Follow-up Phase Research Articles

Acceptance Factors of Generative AI in EFL Teaching: A Pedagogical Perspective

<p>The emergence of generative artificial intelligence (GenAI) has brought abundant potentials and challenges to the educational sector. This study explores the acceptance and adoption of GenAI in English language and its pedagogical affordability for EFL instructors in tertiary level institutions in the Kingdom of Saudi Arabia. An exploratory sequential mixed method was utilized in this study to gain in-depth insights into the quantitative findings. The first quantitative phase recruited 256 EFL instructors in Saudi Arabia while the follow-up qualitative phase incorporated 17 interviewees. The findings of this study indicate that anthropomorphism, trust, ethics and regulations, and pedagogical affordability are significant determinants of instructors’ acceptance of GenAI. Conversely, instructors’ acceptance was not significantly influenced by communication capability of GenAI. Yet, there was no evidence of significant differences in GenAI acceptance or adoption due to demographic variables such as gender, age, and degree. The pedagogical affordances of GenAI appears to be the most acceptance factor specifically the productivity and efficiency that GenAI afford for instructors. The study recommends establishing ethical guidelines and embracing transparency and accountability to maintain academic integrity.</p>

Investigating the Comparative Effectiveness of Yoga and Relaxation Therapy on Restlessness, Fatigue and Difficulty Concentrating in Multiple Sclerosis Patients

Background: Multiple sclerosis (MS) is a long-term autoimmune disorder affecting the central nervous system, leading to reduced quality of life and impaired physical and psychological functions. Objectives: This study aims to examine the relative efficacy of yoga and relaxation therapy in improving sleep disturbances, fatigue, and cognitive impairment among individuals diagnosed with MS. Methods: This study employed a semi-experimental research design, including a pre-test, post-test, and follow-up over three months. The target population comprised all MS patients referred to the Iranian MS Association in Tehran between July and November 2023. Sixty participants were selected using purposive sampling and randomly assigned to research groups: Two yoga therapy groups with 17 participants each, a relaxation therapy group with 16 participants, and a control group with 18 participants. The yoga therapy group participated in twelve 90-minute sessions twice a week, while the control group received no intervention and was placed on a waiting list. Various tools, including the Multidimensional Fatigue Inventory (MFI), Cohen-Mansfield Agitation Inventory (CMAI-O), and a concentration skills questionnaire, were used to collect data. The data were analyzed using ANOVA, Bonferroni post hoc test, MANCOVA, and Kruskal-Wallis H tests with a significance level of 0.05, utilizing SPSS 27 software. Results: The study found a significant difference (P < 0.001) in the restlessness factor in both the post-test and follow-up phases. Additionally, there was a significant difference (P < 0.001) in the levels of physical fatigue, mental fatigue, decreased activity, and decreased motivation in both the post-test and follow-up phases, indicating significant changes in the fatigue factor among the research groups. However, there was no significant difference in the general fatigue component between the research groups. A significant difference (P < 0.001) was also found in the concentration factor, particularly in the components of voluntary and involuntary concentration, during both the post-test and follow-up stages. Conclusions: The results of this study indicate that both yoga and relaxation therapy techniques significantly reduce restlessness, physical tiredness, mental fatigue, decreased activity, and decreased motivation. Furthermore, the findings validate that both yoga and relaxation therapy techniques effectively enhance voluntary and involuntary concentration.

Copper and zinc status in cord blood and breast milk and child's neurodevelopment at 18months: Results of the Italian PHIME cohort.

