Comprehensive Outcome Research Articles

Expanding subtitles: An exploration into scaffolding and deepening educational content through subtitling

Educational videos have proliferated in recent years due to increased demands for online content in massive open online courses (MOOC) and blended classroom and pandemic contexts. While these videos are often subtitled to provide greater access, questions remain about whether the educational content of these videos can be deepened. This qualitative study initiates exploration into whether subtitles could and/or should be expanded, providing more in-depth information and thus bridging gaps in background knowledge and deepening comprehension of the video content. The study suggests expanding subtitles by creating clickable keywords and concepts within the subtitles. The findings indicate that higher-risk participants who accessed a moderate number of expansions (approximately one every 90 seconds) had better comprehension outcomes than lower-risk participants who either did not access expansions, or accessed a high number of expansions (approximately one every 50 seconds). Furthermore, the study finds that there was a positive attitude towards expanded subtitles, with 60% of participants indicating a desire to see more expanded subtitles. These findings suggest that future research taking a quantitative approach is necessary to determine the full educational value of this subtitle format.

Small-scale farmers' market constraints in Ghana: influential farm-level contingencies

This study sought to identify significant barriers to market access and marketing connections for small-scale rural farmers, evaluating the impact of demographic factors (gender, education level) and operational factors (years in farming, distance from home, type of commodity) on these constraints. The research employed a cross-sectional descriptive and inferential quantitative approach to examine the barriers to market access and marketing connections among small-scale rural farmers in Ghana's Volta area. The conceptual framework is based on a multi-theory approach. The contingency theory elucidates the significance of farm size, resource availability, and geographic location; the human capital theory delineates the impact of education level and years of farming experience; and the logistics and spatial analysis framework examines how transportation infrastructure, geographic location, and commodity type affect market access and connections. The investigation indicated that inadequate road infrastructure and elevated transportation expenses were the primary obstacles for small-scale rural farmers in accessing markets, with notable disparities based on gender and educational attainment. The commodity kind, years of cultivation, and distance from home substantially influenced limitations. The study concentrated on the Volta region, however the results are probably relevant to other regions in Ghana because of comparable agro-ecological zones and rural socio-economic traits. The rigorous research design, data collection techniques, and comprehensive analysis guarantee dependable and valid outcomes. Notwithstanding possible constraints in generalisability, the research provides comprehensive insights into the distinct issues encountered by small-scale farmers. It emphasises socio-economic factors affecting market access, illustrates the impact of farm-level contingencies on market access and linkages, identifies both diversity and uniformity among small-scale farmers, and addresses a gap in the literature by offering empirical evidence on market access constraints specific to the Volta region that may have global relevance. These contributions are significant for both academic comprehension and practical initiatives aimed at assisting small-scale rural farmers in Ghana and analogous environments worldwide.

A Socio-Educational Study on NEP 2020's Emphasis on Local Language Inclusion in Digital Content: With Special Reference to the Arunachal Pradesh

This socio-educational study explores the emphasis of the National Education Policy (NEP) 2020 on local language inclusion within digital educational content, specifically focusing on Arunachal Pradesh's unique linguistic landscape. NEP 2020 highlights the importance of multilingualism to ensure equitable access and meaningful learning experiences for students across India. Given Arunachal Pradesh’s rich linguistic diversity, implementing digital content in local languages presents both challenges and opportunities for educators, policymakers, and communities. This study investigates the effectiveness of NEP 2020’s language inclusion strategies, examining their impact on student engagement, comprehension, and overall educational outcomes. Through interviews with educators and analyses of student responses to local language content, the research assesses how digital multilingualism aids or hinders learning. Findings contribute to a broader understanding of NEP 2020’s role in supporting regional language preservation while promoting inclusive digital education, providing insights to enhance digital learning across diverse linguistic regions.

