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Objectives Unnecessary antibiotic prescribing contributes to antimicrobial resistance. A randomized controlled trial in 2014–15 showed that a letter from England’s Chief Medical Officer (CMO) to high-prescribing GPs, giving feedback about their prescribing relative to the norm, decreased antibiotic prescribing. The CMO sent further feedback letters in succeeding years. We evaluated the effectiveness of the repeated feedback intervention. Methods Publicly available databases were used to identify GP practices whose antibiotic prescribing was in the top 20% nationally (the intervention group). In April 2017, GPs in every practice in the intervention group (n=1439) were sent a letter from the CMO. The letter stated that, ‘the great majority of practices in England prescribe fewer antibiotics per head than yours’. Practices in the control group received no communication (n=5986). We used a regression discontinuity design to evaluate the intervention because assignment to the intervention condition was exogenous, depending on a ‘rating variable’. The outcome measure was the average rate of antibiotic items dispensed from April 2017 to September 2017. Results The GP practices who received the letter changed their prescribing rates by −3.69% (95% CI=−2.29 to −5.10; P<0.001), representing an estimated 124 952 fewer antibiotic items dispensed. The effect is robust to different specifications of the model. Conclusions Social norm feedback from a high-profile messenger continues to be effective when repeated. It can substantially reduce antibiotic prescribing at low cost and on a national scale. Therefore, it is a worthwhile addition to antimicrobial stewardship programmes.

One of the special arrangements in testing contexts is to allow dyslexic students to listen to the text while they read. In our study, we investigated the effect of read-aloud assistance on young English learners' language comprehension scores. We also examined whether students with dyslexia identification benefit from this assistance differently from their peers with no official identification of dyslexia.Our research was conducted with young Slovenian learners of English who performed four language assessment tasks adapted from a standardized battery of Slovenian national English language tests. In a counter-balanced design, 233 students with no identified dyslexia and 47 students with dyslexia identification completed two language comprehension tasks in a readingonly condition, one task with read-aloud assistance and one task in listening-only mode. We used Generalized Linear Mixed-Effects Modelling (GLMM) to estimate accurately the effects of Article Language Testing 36(1) the mode of administration, dyslexia status, and input text difficulty, while accounting for error variance owing to random differences between students, texts, and questions.The results of our study revealed that young L2 learners with no dyslexia identification performed similarly in the three conditions. The read-aloud assistance, however, was found to increase the comprehension scores of dyslexic participants when reading difficult texts, allowing them to perform at the level of their non-dyslexic peers. Therefore, our study suggests that this modification of the test administration mode might assist dyslexic students in demonstrating their text comprehension abilities.

This study used eye‐tracking to examine changes in how second language (L2) learners process target grammatical exemplars in written L2 input in implicit and explicit instructional conditions and how these changes relate to learning gains. In three separate sessions, 77 L2 learners of English read a story containing seven examples of a grammatical construction. The results of a growth curve analysis indicated significant main effects for the instructional condition and test sessions on total fixation duration and a significant interaction between these two variables. There was minimal attentional processing and no improvement in processing efficiency of the target construction in the unenhanced condition. Learners’ attentional processing in the textually enhanced conditions decreased and, by the end of the experiment, they engaged in establishing and fine tuning form–meaning links. In the two explicit instructional conditions, participants’ attention decreased over time and form–meaning representations of the target structure were strengthened. Open Practices This article has been awarded an Open Materials badge. All materials are publicly accessible via the IRIS Repository at https://www.iris-database.org. Learn more about the Open Practices badges from the Center for Open Science: https://osf.io/tvyxz/wiki.