Trace elements, including zinc (Zn) and copper (Cu), although toxic at higher concentrations are known to play important roles in the maintenance of human health and neurodevelopment. Few epidemiological studies have investigated the association between prenatal or early postnatal Cu and Zn levels and child neurodevelopment. The aim of this research is to assess the association between child neurodevelopment at 18 months of age and cord blood and breast milk concentrations of Cu and Zn in Italian mother-child pairs enrolled in the Italian Northern Adriatic Cohort II (NAC-II), a part of the "Public health impact of long-term, low-level, mixed element exposure in susceptible population strata" project PHIME. The study population consisted of 632 children, and their mothers, born within the NAC-II, who were tested with the Bayley Scales of Infant and Toddler Development third edition (BSID-III) at age 18 months. Cu and Zn concentrations were measured in cord blood and breast milk samples. Only children born at term (≥37 gestational week), who completed the BSID-III test and had at least 1 measure of Cu and Zn concentrations were included in the analysis. Information about socio-demographics and lifestyles were collected through questionnaires at different phases of follow-up. Cu and Zn concentrations were log2 transformed because of their skewed distribution. Multiple linear regression models were performed to study the association between each BSID-III composite score (cognitive, motor and language) and each metal concentration. Separate models were applied for each biological sample. The β coefficient (β) and its 95% confidence interval (95% CI) were estimated. Stratified analyses by child's sex were also conducted. The mean±standard deviation (SD) of cognitive, motor and language composite scores were respectively: 106±8, 101±5 and 97±8. The mean±SD of Cu and Zn concentrations (ng/g) were respectively 699.2±129.0 and 2538±589 in cord blood and 607±498 and 3226±1428 in breast milk. No association between metal concentration and cognitive composite score was found. A higher motor composite score was associated with higher Cu concentrations in cord blood (β=4.31 95% CI 2.03; 6.59). No associations were found between language composite score and metal concentrations. The effect of Cu cord blood concentration on motor composite score was confirmed when stratified by sex: males (β=5.49 95% CI 2.15; 8.36) and females (β=3.11; 95% CI 0.00; 6.22). A direct association, in females only, was found between language composite score and Cu concentration in cord blood (β=5.60 95% CI 0.63; 10.57) and in breast milk (β=3.04 95% CI 1.06; 5.03), respectively. The results from this cohort study showed a strong direct association between prenatal Cu levels and child motor neurodevelopment at 18 months. However, for generalizability, future research on the effects of Zn and Cu on neurodevelopment should include a larger range of early-life concentration of trace elements.

The motivational impact of sport education model on daily physical activity levels among university students: a mediation analysis.

This study investigates the effects of the sport education model on physical literacy and its subsequent impact on daily physical activity levels among university students. Through mediation analysis, this study seeks to uncover the role of situational motivation in these effects. The participants in this study consist of 188 university students (male n = 132, female n = 70; mean age: 18.53 years) who were exposed to an 8-class, 10-lesson season as part of their physical education curriculum. Self-report measures were collected at baseline (1st lesson), post-intervention (10th lesson), and follow-up phases (5 weeks after). The results reveal significant mediation effects at the post-intervention (β = 0.201, t = 3.576, p < .001) and follow-up (β = 0.187, t = 3.069, p < .01) phases. Additionally, significant direct effects of physical literacy on physical activity metabolic minutes were found in the post-intervention phase (β = 0.293, t = 1.807, p < .05). Gender differences were also observed in the multigroup analysis. These findings demonstrated the motivation mediates the impact of the sport education model on promoting physical activity and highlight the multidimensional nature of physical literacy. Future research is recommended to explore the application of this pedagogical model in different educational contexts and populations, utilising robust analytical methods.

Abstract 4124065: Clonal Hematopoiesis of Indeterminate Potential (CHIP) in Chronic Coronary Artery Disease: A Report from the ISCHEMIA Trials Biorepository