Semantic Ambiguity in the Use of 'Konteks' in Merdeka Curriculum Textbooks: Implications for Learning Outcomes and Pedagogical Strategies

This study examines errors in interpreting the word “konteks” (context) and its equivalents in Merdeka Curriculum textbooks for Indonesian Language, Civic Education, and English Language subjects. Semantic ambiguity and inaccuracies in the use of this term have led to misunderstandings that hinder students' comprehension and learning outcomes. The research aims to identify patterns and potential sources of misinterpretation to ensure alignment between textbook language and the learning objectives of the Merdeka Curriculum. Using a qualitative approach with a comparative method, the study analyzed the meaning and usage of “konteks” across subjects. Data were collected through documentation of both explicit and implicit references, followed by descriptive content analysis based on Miles et al.'s interactive model. Triangulation, expert validation, and adherence to ethical standards ensured the validity and reliability of findings. Results indicate that misinterpretations of “konteks” often lead to fragmented understanding, making it difficult for students to connect concepts across academic and social settings. This disrupts cognitive processes, preventing the development of complex analytical skills. To address these issues, teachers should facilitate clarifying exercises and discussions emphasizing context. Additionally, textbook evaluations must prioritize accurate definitions, precise usage, and illustrative examples to minimize ambiguity and enhance learning outcomes.

Hyperspectral anomaly detection via low-rank and sparse decomposition with cluster subspace accumulation

Anomaly detection (AD) has emerged as a prominent area of research in hyperspectral imagery (HSI) processing. Traditional algorithms, such as low-rank and sparse matrix decomposition (LRaSMD), often struggle to effectively address challenges related to background interference, anomaly targets, and noise. To overcome these limitations, we propose a novel method that leverages both spatial and spectral features in HSI. Initially, the original HSI is segmented into several subspaces using the k-means method, which reduces redundancy among HSI bands. Subsequently, the fractional Fourier transform (FrFT) is applied within each subspace, enhancing the distinction between background and anomaly target information while simultaneously suppressing noise. To further improve the stability and discriminative power of the HSI, LRaSMD is employed. Finally, the modified Reed–Xiaoli (RX) detector is utilized to identify anomalies within each subspace. The results from these detections are then aggregated to produce a comprehensive final outcome. Experiments conducted on five real HSI data sets yield an average area under the curve (AUC) of 0.9761 with a standard deviation of 0.0156 for the proposed algorithm. These results indicate that our method is highly competitive in the field of anomaly detection.

Comprehensive assessment and progression of health status during neurorehabilitation in survivors of critical illness: a prospective cohort study

BackgroundCritical illness survivors frequently suffer from long-term impairments, often described as post-intensive care syndrome (PICS). PICS encompasses physical, cognitive, and mental impairments. Additionally, the term intensive care unit (ICU)-acquired weakness (ICUAW) was coined for muscle weakness after critical illness. Research on the progression and outcome of individuals affected by PICS and ICUAW is scant. Thus we aimed to assess the health status and its progression during neurorehabilitation in critically ill patients using comprehensive outcome measures, describe the prevalence of PICS, and evaluate factors associated with rehabilitation outcomes.MethodsPatients with mixed reasons for critical illness who received ≥ 5 days of mechanical ventilation on the ICU and who were admitted to neurorehabilitation, were eligible to be included in this prospective cohort study. A number of outcomes (patient-reported, clinician-reported, and performance) were assessed after discharge from the ICU (V1) and shortly before discharge from inpatient neurorehabilitation (V2). The prevalence of PICS, defined as having at least one impairment in any PICS dimension), was calculated at V1 and V2. Multiple logistic regressions were conducted to identify factors associated with rehabilitation outcome (poor outcome = modified Rankin Scale > 2) and ICUAW at V2 (MRC sum score < 48).ResultsIn total, 250 critical illness survivors (62 ± 14 years, 34% female, median stay on ICU 55 days, median inpatient rehabilitation 65 days) were included. 11 participants (4.4%) died before V2. All outcomes improved significantly during rehabilitation except sensory impairment and pain. PICS was present in 96% at V1 and in 85% at V2, whereby mainly the physical domain (V1: 87%, V2: 66%; ICUAW with MRC sum score < 48) and the cognitive domain (V1:65%, V2:55%; Montreal Cognitive Assessment < 26) were affected. Mental impairment was lower (V1:48%, V2:29%; Hospital Anxiety and Depression Scale > 7), but still affected a considerable number of participants. Accordingly, health-related quality of life was rather low at discharge (0.64 ± 0.28, index value of EQ-5D-5L). MRC sum score at V1, duration of mechanical ventilation, and female gender were significantly associated with a poor rehabilitation outcome. Grip strength in % of reference at V1, age, female gender, and comorbidities were significantly associated with persistent ICUAW at discharge.ConclusionsDespite significant improvements during rehabilitation, survivors after critical illness experience a substantial burden of PICS and ICUAW at discharge from rehabilitation care. Survivors of critical illness require long-term follow-up, supportive structures, and tailored long-term multi-disciplinary therapies even after intensive rehabilitation.Trial registration: German Clinical Trials Register, DRKS00021753. Registered 03 September, 2020. https://drks.de/search/en/trial/DRKS00021753.

