that attempted to explain the concreteness effect, underlined the crucial role of contextual information in the processing of abstract and concrete words [The te words . This acte words , 32.Characterizing the concreteness degree of target words in contexts  is thus particularly important to understand cognitive effects of concreteness; it is also challenging, as it requires integrating both word-specific and contextual information. Recent attempts to predict the concreteness score associated with target words presented in different contexts come from the Natural Language Processing (NLP) community. Specifically, a shared task for systems able to predict the concreteness score of participants for words in context in different languages had been organized in 2020 . The besexplanandum) is explained by referring to something else, which is more directly understood (explanans) [Love is a rose, but you better not pick it’. Typically, this second element comes from a more direct physical experience of the real world [Databases providing concreteness ratings for words in isolation have been developed in several languages such as, for example, English , Italianplanans) , such asal world .Katz et al.  were theFollowing this line of reasoning, Muraki et al.  recentlyAlthough all the norms presented above represent a great tool for controlling psycholinguistic variables at the sentence level, they overlook the type of information conveyed by a specific target word presented in different contexts. Due to the crucial effect of contextual information on processing differences between abstract and concrete words, we focused our investigation on the dimension of concreteness.One main assumption underlying the whole work is that each term may have more associated meanings, and meaning selection is determined based on the context, which, in turn, corresponds to some sort of word meaning disambiguation. That is, the concreteness rating involves a hidden task in which meanings are identified , and conhttps://lablita.github.io/CONcreTEXT/ and https://osf.io/j4dz3/, respectively) [To our knowledge, we presented the first set of concreteness values for target words in context sentences as material for the CONcreTEXT task, in the framework of the evaluation campaign of NLP and speech tools for the Italian language  .The presAlthough the concept measures are in general stable across languages and cultures, language-specific effects can be also present, especially in our case, where words were presented within context sentences. A comparison (even if not direct) between English and Italian data may help to investigate an important issue that has been somewhat overlooked in the relevant literature, namely to what extent the concreteness ratings reflect a universal  property of concepts that are stable across languages and to what extent they are instead language specific. Unfortunately, given the lack of sentences overlap between English and Italian, we could compare the data across the two languages only indirectly.The data set also contains additional lexical and syntactic measures, such as lexical density and syntactic tree depth, which characterize sentences in terms of readability and complexity in both semantic and syntactic accounts. The main strength of this dataset is that the stimuli have been derived from the WikiHow website, and thus they represent natural and ecological examples of real-world usage of the language. Additionally, WikiHow offers articles in a multilingual environment, making this stimuli collection methodology and the relative scores easily extensible to other languages. The target words were chosen from the Italian  and Englhttps://www.prolific.co/). Data collection occurred between May 2020 and November 2020. Some participants took part as volunteers without further compensation , while others received a small monetary reward . All participants were over 18 years old.The complete sample included 319 native Italian speakers and 362 native English speakers for the Italian and English norms, respectively (see Comitato di Bioetica dell’Ateneo) of the University of Turin (Protocol number 179481) and was carried out in accordance with the ethical standards of the Declaration of Helsinki for Human Studies . The authors did not have access to information that would allow identification of individual participants during or after data collection.The study has received approval from the Research Ethics Board  or abstract events . We extracted the articles that were present in both the English and Italian sections, to guarantee a parallel between our English and Italian datasets.Given our aim to investigate concreteness ratings in context, we extracted the occurrences of the words to be annotated from natural examples. Sentences were derived from the English-Italian parallel section of The Human Instruction Dataset , a corpuhttp://corpora.dipartimentidieccellenza-dilef.unifi.it/noske/) [We then manually extracted from the corpus the sentences containing the candidate target words; in doing so, we tried to preserve as many different meanings as possible to ensure a comprehensive coverage of the semantic variation for each target word. Specifically, we uploaded the corpus to an instance of Nosketchengine (/noske/)  and seleSD = 12.15) ratings from 362 raters for the English data and 38.6 (SD = 6.55) ratings from 386 raters for the Italian data. Tables Finally, the selected sentences see  were parAn online survey procedure (using Google forms) was devised to ask participants to assign a concreteness score to the target words marked with asterisks  within a sentence. The scale used ranged from 1 to 7, where 1 corresponds to ’completely abstract’ and 7 to ’completely concrete’. At the beginning of the form, participants were informed about the purpose of the study, the institutions, and the researchers involved, and were asked to give their informed consent. Their demographic information  was collected. The first four items of the online survey were intended to familiarize participants with the task. We calculated a mean score for each item by averaging the concreteness scores of all participants. The ratings provided by each participant were then compared to the mean rating using the Euclidean distance.Finally, the ratings provided by a given participant were discarded if their Euclidean distance was greater than two standard deviations from the average of the Euclidean distances featuring all raters. Ratings were collected through 10 lists of sentences, each containing about 60 target terms and as many sentences. Overall, 429 lists were collected for the English language and 371 for the Italian language: 60 and 48 were filtered out , based on the above procedure.The normative data in CONcreTEXT include concreteness values for 118 English and 146 Italian words presented in different contexts for a total of 544 English and 562 Italian sentences. Values are derived from judgments provided by 362 English and 386 Italian speakers (see section Participants), and each word in the context was rated by at least 31 participants. There were no missing values, that is all participants provided a rating for all target words under evaluation.The database includes the full list of English and Italian target words along with their part of speech tag, the index of the word in the sentence, the sentences, aggregated means and standard deviations of the concreteness ratings, the WordNet synset of the target word (if available) and a series of linguistic  variables characterizing the target word and the full context of the sentence. Lexical and syntactic measures have been obtained making use of the Profiling-UD tool . This toWN_synset is the ID of the word meaning as it is encoded in the meaning inventory of WordNet. WordNet is a lexical database for the English language. Its constructive rationale relies on grouping terms into sets of synonyms  that are equipped with short definitions and usage examples. WordNet is a broad-coverage semantic network whose relations include several semantic relations between synset elements, such as hyponymy/hypernymy, meronymy/holonymy, antonymy, and others [d others . To retrd others , 58. Thetarget lexical accessibility and the sentence lexical accessibility are two measures related to the frequency of tokens (word forms). We include these measures based on the assumption that more frequent words are more accessible to the speaker and thus potentially more familiar. We used the Wacky corpora for English and Italian (ukWaC and itWaC [The nd itWaC ) as refend itWaC . We scalSentence lexical accessibility is the average of the lexical accessibility of all the word forms composing the sentence.Lexical density denotes the ratio between content and function words inside a text. We consider as content words those belonging to open classes of parts of speech that carry semantic information: nouns and verbs (and their modifiers), adjectives, and adverbs. This feature is computed as the sum of content words divided by the total number of words in a sentence. Lexical density is typically considered as an indicator of cognitive load [ive load .Sentence length, clauses, and average tokens per clause indicate respectively the total number of word forms, the number of clauses composing the sentence, and the average word distribution over the total number of clauses. These are basic measures derived from raw counts but are typically considered as a proxy for lexical and syntactic complexity in traditional readability assessment metrics [ metrics .syntactic tree depth indicates the longest path from the root of the dependency tree to the deepest leaf. Dependency parsing of sentences results in tree representations in which words are nodes (leaves) and dependency/modification relations are edge labels. This measure is related to the sentence length and is considered as a feature that impacts processing difficulty [The fficulty .https://osf.io/j4dz3/). The concreteness norms are freely available to the scientific community for noncommercial use in the Open Science Framework repository  with a mean of 3.97  and 4.28 , and data points ranging between 1 and 7, and 1.44 and 6.96, for English and Italian ratings, respectively. Kurtosis was -1.16 for English and -1.33 for Italian. Skewness was .0220 for English and—.0007 for Italian. A bias towards the high range of the scale was observed for both English and Italian, since 58% of the English words and 56% of the Italian words were rated as above the median value , both percentages being statistically different from the chance level . This bias was similar between the English and Italian participants (χ2 (1) = .550, p = .458).Regarding the homogeneity of the participant ratings, The consistency of the collected data was first evaluated by applying split-half correlations corrected with the Spearman-Brown formula after randomly dividing the participants into two subgroups of equal size. Reliability indexes were calculated on 2000 different randomizations of participants. The corrected split-half correlations were very high , revealing that the resulting ratings were highly reliable and can be used in the Italian and English-speaking populations. An analysis of internal consistency was also performed using the Cronbach alpha coefficient. The ratings of each participant were used as variables and the individual sentences as cases following the procedure of , 