Introduction: CHIP is associated with CAD and mortality. The prognostic relevance of CHIP for high-risk patients with confirmed CAD is unknown. Hypothesis: CHIP variants are associated with cardiovascular (CV) events and mortality in high-risk patients with known CAD in the ISCHEMIA Trials Biorepository. Methods: 895 ISCHEMIA and ISCHEMIA-CKD (hereafter, ISCHEMIA Trials) participants with moderate-severe ischemia and next-generation sequencing performed for CHIP variant allele fractions of ≥2% (CHIP) and ≥10% (large CHIP) were included. Unadjusted and multivariable adjusted (age, sex, diabetes, eGFR not on HD, HD, and LVEF) associations of CHIP and large CHIP with a) ISCHEMIA Trials initial phase primary endpoint (CV death, myocardial infarction (MI), or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest, RCA) and b) ISCHEMIA Trials combined initial and extended follow-up phase (hereafter, Cumulative) endpoint of all-cause death . Results: Median (IQR) age of sequenced participants was 67 (56 – 79) years, 19% were female, 83% white, and 6% Hispanic. Hypertension (84%), diabetes (45%) and obesity (47%) were common, 26% had an eGFR &lt;60 ml/min/1.73m 2 . The prevalence of CHIP and large CHIP was 23% and 7%, and both increased with age ( Figure 1a ). CHIP mutations in DNMT3A were detected in 106 (12%), TET2 CHIP in 44 (5%), and ASXL1 CHIP in 21 (2%) participants ( Figure 1b ). DNMT3A, TET2, and CREBBP mutations collectively comprised 199 (52%) of overall CHIP mutations, including individuals with multiple mutations in the same gene (N overall = 385); 67 participants (7%) had mutations in &gt;1 gene. Over 3.1 years of RCT follow-up there were 135 (20%), 32 (16%) and 15 (18%) primary endpoints for no CHIP, CHIP and large CHIP, respectively. Over 6.8 years of EXTEND follow-up, there were 126 (18%), 47 (23%) and 24 (29%) deaths in the no CHIP, CHIP and large CHIP groups, respectively. After multivariable adjustment there was no association between CHIP or large CHIP and CV events or mortality ( Figure 1c ). Conclusion: Neither CHIP nor large CHIP was associated with adverse outcomes in 895 high-risk individuals with confirmed CAD, despite a high prevalence of these mutations.

Examining an Explicit Phonological Awareness Intervention: The Impact on First Sound Fluency in Young Children.

The authors evaluated the ability of typically developing preschool children to acquire the phonemic awareness skill of first sound fluency (FSF) when trained through an explicit modeling treatment paradigm. Three preschool children participated in a single-case A-B-A research design in which the independent variable was shared book reading between professional and child with embedded modeling of first sounds in words and the dependent variable was the participants' ability to produce first sounds in words in response to the professional's auditory probes. A baseline phase included sessions without intervention. An intervention phase followed with sessions of explicit modeling of first sounds with hierarchal cueing and a follow-up phase. All three participants demonstrated immediate behavior change in an accelerating trend direction for FSF performance which was achieved after five sessions. However, the children's accuracy in producing first sounds in words was not maintained at levels expected for any of the participants. Suggestions are provided for how this strategy can be used and adapted by clinicians and educators to prepare preschool children for phonologically based emergent literacy skills needed to succeed in kindergarten.

Mindful With Your Baby/Toddler: A Single Case Design (SCD) Study.

Transitioning to motherhood comes with new and intensive tasks that may cause parental stress, low parental self-efficacy, and internalizing problems. This can in turn negatively affect the mother-child relationship. Mindful with your Baby/Toddler (MwyB/T) is a mindfulness-based intervention for parents of young children experiencing parental stress and internalizing problems. Previous evaluative studies showed promising results, but methodology of these studies was limited. The current study used a single case design, including a baseline, intervention, posttest, and follow-up phase, to evaluate the effectiveness of MwyB/T. Ten participants were included and completed daily administered personalized items and validated questionnaires measuring mindfulness, mindful parenting, parental self-efficacy, internalizing problems, and parental stress, for 10 participants. Personalized items were first coded into themes and then assessed using visual analysis and descriptive effect size measures. Reliable change indices were computed for the questionnaires. All mothers improved on personalized items, with most improving on most (or all) of their items. On the questionnaires the majority of mothers improved. Results indicate that MwyB/T could benefit mothers with various intervention goals. More research is needed on the role of personalized items, both as a research measure and an as a possible additional element of interventions.