Extensive research has demonstrated the impact of working memory (WM) on first language (L1) reading comprehension across age groups (Peng et al., 2018), and on foreign language (FL) reading comprehension of adults and older adolescents (Linck et al., 2014). Comparatively little is known about the effect of WM on young FL readers’ comprehension, and even less within testing contexts. Young FL readers are still developing their L1 reading skills and general cognitive skills (e.g., attentional regulation abilities). Completing FL reading tests might be particularly taxing on their WM, and differences in WM capacity – as well as other learner and task characteristics – might create construct-irrelevant variance in test performance. In this study we investigate the effects of WM, grade level, and reading task on young learners’ FL reading test performances. Ninety-four young English language learners (Grades 6–7) in Hungary completed the TOEFL® Junior™ Comprehensive’s reading test and a WM test battery. Our mixed-effects model predicted significantly higher comprehension accuracy among learners with higher WM capacity, and among learners in Grade 7 compared to learners in Grade 6. Reading task differences were not associated with significant comprehension accuracy differences. We discuss the implications of our findings for testing young learners’ FL reading comprehension.

Aim The Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing. Subject and methods We conducted a two-armed randomised controlled trial amongst practices whose STAR-PU-adjusted prescribing was in the 20th–95th percentiles and had increased by > 4% year-on-year in the 2 previous financial years. Intervention practices received a letter on 1st March 2018 stating ‘The great majority (80%) of practices in England reduced or stabilised their antibiotic prescribing rates in 2016/17. However, your practice is in the minority that have increased their prescribing by more than 4%.’. Control practices received no letter. The primary outcome was the STAR-PU-adjusted rate of antibiotic prescribing in the months from March to September 2018. Results We randomly assigned 930 practices; ten closed or merged pre-trial, leaving 920 practices — 448 in the intervention and 472 in the control. An autoregressive and moving average model of first order ARMA(1,1) correlation structure showed no effect of the intervention (β < −0.01, z = −0.50, p = 0.565). Prescribing reduced over time in both arms (β < −0.01, z = −36.36, p < 0.001). Conclusions A social-norms-feedback letter to practices whose prescribing was increasing did not decrease prescribing compared to no letter. Trial registration NCT03582072.

Misinformation has the potential to damage the public’s trust in governments’ policies and communications. In this large three-arm parallel online randomised controlled trial, we aimed to test the efficacy of two commonly applied misinformation interventions: false tags and psychological inoculation.Australian residents (n = 1,815) were randomly allocated to one of three experimental arms: control, false tags or inoculation. We exposed participants to 30 real-life social media posts, 15 of which were misinformation. While previous misinformation experiments have predominantly used perception- or intention-based outcome measures, our social media platform simulation measured engagement with misinformation, a more ecologically valid approach. Specifically, the ‘reactions’ of participants to each post were recorded. Using pre-registered mixed-effects logistic regression models, we found that inoculation conferred the most protection against misinformation, significantly reducing ‘likes’/‘loves’ and ‘reactions’ compared to the control. Inoculation also suppressed ‘likes’/’loves’ significantly more than false tags, the approach currently used by Meta. The results of this experiment suggest that inoculation has the potential to attenuate engagement with misinformation in Australia. The results of this study may be used by Australian regulators and social media platforms to inform future policy decisions.

Misinformation can have a profound detrimental impact on populations’ wellbeing. In this large UK-based online experiment (n=2,430), we assessed the performance of false tag and inoculation interventions in protecting against different forms of misinformation (‘variants’). While previous experiments have used perception- or intention-based outcome measures, we presented participants with real-life misinformation posts in a social media platform simulation and measured their engagement, a more ecologically valid approach. Our pre-registered mixed-effects models indicated that both interventions reduced engagement with misinformation, but inoculation was most effective. However, random differences analysis revealed that the protection conferred by inoculation differed across posts. Moderation analysis indicated that immunity provided by inoculation is robust to variation in individuals’ cognitive reflection.This study provides novel evidence on the general effectiveness of inoculation interventions over false tags, social media platforms’ current approach. Given inoculation’s effect heterogeneity, a concert of interventions will likely be required for future safeguarding efforts.