40. An p = 0.05, with the procedure described by Benjamini and Hochberg [r = 0.098, p = 0.022) and a negative correlation with sentence accessibility . The same significant correlations were found for Italian .Zero-order pairwise correlations showed that concreteness was related to the lexical density and accessibility of the sentence in both English and Italian. False Discovery Rate (FDR) correction was applied at Hochberg , to corrr = 0.096, p = 0.026) and target lexical accessibility .Furthermore, for the English language, we found small positive correlations with sentence length  of 0.88 (p < 0.001); for Italian we obtained a ρ = 0.75 (p < 0.001).Although we had to retrieve only one concreteness rating per term from the mentioned norms (where terms are rated once and in isolation), in our dataset each target term appears more than once . We then compared our ratings with those in the literature by recording the correlation between the average of the values recorded in our norms and the value in either the BRYS or MONT data. In general, CONcreTEXT norms were significantly correlated to BRYS and MONT, respectively for English and Italian see . For Enghttp://compling.hss.ntu.edu.sg/omw/) was used as the meaning inventory. The target word of each sentence was annotated with the best matching synset, according to the word meaning in the given context.We associated one or more meanings to each target term. In doing this, we relied on the WordNet  classifiAs expected, the annotators did not find a meaning for each occurrence since in some cases the set of available WordNet synsets does not cover the needed concept. Conversely, in other cases, a word was provided with multiple synset assignments, when annotators found more than one synset as suitable for the word in the given context. Incompleteness and multiplicity of synset annotations are common issues in this task . In the First dataset, only the first annotated synset was reported; in the Best dataset, the combination of annotated synsets that maximize the agreement between annotators was selected. The agreement was calculated according to two measures, Fleiss k and Krippendorff α. The results are reported in To measure the inter-rater agreement, annotation has been performed in parallel by three authors on a subset of 20% of sentences in Italian and English. Sentences in which the target lemma had less than three synsets on Open Multilingual WordNet have been discarded: Although the number of synsets of a lemma should not have a significant impact on the agreement , a lemmak values ranging from 0.3 to 0.8 [Human agreement in word meaning disambiguation tasks based on WordNet is highly dependent on the selected target words, and it is usually not high, with 3 to 0.8 –71. MoreBest are higher than in First, with a standard deviation of 0.02 in English, and of 0.05 in Italian. The agreement differences between nouns and verbs are significant and completely unrelated between the two languages: the agreement value is higher for nouns in English, with a deviation of 0.06 , while in Italian a much higher agreement on verbs was obtained (SD = 0.17).The agreement measured on the current dataset is in line with the values reported in the literature for the same task on other datasets. A strong difference between Italian and English was observed, probably depending on a better-meaning distinction and coverage of the English WordNet. Agreement values in Nsyn); and the range of variation of the degree of concreteness, measured as the difference between the maximum and minimum concreteness rating (Cvar). Finally, we grouped the lemmas according to their Nsyn value and computed the mean Cvar of each group. In this way, we obtained a measure of variance for each group of lemmas with the same number of synsets in the data set. Results are reported in A comparison between synset annotation and concreteness ratings has been performed to see if and to what extent a variation of meanings in a target word is linked to a variation of the concreteness degree. To this aim, we counted the following numbers for each target lemma in our dataset, that is, the number of different synsets used in all the occurrences of a lemma . These results show that when a lemma is used with only one meaning, it tends to have a more stable concreteness degree; conversely, a wider variability in concreteness ratings is observed when a lemma is used with different meanings.The correlation between We deepened our analysis on the standard deviation associated with the average concreteness scores of words with one sense vs words with multiple senses. Even though we observe an increasing difference between highest and lowest concreteness score as the number of senses grows, the standard deviation associated with terms with one sense is only slightly lower than that associated with polysemous terms . Our results show that the variability in the identification of the underlying sense is similar for targets, irrespective of whether these had one or more annotated senses. Such a hypothesis seems to be confirmed by the ratio between standard deviation and concreteness average scores: this figure is .37 and .43 for terms occurring with one sense and polysemous terms (English), and .42 and .43 for Italian terms, respectively. No information was provided to our raters on whether a word was polysemous or not.t-tests. We found that the average concreteness ratings of Italian speakers were not significantly different between verbs and nouns  = .677; p = .498), and the effect size was very small (Hedges’ g = .059). The same result emerged for English ratings, with no differences between nouns and verbs  = 1.041; p = .298; g = .093). Furthermore, in order to