Real-world impact of Elexacaftor-Tezacaftor-Ivacaftor treatment in young people with Cystic Fibrosis: A longitudinal study

BackgroundElexacaftor, Tezacaftor, Ivacaftor (ETI) became available in the UK in August 2020 to treat people with Cystic Fibrosis (CF) aged > 12 years. We report a real-world study of clinical outcomes in young people treated with ETI at our CF centre within the first two years of its availability. MethodsParticipants aged 12-17 were identified within our clinic, with demographic data supplemented by the UK CF registry. Comprehensive outcome data spanning two years pre- and two years post-initiation of CFTR modulators were compiled from various local sources, including patient records, medication delivery logs, and clinical notes. ResultsOf the 62 patients started on ETI (32 male, mean age 13.3 years), most (76%) were homozygous for the F508del mutation. Three discontinuations occurred: one pregnancy, two related to side effects. Adherence was high (Proportion of Days covered >90% both years). Following ETI initiation there was a significant increase in mean FEV1% (+11.7 units; 95% CI 7.4 – 15.6), sustained throughout the two-year treatment period. There was no association between baseline lung function and the degree of improvement or rate of decline post-treatment. Improvements were similar for all treatable genotypes. BMI z-score increased by 0.25 units after four months of treatment, returning to baseline by 24 months. Intravenous antibiotic use decreased by 88% (median IV days/year reduced from 32 to 4 days, p < 0.01). ConclusionsETI use in adolescents in a real-world setting led to sustained improvements in health outcomes, consistent with those seen in open trial extension studies

From Silos to Synergy: A Scoping Review of Team Approaches to Outpatient Eating Disorder Treatment.

This scoping review synthesizes the available evidence on team outpatient eating disorder treatment, focusing on team composition, reported health and service outcomes, and reported principles of Interprofessional Collaborative Practice (IPCP), a synergistic healthcare approach characterized by shared values and ethics, clear roles, communication, and teamwork. A comprehensive search was conducted across five databases, targeting studies published between January 2004 and August 2024 that discussed team-based outpatient eating disorder treatment. Peer-reviewed and gray literature were included if they detailed team composition, characteristics, dynamics, experiences, processes, or outcomes. Forty-five studies met the inclusion criteria; nearly half were case reports or lacked primary data. Treatment teams commonly comprised mental health professionals, dietitians, and medical practitioners. Clinical outcomes, such as body mass index and psychopathology, were the most frequently reported, while satisfaction and organizational outcomes were underrepresented. IPCP principles were inconsistently reported, with "Roles/Responsibilities" and "Communication" most frequently mentioned but often superficially addressed. The evidence base for team outpatient eating disorder treatment lacks rigor and depth. Future research should focus on refining the integration of roles across disciplines, developing comprehensive outcome measures for benchmarking, and applying IPCP principles more systematically.

Enhancing multimodal output in CLIL education: the impact of VR games on fourth-grade students’ English poster designs and presentations in Taiwan