Implementing Person-Centred Lean Six Sigma to Transform Dermatology Waiting Lists: A Case Study from a Major Teaching Hospital in Dublin, Ireland

The study site, a major teaching hospital in Dublin, Ireland, addressed significant challenges within its dermatology service through a comprehensive improvement initiative using a person-centred Lean Six Sigma methodology. Initially, the hospital’s dermatology department faced excessive outpatient waiting times, with 3736 patients awaiting appointments, and 1615 waiting over 12 months. The person-centred Lean Six Sigma approach, which combines Lean techniques to reduce non-value add and Six Sigma methods to eliminate variation through a person-centred lens, was applied to overhaul the referral, triage, and scheduling processes. Key interventions included standardising triage categories, centralising the triage process, and redistributing referrals equitably among consultants. A new centralised triage system was established, leading to a more efficient allocation of appointments and better management of urgent cases. Post-implementation data showed a 40% reduction in the overall waiting list and a 60% reduction in the number of patients waiting over 12 months. The initiative significantly decreased the wait times across all urgency categories, with the most notable improvements in soon and urgent referrals. These changes were also the impetus for a follow-up design-led innovation phase, where the team worked with partners across the educational and healthcare system to enable disruptive change. The success of this project provides a scalable model for improvements in similar healthcare settings.

The effectiveness of a sentence-building treatment protocol based on Colorful Semantics

This study investigated the effectiveness of a color-coding system on the sentence-construction skills of a Greek child with Down syndrome. A five-stage single-subject design was implemented, consisting of assessment, baseline, treatment, post-treatment and follow-up phases. The treatment protocol was devised based on the Colorful Semantics program (Bryan, 2003). It focused on the construction of SVO clauses in the context of a picture-description task. The sentence-building process involved the segmentation of the target utterance into its basic syntactic constituents, facilitated by color-coding information of the subject, the verb and the object, and the use of wh- questions. Evidence based on an extensive assessment battery guided the selection and the design of the treatment program. During the baseline, post-treatment and follow-up phases, the child described the same set of action images for comparison purposes, whereas the sentence-coding protocol was introduced and implemented within two 45-minute sessions in a single week. In the baseline session, the child produced a full utterance in response only to 2/16 target pictures. After two treatment sessions, the child was able to describe almost all target pictures using full sentences, while adopting the coding system independently, without the aid of the clinician. Additionally, at 8 weeks post-treatment, the child was still able to describe nearly 50% of the pictures correctly, while using full clauses without the aid of the sentence-coding system. Conclusively, these results not only demonstrate the effectiveness of the designed treatment protocol, but also its efficiency and long-term effects. Given that the protocol was applied to a single participant, findings cannot be generalized without conducting a more extensive investigation.

Thirty days clinical outcomes following stent implantation with aspirin-free prasugrel monotherapy in non-ST segment elevation myocardial infarction. Interim report from ASET-Japan pilot study

Abstract Background Dual antiplatelet therapy with a P2Y12 inhibitor, in addition to aspirin, is the standard therapy after percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) to prevent ischemic cardiovascular events. The Acetyl-Salicylic Elimination Trial (ASET) pilot studies conducted in Japan in patients with NSTE-ACS investigated the safety and feasibility of a low-dose prasugrel monotherapy after PCI. Purpose To ensure the safety of the patients, enrolment in the study was implemented only after confirmation of a successful procedure. The abstract reports our interim analysis, aimed at evaluating preliminary safety and feasibility. Methods The ASET-Japan pilot study was designed to explore the feasibility and safety of a low dose of prasugrel monotherapy (3.75mg/day), without adjunctive aspirin, after optimal PCI using Everolimus eluting stent (EES) in Japanese patients with non-ST-segment elevation acute coronary syndromes. The primary endpoint in the ASET-Japan NSTE-ACS (Phase 2) is a 12-month clinical outcome. The study is currently in the follow-up phase. All the target lesions were treated with a platinum-chromium everolimus-eluting stent. The primary ischemic endpoint was the composite of cardiac death, spontaneous target vessel myocardial infarction, or definite stent thrombosis, and the primary bleeding endpoint was Bleeding Academic Research Consortium types 3 and 5 bleeding up to 12-month. If more than 3 events occurred, trial enrollment would have to be terminated by the data and safety monitoring board. Results One hundred one patients were enrolled after successful index PCI and completed a 30 days follow-up. The mean age was 69.1±12.3 years and 75.2% was male. The mean anatomical SYNTAX score was 7.9±4.7. Unstable angina (UAP) and NSTEMI were seen in 24.8% (25/101) and 75.2% (75/101) patients, respectively. According to the Braunwald classification, 8 percent of the patients were categorised as Class IA UAP, 48% as Class IB, 20% as Class IIB, 4% as Class IIIA and 20% as Class IIIB. In NSTEMI patients, the median (IQR) pre-procedural troponin value (cardiac Troponin T or I) was 2.79 (1.12 – 22.27) times the Upper Limit of Normal. According to the PRECISE DAPT score, 36.6% of patients were categorised as High Bleeding Risk (HBR) with scores above 25. At one month, the primary ischemic endpoints of cardiac death, target-vessel spontaneous MI or definite Stent thrombosis did not occur. Two patients (2.0%) had BARC type 3a bleeding. Conclusion Prasugrel monotherapy in the first 30 days following platinum-chromium everolimus-eluting stent deployment is a feasible and safe strategy in NSTE-ACS patients with simple anatomy and successful PCI.