investigate whether there was a difference in the rating variability between nouns and verbs for each language, we performed the t tests on their standard deviations. While the results did not show any difference for the Italian sentences  = .952; p = .342; g = .084), a significant difference has been found for the English sentences (t(542) = 2.203; p = .028), with a higher variability for verbs  compared to nouns , although the effect size was small (g = .178).We investigated differences between the concreteness ratings provided for target nouns and verbs in each sentence by both Italian and English participants. To this end, we performed a series of two-tailed independent The present study has proposed a set of newly collected contextual concreteness ratings that substantially extends with further ratings and lexical measures the data released for the shared task CONcreTEXT@Evalita . These nThe key asset of these norms is that the sentences have been obtained from the WikiHow website as natural, ecological, examples of real-world language. This aspect makes the current concreteness norms easily extensible to other languages.An exploration of the distribution of concreteness ratings revealed that their distribution deviated significantly from normality. Furthermore, by plotting the mean and standard deviation of the ratings, the results showed a quadratic function, suggesting that item sentences that assume midrange values tended to receive more variable ratings across participants.We tested the reliability of our ratings, which was checked in depth and through different measures, obtaining high figures, well above 0.9, both in the split-half tests and in the Cronbach’s alpha coefficients in both English and Italian languages. This pattern of results indicates that our ratings have high internal consistency, and thus they provide an optimal estimate of how participants perceive the meanings delivered by target terms in context based on their perceptual grounding and language.Importantly, different from existing work , 2, 48 oWord concreteness is an intriguing research topic area at the intersection of psychology, linguistics, lexical semantics, computational modeling, and NLP. In the last few years, it has attracted growing research efforts since it impacts how we acquire, access, and make use of word meanings. For the NLP community, the present norms may be relevant for building meaning embeddings that are indexed on both terms and meanings, such as DeConf , LSTMEmbAlthough the number of annotated occurrences is limited and not all term meanings are covered, the present work offers a first investigation reporting on the role of context in concreteness ratings in two languages  and introduces a methodology for data collection that has proven to be solid. Following this methodology, the data set can be easily expanded in the future, about the number of target words, contextual sentences per target word, and additional languages. This will contribute to promote the generalizability of studies on the concreteness effect (and to drive a more overarching theory of semantic representation) since our understanding of this effect has been disproportionally informed by English native speakers. Future research should also take into account the homonymous words, which are currently underrepresented within our dataset. Indeed, the different meanings of homonymous words can vary in concreteness, and the context is essential to select the exact meaning of homonymous words as well as of polysemous words. Therefore, increasing the inclusion of homonymous words in future normative studies will allow investigations on the intricate interplay between concreteness, context and word ambiguity, shedding new light on the dynamics of language processing.In summary, we collected word concreteness norms in more than 1000 English and Italian sentences. The high consistency of the collected data has been demonstrated by the high split-half correlations and the Cronbach alpha coefficients. We also showed a significant correlation between the concreteness value of a target word and the number of different meanings in which it is encountered, confirming a link between word concreteness and context. We believe that CONcreTEXT norms are a valuable source of information and can be used confidently for the selection of words in different contexts in future research, despite its small size. We hope indeed, that these norms will be useful to the research community. As far as we know, ours are the first concreteness norms for words in context sentences for English and Italian. As such, these norms should be useful to researchers working with these languages or interested in cross-linguistic comparisons.


The WEAICOR  study was a prospective observational study that used continuous monitoring to detect and analyze biometrics. Compliance to wearables was a major challenge when conducting the study and was crucial for the results.The aim of this study was to evaluate patients’ compliance to wearable wristbands and determinants of compliance in a prospective COVID-19 cohort.The Biostrap (Biostrap USA LLC) wearable device was used to monitor participants’ biometric data. Compliance was calculated by dividing the total number of days in which transmissions were sent by the total number of days spent in the WEAICOR study. Univariate correlation analyses were performed, with compliance and days spent in the study as dependent variables and age, BMI, sex, symptom severity, and the number of complications or comorbidities as independent variables. Multivariate linear regression was then performed, with days spent in the study as a dependent variable, to assess the power of different parameters