Despite the growing recognition of the importance of multimodal input and digital virtual reality (VR) games in enhancing EFL learners’ productive language skills, a significant gap remains in empirical research examining their impact on multimodal output—particularly writing and speaking—within content and language integrated learning (CLIL) science education. This quasi-experimental study addresses this gap by investigating the potential benefits of using VR games to enhance fourth-grade CLIL students’ productive language skills, specifically writing and speaking, through the analysis of their ability to convey scientific concepts in multimodal output. Grounded in self-regulated learning (SRL) theory, the study compares the effects of multimodal input embedded in VR games with those of traditional PowerPoint (PPT)-led games on students’ English poster designs (writing) and oral presentations (speaking), using the 4Cs (Content, Communication, Cognition, and Culture) framework in multimodal assessments. The study involved 81 fourth-grade students from three Taiwanese public elementary schools, divided into an experimental group (EG = 40) using VR-based games and a control group (CG = 41) using PPT-led games for content review. A mixed-methods approach was employed, combining quantitative evaluations with rubrics based on the 4Cs framework and qualitative rater reflections to provide a comprehensive understanding of how different review methods influenced student performance and creative output. Quantitative findings revealed that students using VR review games significantly outperformed those using traditional PPT games in aspects of Content and Cognition for both poster designs and presentations, demonstrating greater depth, accuracy, and application of scientific concepts and higher-order cognitive skills. In terms of Communication, the EG showed higher target vocabulary usage and sentence complexity in presentations, but no significant differences were found in Culture outcomes between the groups or in Communication in posters. Expert raters’ reflections further highlighted that students using VR games exhibited more innovative and integrated use of scientific content, critical thinking, and multimodal expressions, reflecting deeper engagement with the material. This study empirically demonstrates that game-based virtual reality learning environments (VRLEs) significantly enhance students’ multimodal output in content and cognitive skills. Theoretically, it extends the application of SRL in CLIL contexts by highlighting the potential of VRLEs to foster advanced cognitive skills and emphasizes the importance of multimodal assessments in capturing comprehensive student learning outcomes. Future research should explore integrating cultural content into VR environments to enhance students’ cultural awareness and sensitivity.

AUTOMATED INDOOR ACTIVITY MONITORING FOR ELDERLY AND VISUALLY IMPAIRED PEOPLE USING QUANTUM SALP SWARM ALGORITHM WITH MACHINE LEARNING

Elderly and vision-impaired indoor activity monitoring uses sensor technology to monitor interaction and movement in the living area. This system can identify deviations from regular patterns, provide alerts, and ensure safety in case of emergencies or potential risks. These solutions enhance quality of life by promoting independent living while offering peace of mind to loved ones and caregivers. Visual impairments have become the chief part of these problems over the past few years. Usually, visually impaired people seek help from others to keep doing their daily tasks. An automated human activity recognition (HAR) technique could enhance a vision-impaired person’s transaction activity and safe movement. HAR using deep learning (DL) includes training neural networks to automatically detect and classify various activities carried out by humans based on sensor information. By leveraging DL approaches, the HAR system could accurately identify and classify activities, including sitting, standing, walking, or running, from the information captured by sensors or wearable devices. This system is integral to smart home automation, healthcare, and sports analytics. This study develops an Automated Fractal Quantum Salp Swarm Algorithm with Machine Learning based HAR (QSSA-MLHAR) for assisting elderly and visually impaired people. The QSSA-MLHAR technique uses sensory input data to identify human activities in diverse classes. In the QSSA-MLHAR technique, the min–max scalar is primarily used to scale the input data. Besides, the QSSA-MLHAR technique applies a mixed extreme learning machine (M-ELM) model to classify various human actions. The QSSA-based hyperparameter tuning process is used to improve the detection results of the M-ELM system. A wide range of simulations was performed to ensure the better performance of the QSSA-MLHAR method. The comprehensive outcomes assured that the QSSA-MLHAR technique performs well compared to other models.

Quality of Life in Mild Cognitive Impairment and Mild Dementia Associated with Alzheimer's Disease: A Systematic Review.

Mild cognitive impairment (MCI) and Alzheimer's disease (AD) have a profound impact on patients' quality of life (QoL), with progressive declines occurring as the disease advances. This systematic review aims to summarize the published evidence on patient-reported outcomes (PROs) in individuals with MCI due to AD and mild AD dementia. Comprehensive searches were conducted across five major databases to identify studies reporting on utility values, disutilities, and QoL measures in these patient populations. A total of 23 studies were included that utilized various QoL assessment tools, including EQ-5D (n = 14), SF-36/SF-12 (n = 4), and QOL-AD (n = 11). Reported EQ-5D scores ranged from 0.81 to 0.92 for patients with MCI and from 0.67 to 0.85 for those with mild AD, indicating a noticeable decline in QoL as the disease progresses. QOL-AD scores ranged from 33.8 to 42.5 for MCI and from 32.4 to 38.1 for mild AD, equally reflecting the greater impairment in QoL with disease advancement. Interventions were generally associated with smaller declines in PROs compared to placebo, suggesting a positive impact of treatment in mitigating QoL deterioration. The findings underscore the significant QoL differences between MCI and mild AD, emphasizing the potential benefit of early intervention to preserve QoL and delay disease progression. This review highlights the importance of continued research to better understand QoL in patients with MCI and mild AD dementia, particularly in terms of capturing comprehensive patient-reported outcomes and evaluating the effectiveness of interventions over time. These findings can contribute to a more informed approach in clinical practice and support decision-making in the management of early-stage AD.