Development of a Medical Device Lifecycle Research Database at the MFDS

Abstract So-called big data are potentially useful in the healthcare field and are of interest to researchers, industry, and government agencies. Over the past 10 years, Europe, the United States, and Asia have been making efforts to collect and systematically manage information on the entire process from clinical trials to follow-up management of medical devices (MD). We developed MD lifecycle research database at the Ministry of Food and Drug Safety (MFDS) of the Republic of Korea, consisting of 61 tables and 2,053 variables. The MFDS possesses statistical information on all MD, pharmaceuticals, foods, and human tissues produced and distributed. The information in the database is categorized according to four MD lifecycle phases-clinical trial, approval, production, and post-approval. For the clinical trial phase, the database contains information on planning and approval of clinical trial and non-clinical trial. The approval phase includes information on models, raw materials, quality, and changes, while the production phase stores information on production, import, export, supply and use. For the last step, follow-up management phase, provide information on post-marketing safety management, risk management, and administrative disposition. All four steps are linked based on primary key, so it is possible to understand information on the overall MD lifecycle. The MD Lifecycle Research Database will help strengthen the industry’s competitiveness in terms of cost-effectiveness in MD development and facilitate policy monitoring by improving its utilization in the public interest. This database contains information on all MD produced and distributed in Korea depending on the phases of the MD lifecycle, and data is easily accessible due to the lack risk of personal information exposure, so it can be widely used by individual researchers, industries, academia, and governments. Funding This research was supported by a grant (22063MFDS498) from ministry of food and drug safety in 2024. Key messages • We developed a medical device lifecycle database that enables tracking management according to the medical device lifecycle. • This database can be used as a scientific basis to ensure the safety, effectiveness, and efficiency of medical devices.

Chronotropic incompetence predictors in a Cardiac Rehabilitation Program following myocardial infarction