in determining the number of days patients spent in the study.r=0.23; P=.01). In addition, age , BMI , and the severity of symptoms  were found to correlate with days spent in the WEAICOR study. Per our multivariate analysis, in which days spent in the study was a dependent variable, only increased age was a significant determinant of compliance with wearables .A total of 122 patients were included in this study. Patients were on average aged 41.32 years, and 46 (38%) were female. Age was found to correlate with compliance (Compliance is a major obstacle in remote monitoring studies, and the reasons for a lack of compliance are multifactorial. Patient factors such as age, in addition to environmental factors, can affect compliance to wearables. The rapid, ongoing integration of digital technologies in medicine has improved patient management, providing safe, effective, and standardized interventions. Digital tools offer several solutions and benefits that were previously unavailable, promoting beneficial behaviors such as smoking cessation ,2, physiadherence as the extent of an individual’s experience with the intervention. However, this definition does not consider the World Health Organization’s initial conclusions that adherence is the extent to which a patient follows medical instructions. They elaborated that the term medical limits the extent of interventions that patients with long-lasting diseases receive. Additionally, the term instructions implies passivity on the patient side and might imply that patients are only recipients rather than collaborators [Although digital tools are currently facilitating medical practice, many new hurdles have emerged during this process. One of these challenges is patient compliance and adherence to these devices. Compliance is commonly viewed as a standard measurement of the quality of digital health studies. Regardless of the efficacy and performance level of a digital intervention, the latter loses its value in the absence of compliance. Unfortunately, there is still no established universal standard for assessing compliance. For example, Christensen et al  defined borators . Therefoborators .The WEAICOR  study was a prospective observational study that used continuous monitoring to detect and analyze biometrics . While pThe aim of this study was to evaluate patients’ compliance and the determinants of this compliance in a prospective COVID-19 cohort.The WEAICOR study was a prospective observational study of patients who were aged 18 years or older and were monitored via the Biostrap (Biostrap USA LLC) wearable wristband device. The study aimed to identify the impact of the post–COVID-19 condition on sleep by using wearables. In this analysis, we sought to evaluate patient compliance.After eligibility screening and the signing of electronic consent forms, all patients were sent a Biostrap device by mail to continuously monitor their biometric data, including heart rate, heart rate variability, respiratory rate, and oxygen saturation. Instructions on how to use the device were provided via phone calls by the study coordinator, along with a recorded video that detailed the steps for activating the device and linking it to the mobile app. Participants were instructed to wear the smart band.This study was approved by Tulane University Institution Review Board on June 9, 2020 (study #2020-678).In this analysis, patients who recovered from COVID-19 were included. Participants who had a positive COVID-19 diagnosis were recruited via flyers and advertisements on different social media platforms and via mass emails that were generated and sent to Tulane University’s staff and student body. A total of 200 patients were assessed for eligibility by September 2021. Participants received a baseline questionnaire that collected demographic and medical history data. We secured informed consent forms and listed Tulane University as an organization with data access.The Biostrap is a photoplethysmography-based smart band that records patients’ vitals at rest and at 5-minute intervals and generates graphic results and reports on the Biostrap mobile app. The device has a life span of 2.5 days and is splashproof. Patients were able to keep the device after the completion of the WEAICOR study. The mobile app transferred photoplethysmography and motion signal data collected from the wrist to the Biostrap cloud server, where the data underwent signal processing and analysis via machine learning algorithms to generate resting physiological data, which were transferred to Tulane University’s data server. The data were automatically synchronized in real time and could be viewed on the Biostrap portal by the research team. The study participants used their own smartphones. The accuracy and reproducibility of the Biostrap device in assessing basic physiological data were already reported in previously published studies ,20. MoreThe Biostrap remote monitoring system ensured data generation, compliance, and technical troubleshooting throughout the WEAICOR study. The research coordinator explained to the participants the purpose of the study, the risks accompanied with the study, the ability to drop out at any time during the study, and the types of data that were being collected . Patients were called regularly by the study coordinator to assess for problems or compliance issues. The compliance of participants was also assessed throughout the study. Noncompliant patients were either contacted by the research coordinator or prompted via cell phone notifications to wear the device. Data on symptoms were collected by using surveys, which were collected at different time points .A wearable device was used to monitor participants’ biometric