Learning Innovations in Coastal Areas Through Augmented Reality and Gamification

This research investigates the development of an augmented reality (AR) application with gamification elements to enhance natural science learning in coastal areas. Validation by media and content experts, along with trials conducted among students, showed high feasibility and strong appeal of the application. Functionality tests, including marker detection range, demonstrated the application's capability to operate effectively in diverse coastal environments. The study highlights the successful integration of AR and gamification as a tool to improve engagement and understanding of natural science concepts in under-resourced coastal schools. This application holds great potential for enhancing the quality of education in coastal areas by offering an interactive and immersive learning experience. Further research is recommended to refine the application and assess its long-term impact on student comprehension and educational outcomes in various coastal communities. This study represents a significant step forward in using innovative AR technology to support learning in coastal regions.

Development of a novel Patient-Reported Outcome Measure (PROM) for adults with an Inherited Cardiac Condition (ICC)

Abstract Background Research on the quality-of-life (QoL) among patients with inherited cardiac conditions (ICC) is limited. Existing evidence from a systematic review indicates that most studies rely on generic measures of health-related QoL, which may not adequately capture ICC-specific factors. The current study aims to develop a disease-specific patient-reported outcome measure to address this gap. Methods Using a qualitative study design, we first conducted focus groups until data saturation was achieved (n=15). Additionally, an expert panel of healthcare professionals was interviewed to ascertain their perspectives on patient-centered care and to evaluate face validity. Transcripts of all focus groups and interviews were analyzed thematically using Atlas.ti, qualitative analysis software, to identify concepts and formulate survey items for the initial instrument. We used the ‘Centre for Health Promotion’ QoL model, consisting of three domains- Being, Belonging, and Becoming- as the theoretical framework for our analysis. Results Our analysis revealed alignment with specific QoL domains of the overarching framework and identified a gap in genetic-specific domains. A novel overarching theme, genetic well-being, was identified, encompassing specific constructs related to future uncertainty, reproductive concerns, and the anticipation of disease development, thus enriching the conceptualization of QoL in the context of inherited cardiac conditions. The discussion will include an exploration of the face validity of the draft instrument. Conclusion Patients diagnosed with an inherited cardiac condition (ICC) face a spectrum of challenges originating from both disease-related stressors and hereditary factors alike. Recognizing that relying solely on objective clinical assessment may fail to capture the full impact of the disease, there has been an increasing focus on incorporating patient-reported measures into disease evaluation. This qualitative study contributes to developing a comprehensive patient-reported outcome measure tailored to individuals with ICC.PROM development study

Telecoupling cannot be ignored for the forest-based carbon market

Abstract Telecoupling interactions between social–ecological systems across large, often global distances drive negative impacts from the forest-based carbon market. However, these negative impacts have been underreported and, therefore, have likely been vastly underestimated. We identify how these unintended negative impacts may occur and provide recommendations for the forest-based carbon market to better account for externalities by prioritizing positive social impact, expanding comprehensive ecological outcomes, and improving the transparency of investments. We call for a carbon market that is designed to account for its global interconnectedness.