Abstract Background Chronotropic incompetence (CI) has been described in many patients after myocardial infarction (MI) and can negatively affect physical capacity, especially if negative chronotropic therapy (NCT) is prescribed. Prediction of CI after MI could be useful for tailored medical therapy and exercise training prescription. Purpose We aim to predict CI on initial exercise ECG testing (ExECG) in MI patients submitted to a Cardiac Rehabilitation Program (CRP). Methods Patients with ST-segment elevation MI (STEMI) or occlusion MI (OMI) submitted to our CRP were prospectively included. After an initial follow-up phase of clinical stabilization and medical therapy optimization, ExECG (conventional or cardiopulmonary) was performed. Peak VO2 and chronotropic reserve index [(maximum heart rate – resting heart rate) / ([220-age] – resting heart rate)] were measured. Chronotropic incompetence was defined as &amp;lt;80% chronotropic reserve index (≤62% in patients treated with NCT). Pharmacological therapy with NCT was registered in absolute and equivalent doses per bisoprolol 2.5mg units (B2.5EU). The effect of NCT on CI was studied by ANOVA test, and predictors of CI by binary logistic regression analysis. The model was tested by area under the curve (AUC) analysis in receiver operating characteristic curves. A p&amp;lt;0.05 was considered statistically significant. Results The cohort comprised 143 patients, mostly middle-aged (mean 60.3±15.8 years) males (85.3%) with anterior or inferior MI (44.8% and 44.8%, respectively). Mean left ventricular ejection fraction (LVEF) was 52.4±10.6% and 36.4% depicted LVEF&amp;lt;50%. NCT was prescribed in most patients (n=125, 87.4%), and median equivalent dose was 1 [0.5-1] B2.5EU. CI was noted on more than half of the population on initial ExECG (n=75, 52.4%). Higher NCT doses per B2.5EU associated with worse mean chronotropic reserve indexes: 72.8±24.4% in patients without NCT; 71.7±18.7% in patients with 0.5 B2.5EU; 62.8±18.2% in patients with 1 B2.5EU; and 58.7±16.9% in patients with ≥2 B2.5EU (ANOVA p=0.04). On binary logistic regression analysis, only two variables were independent predictors of CI: diabetes mellitus (HR 3.02 [1.26-7.23], p=0.01) and LVEF (0.97 [0.94-0.99] per increased %, p=0.04). However, the predictive power of the model was poor (AUC 0.62 [0.53-0.71], p=0.01). Conclusions Chronotropic incompetence after a MI is associated with lower LVEF, diabetes mellitus, and higher doses of NCT. Although significant interindividual variability exists in chronotropic response in the post-infarction period, these factors could be taken into consideration for tailored prescription (or deprescription), especially in patients who may not derive any prognostic benefit from NCT.Chronotropic incompetence in CRP

Automated digital counselling with social network support for chronic heart failure fails to improve health status but promotes health-related quality of life: ODYSSEE-vCHAT pilot trial

Abstract Background Automated digital counselling programs have the potential to provide a scalable, complementary behavioural intervention to improve clinical outcomes for chronic heart failure (CHF). Purpose The primary hypothesis for this pilot trial was that automated digital counseling with social network support (ODYSSEE-vCHAT) vs. Usual Care would decrease the incidence of all-cause re-hospitalization or ED visits. Secondary outcomes included: minimal clinically important difference for improvement on the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS), and improvement on ENRICHD Social Support Index (ESSI), Patient Health Questionnaire for Depression (PHQ-9) Godin-Shephard Leisure Time Physical Activity Scale (GSLTPAQ), and Self-Efficacy in Managing Chronic Disease (SEMCD6). Methods This 2-arm, parallel group, single-blind pilot trial randomized patients to ODYSSEE-vCHAT vs. Usual Care. Patients were ≥18 years of age with CHF (reduced ejection fraction [HFrEF] &amp;lt; 40%, mid-range [HFmrEF] 40-49%, or preserved [HFpEF] ≥ 50%). Exclusion was based on inability to participate due to co-morbidities. All-cause hospitalization or ED visit were assessed digitally by hospital administrative data. Questionnaires were administered at baseline and end-of-study (approximately 8 months). The digital counselling protocol aimed to improve CHF self-care, HRQL, and adherence to medications, exercise, diet, and smoke-free living (Figure 1). The primary outcome was assessed using multivariable binary logistic regression. Secondary outcomes were assessed using multivariable linear regression analyses with ethno-racial group as a covariate. Results 61 patients were randomized: ODYSSEE-vCHAT, n = 30 (49%), vs. Usual Care, n = 31 (51%). There were 2 deaths, 3 withdrawals, and 12 patients failed to complete secondary outcome assessments. Sample characteristics included mean age = 59 years (95% Confidence Interval, CI, 30, 76), gender identity as women, n = 23 (38%), ethno-racial group other than White, n = 17, (28%) and CHF with HFrEF, n = 47 (77%), HFmrEF, n = 8 (13%), and HFpEF, n = 4 (7%). Duration of enrollment to trial endpoint: mean = 247 days, (95% CI, 75, 382). Figure 2 indicates that ODYSSEE-vCHAT was not associated with lower incidence of all-cause hospitalization/ED visit: composite index events for Usual Care, n = 8 (28%), ODYSSEE-vCHAT, n = 7 (23%). However, ODYSSEE-vCHAT was associated with greater prevalence of KCCQ-OS change (≥ 5 points), and greater improvement in self-efficacy (SEMCD6) for managing CHF. There was a statistical trend to decreased prevalence of depression. Social support was inversely associated with ODYSSEE-vCHAT. No benefit was observed for physical activity (Figure 2). Conclusions Automated digital counselling with social network support promotes improvement in HRQL indices, but not health status. Findings for this pilot trial support a follow-up phase 2 randomized controlled trial.Digital Counselling ProtocolODYSSEE-vCHAT Outcomes