data. Analyses were performed by using prospectively obtained continuous wearable data. Adherence to the wearable device was based on the following two metrics: compliance and days spent in the WEAICOR study. Compliance was calculated as a percentage by dividing the total number of days in which data were transmitted by the total number of days spent in the study. Because compliance could take any data value between 0 and 100, it was considered a continuous variable for the analysis. We also calculated the total number of days patients remained in the study.A univariate correlation analysis was performed, with compliance as a dependent variable and age, BMI, sex, symptom severity, and the number of complications or comorbidities as independent variables. Symptom severity was calculated on a scale of 1 to 5, with 1 indicating no symptoms or minor symptoms and 5 indicating very severe symptoms. The number of complications was the sum of the number of comorbidities in each patient. For example, for a patient with hypertension and diabetes who has no other risk factors, the number of complications or comorbidities would be 2.r=0.23; P=.01).The same analysis was performed with days spent in the study as a dependent variable. Since multiple independent variables correlated with the days spent in the study, backward stepwise multivariate linear regression was performed, with days spent in the study as a dependent variable, to assess the power of different parameters in determining the number of days patients spent in the study. No multivariate analysis was performed with compliance as a dependent variable, as only age was significant in the univariate analysis  years, and 46 (38%) were female. The population tended to be young and had few or no comorbidities. Most of the participants  were not hospitalized during their COVID-19 course. Baseline demographics are detailed in r=0.23; P=.01). The number of complications , BMI , sex , and the severity of symptoms  were not found to be determinants of compliance. In addition, age , BMI , and the severity of symptoms  were found to correlate with days spent in the WEAICOR study  and sex  were not found to be determinants of increased days spent in the study . BMI (P=.07), the severity of symptoms (P=.25), complication count (P=.47), and sex (P=.86) were nonsignificant determinants of increased days spent in the study . However, the power of the association was weak, suggesting unknown determinants. Second, patients with increased symptom severity were more likely to be compliant to a wearable device. Third, environmental factors, such as natural disasters, can affect wearable compliance during remote studies.In our study, we report several findings. First, advanced age was the most significant factor in increasing compliance with wearables , age , and BMI  were significant in determining the number of days patients spent in our study. Additionally, as seen in the multivariate analysis, age was the strongest predictor. The influences of age and patient-related factors on compliance rates and days spent in the study emphasize the fact that compliance to a wearable is multifactorial and cannot be well defined.The severity of symptoms , which may suggest that age might be a potential confounder. These discrepancies support the multifactorial aspects of patient compliance and the need for detailed prospective studies that specifically aim to understand determinants of compliance. Moreover, the low power of association in the multivariate analysis indicates that there remain many unknown determinants of compliance.Patients with more severe symptoms spent more days in the WEAICOR study when compared to patients with lower symptom severity. Previous studies are conflicting with regard to this finding. Similar to our study, Wild et al  reportedFinally, the impact of Hurricane Ida (which occurred in New Orleans) on the WEAICOR study proves that while compliance is intimately related to patient factors, environmental factors can also dramatically affect an entire group's compliance. Since all of the study participants were recruited from Louisiana, from Hurricane Ida’s landfall on August 29, 2021, onward, compliance dropped drastically. The drop in patient compliance after this date is an example of the difficulties associated with continuing routine care after a natural disaster and shows that remote monitoring can be as problematic as medication maintenance in postdisaster health care . This deOur study presents several limitations. First, the recruitment of Tulane University staff and students likely resulted in a highly health literate, younger study population. Our results should be replicated in larger studies that include older patients and patients with a health literacy level that is reflective of the broader population. Second, our study population was mostly comprised of healthy individuals . As such, the impact of comorbidities on compliance might not have been well assessed. Third, female patients were underrepresented in this study, which could limit the generalizability of our results. Fourth, even though all participants were technology literate, they were not asked about their previous wearable usage. Finally, subjective and participant-specific factors that may affect participant compliance were not researched and should be the subject of further studies.Device compliance is a major obstacle in remote monitoring studies. Patient and environmental factors, including age, symptom severity, and natural disasters, play a role in adherence to wearable devices and can impact study results. Future remote monitoring studies should focus on increasing compliance to achieve more accurate and reliable results.