Debiased hybrid contrastive learning with hard negative mining for unsupervised person re-identification

The goal of unsupervised person re-identification is to retrieve a specific person across several non-overlapping cameras without the aid of manual labeling information. In recent times, contrastive learning has found extensive application in undertaking the complexities of unsupervised person Re-ID. Nevertheless, prevailing approaches often ignore the bias in negative proxy sampling and the significance of hard negatives in contrastive learning. These limitations have constrained the performance of existing methods. To solve these issues, we introduce a Debiased Hybrid Contrastive Learning with Hard Negative Mining (DHCL-HNM) approach. Particularly, the proposed approach employs an instance-level memory bank to save the class prototypes for all training images. In each training epoch, the memory bank undergoes clustering, dividing the dataset into un-clustered outliers and clustered images with pseudo labels. Then, the debiasing of negative proxies and the hard negative mining are integrated into a hybrid contrastive learning process to enhance the intra-class similarity and the instance discrimination. The debiasing operation is realized during the sampling of negative proxies to reduce the negative effects of false negatives. In the meantime, the hard negative mining can guide the Re-ID model to concentrate on the hard negatives by reweighting negative proxies based on their similarities to the anchor sample. The efficiency of the proposed method in the realm of unsupervised person Re-ID is demonstrated through comprehensive experiment outcomes conducted on several datasets.

Multi-Scale Risk-Informed Comprehensive Assessment Methodology for Lithium-Ion Battery Energy Storage System

Lithium-ion batteries (LIB) are prone to thermal runaway, which can potentially result in serious incidents. These challenges are more prominent in large-scale lithium-ion battery energy storage system (Li-BESS) infrastructures. The conventional risk assessment method has a limited perspective, resulting in inadequately comprehensive evaluation outcomes, which impedes the provision of dependable technical support for the scientific appraisal of intricate large-scale Li-BESS systems. This study presents a novel Li-BESS-oriented multi-scale risk-informed comprehensive assessment framework, realizing the seamless transmission of assessment information across various scales. The findings from a previous smaller-scale analysis serve as inputs for a larger scale. The evaluation process of this method is more scientifically rigorous and yields more comprehensive results compared to assessment technologies just relying on a single perspective. By utilizing the proposed comprehensive assessment methodology, this study utilized the emergency power supply of nuclear power plants (NPPs) as an application scenario, demonstrating the complete implementation process of the framework and conducting a comprehensive assessment of Li-BESS feasibility as an emergency power source for NPPs. Our findings propose a novel paradigm for the comprehensive assessment of Li-BESS, which is expected to serve as a scientific foundation for decision-making and technical guidance in practical applications.

Petrous Bone Cholesteatoma- A Comprehensive Management Algorithm and Outcomes

Petrous Bone Cholesteatoma- A Comprehensive Management Algorithm and Outcomes

Prenatal diagnosis and postnatal follow-up of 15 fetuses with 16p13.11 microduplication syndrome.

The clinical phenotypes of 16p13.11 microduplication syndrome have been extensively reported in previous studies, mostly about adults and children, with limited information available on fetal cases. This study aims to explore the genotype-phenotype correlation of fetuses with 16p13.11 microduplication syndrome and analyze the characteristics of prenatal diagnosis indications and provide clinical information for prenatal and postnatal genetic counseling. We conducted a retrospective analysis of 3,451 pregnant women who underwent invasive prenatal diagnosis for SNP array between January 2018 and December 2022 at the Jinan Maternal and Child Health Hospital. Descriptive statistical analysis was performed on the prenatal diagnosis indications, pedigree analysis, pregnancy outcomes and postnatal follow-up of 15 fetuses with 16p13.11 microduplication syndrome. SNP array revealed that 15 fetuses had duplications in the 16p13.11 region with varying prenatal diagnosis indications. Among the cases, 6/15 exhibited ultrasound abnormalities, 5/15 had abnormal chromosomal copy number variations as indicated by non-invasive prenatal testing (NIPT), one case involved advanced maternal age, and 3/15 had other abnormalities. 16p13.11 microduplication syndrome was closely related to ultrasound abnormalities, especially structural abnormalities and soft marker anomalies (abnormal ultrasonic soft indicators), while the indication of NIPT could improve the detection rate of copy number variations (CNVs) in this region. Only 7/15 fetuses underwent pedigree verification, with one case of de novo 16p13.11 microduplication, and the others inherited from one parent. Pregnancy was terminated in 2/15 cases and the outcome of one case is unknown due to loss to follow-up. Among the remaining cases, only one case exhibited a ventricular septal defect, while another presented with omphalocele. No other obvious abnormalities were reported postnatally. The prenatal phenotypes of fetuses with 16p13.11 microduplication were highly associated with ultrasound abnormalities but lacked specificity. Comprehensive genetic tracing, outcome analysis, and follow-up are essential for providing accurate prenatal and postnatal genetic counseling.