ESPRIT study, analysis of the results of the pre-intervention survey in upper secondary schools

Abstract Background Sexually transmitted infections are a major public health problem, and their number is increasing in Italy. However, affective sexuality education is not yet part of the curricula. Therefore, a project entitled ESPRIT was launched, involving 3 regions (Friuli-Venezia Giulia, Lazio and Sicily), the IRCSS ‘Burlo Garofolo’ and the Istituto Superiore di Sanità, and implemented with the technical and financial support of the Ministry of Health - CCM. Methods A multicenter prospective intervention study was designed involving public upper secondary school students (grade 10-11). All target groups completed a KAP (knowledge, attitude, practice) questionnaire before and after participation in the educational intervention to measure its effectiveness. The questionnaires from the first phase were collected between January and April 2024, and the results were analyzed using R statistical software. Results The analysis of the overall results (463 students in total; female 58%, male 39%, other 2%; FVG 49%, Lazio 25%, Sicily 26%) showed that the group of upper secondary school students, targeted by peer education answered the knowledge part correctly by 56.6±13.8% on average. Applying the Kruskal-Wallis test showed that the percentage was significantly higher for females than males (p-value=0.005) and for licei students compared to technical and vocational schools (p-value=0.000). In terms of to attitudes, only 17% of students talked at length about sexually transmitted infections, and in 86.6% of cases, the interlocutors were friends or peers. Conclusions The results of the first phase show differences between the sexes and between the different types of educational institutions. The current level of knowledge still leaves much room for intervention and improvement. Analyzing the results of the follow-up phase will allow us to understand the effectiveness of the peer education intervention. Key messages • Adolescents’ knowledge of sexually transmitted infections needs to be improved. • Gender and the type of school attended affect the level of knowledge.

Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Coronary Artery Disease.

The Placebo-controlled Trial of Percutaneous Coronary Intervention for the Relief of Stable Angina (ORBITA-2) provided evidence for the role of percutaneous coronary intervention (PCI) for angina relief in stable coronary artery disease (CAD). Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are often used to guide PCI, however their ability to predict placebo-controlled angina improvement is unknown. Participants with angina, ischemia, and stable CAD were enrolled and antianginal medications were stopped. Participants reported angina episodes daily for 2 weeks using the ORBITA-app. At the research angiogram, FFR and iFR were measured. After sedation and auditory isolation, participants were randomized to PCI or placebo, before entering a 12-week blinded follow-up phase with daily angina reporting. The ability of FFR and iFR, analyzed as continuous variables, to predict the placebo-controlled effect of PCI, was tested using Bayesian proportional odds modelling. Invasive physiology data were available in 279 patients (140 PCI and 139 placebo). The median (IQR) age was 65 years (59.0 to 70.5) and 223 (79.9%) were male. Median FFR was 0.60 (0.46 to 0.73) and median iFR was 0.76 (0.50 to 0.86). The lower the FFR or iFR, the greater the placebo-controlled improvement with PCI across all endpoints. There was strong evidence that a patient with an FFR at the lower quartile would have a greater placebo-controlled improvement in angina symptom score with PCI than a patient at the upper quartile (FFR 0.46 vs. 0.73: OR 2.01, 95% CrI 1.79 to 2.26, Pr(Interaction)>99.9%). Similarly, there was strong evidence that a patient with an iFR at the lower quartile would have a greater placebo controlled improvement in angina symptom score with PCI than a patient with an iFR at the upper quartile (iFR 0.50 vs. 0.86: OR 2.13, 95% CrI 1.87 to 2.45, Pr(Interaction) >99.9%). The relationship between benefit and physiology was seen in both Rose angina and Rose nonangina. Physiological stenosis severity, as measured by FFR and iFR, predicts placebo-controlled angina relief from PCI. Invasive coronary physiology can be used to target PCI to those patients who are most likely to experience benefit.