Colonization of Bone Flaps by Cutibacterium acnes During Decompressive Craniectomies for Traumatic and Non-traumatic Indications: A Retrospective Observational Study.

Background Cutibacterium acnes (C. acnes) is one of the most common bacteria in the human skin microbiota. Due to it generally requiring special culturing techniques, it was generally not routinely included in culture. However, recent laboratory automation advancements have allowed C. acnes to be a routinely tested pathogen. Though this could improve outcomes by detecting a virulent pathogen early, it has raised concerns about potential false positives leading to increased costs and medical risks. This study aims to analyze the C. acnes colonization rates in traumatic craniectomies and compare it to non-traumatic craniectomies, the former including risk factors due to penetrations and the latter being conceptually similar to a craniotomy with a lack thereof. This would help establish a baseline rate to understand the pathogen's implications better. Methodology We analyzed the electronic health records of 124 patients who underwent a craniectomy followed by a cranioplasty at Inova Health System from January 1, 2018, to January 1, 2023. The following categories of data were recorded for each patient: patient descriptors, comprehensive surgical timelines and outcomes, and bone flap viability and microbial colonization assessment. The chi-squared tests of independence and Wilcoxon signed-rank tests were used to assess statistical significance between groups in the indications underlying surgery (traumatic vs. non-traumatic) with C. acnes colonization, flap status (reimplanted vs. discarded), hospital length of stay (LOS), and unexpected 30-day readmission. Results Traumatic (67%) and non-traumatic (33%) craniectomies were compared. There was no significant association between the two craniectomy etiologies in terms of C. acnes colonization (40% vs. 26.5%, p=0.19), flap discardment (40% vs. 24%, p=0.12), or readmission rates (20% vs. 9.6%, p=0.18). However, a significant association was found between C. acnes colonization and LOS during the index craniectomy procedure (24.8 vs. 25.9 days, p=0.049), indicating that colonization may influence LOS. No significant association was found between the type of cranial surgery and LOS (p=0.83), suggesting other factors may play a more crucial role in determining LOS. The findings highlight the need to consider the impact of C. acnes colonization on surgical outcomes and hospital protocols. Conclusion Our findings illustrate that there is no significant difference between C. acnes colonization in traumatic and non-traumatic craniectomies; therefore, C. acnes can be expected to be cultured at a baseline level regardless of the etiology. Furthermore, there was no association with surgical indication and flap status, LOS, and readmission rates. However, a significant association was found between C. acnes status and LOS, indicating the increased complexity of care associated with the pathogen's detection. These findings support the protocol of deferring C. acnes culturing unless specific concerns are found.

Modelling the effects of the reading medium on L2 Spanish reading emotions: The moderating role of individual difference variables

While existing research has documented that the reading medium significantly impacts language learners’ reading comprehension processes and outcomes, empirical evidence on how the reading medium influences reading emotions is lacking. The present study contributes to the field by investigating whether reading emotions (i.e. enjoyment, anxiety, and boredom) of learners of Spanish as a second language (L2) differ between mobile-assisted and paper-based reading processes. In addition, it explores whether individual difference variables (i.e. L2 Spanish proficiency and preferences for the reading medium) moderate the relationship between the reading medium and reading emotions. The instruments used are reading comprehension tests and questionnaire surveys administered to a sample of 245 first-year college students majoring in Spanish. Paired samples t-tests indicate that L2 Spanish learners perceive more enjoyment and less negative emotions when reading from a paper-based format than those from a mobile-assisted mode. In addition, moderation analyses indicate that both L2 Spanish proficiency and preferences for the medium are moderators of the relationships between the medium and reading emotions. More proficient L2 Spanish readers perceive more enjoyment and less anxiety and boredom when reading from paper than those from mobile phones; less proficient L2 readers demonstrate the opposite pattern. Students’ preference for mobile-assisted language reading would significantly enhance their reading enjoyment while reducing reading anxiety and boredom when they engage in such a type of reading mode. These results imply that individual differences are crucial factors in shaping students’ emotions across different reading modes. Reasons for differences in reading emotions across mediums and the moderating roles of individual variables are discussed.