'Between Inner Strength and Fighting Prejudice': Psycho-Social Processes Implemented by Women with Leukemia Along the Illness Trajectory: A Grounded Theory Study.

Disease trajectories in leukemia are often unpredictable and recurrent, and patients' experiences can impact their quality of life. Studies in the literature often do not explore gender-related illness experiences from an intersectional approach and throughout the illness trajectory. This comprehensive study aims to explore the full spectrum of experiences lived by women with leukemia throughout the disease trajectory, from diagnosis to treatments and post-stem cell transplant follow-up. A grounded theory approach was meticulously developed to analyze semi-structured interviews with 13 women with leukemia in the post-transplant follow-up phase at a hospital in Northern Italy. The data analysis was an iterative process, conducted concurrently using a constant comparative method. Data collection concluded when data saturation was reached. The core category identified is women's inner strength during the disease trajectory, which was identified for its recurrence and cross-cutting nature, according to the women. This core category interconnects with five main categories: 1. Facing the disease: Between resistance and surrender. 2. Living for today and moving forward. 3. Unexpected elements in relationships. 4. Changes that shape women. 5. Demystifying the body and embracing 'diminished beauty'. An explanatory model of the disease trajectory of women with leukemia was defined as: 'Women with leukemia, between inner strength and fighting prejudice'. An in-depth analysis of the disease experiences revealed aspects that are not easily understood through a purely biological perspective of gender differences, often overlooking the psycho-social and relational peculiarities of women.

Effect of holistic reflective learning program on development of nursing students’ professional competency in geriatric clinical practice: a quasi-experimental study

BackgroundReflection is a core competency in geriatric nursing, and reflective learning is an effective approach in nursing education and pracice. An internship program is a transition course that enhances the knowledge, skills, and attitudes of aspiring nursing students in real clinical work. In geriatric clinical setting, nursing internship students require a broad understanding of professional competency that integrates reflective learning with clinical practice to deal with geriatric patient problems and equip them with the knowledge, attitudes, and skills needed to provide quality of care. However, there is a lack of studies examining the effect of holistic reflective learning on professional competency development among nursing internship students in geriatric settings.AimThis study aimed to investigate the effect of professional holistic reflective learning on professional competency development among nursing internship students caring for hospitalized older adults in medical-surgica wards.DesignThis study employed a quasi-experimental pretest–posttest design, where 160 participants were grouped into control and intervention groups. This study was conducted at two nursing schools under the Mashhad University of Medical Sciences in Iran in 2020. Baseline information was collected from both groups, followed by a pretest and follow-up assessment. The intervention group received a Blended Professional Holistic Reflective learning program, while the control group received conventional learning(undertaking professional clinical practice as a usual treatment and submitted reflective logbooks),, which included standard lectures and group discussions.MethodsParticipants were selected based on specific inclusion and exclusion criteria. The selection process was non-randomized and unblinded. The participants were equally divided, with 80 in the control group and 80 in the intervention group. Baseline data, including demographic characteristics, were collected. Pretest data were collected for both groups using the Geriatric Nursing-Specific Mini-CEX (GN-Specific Mini-Clinical Evaluation Exercise), an instrument designed to assess nursing students' professional competency in geriatric nursing practice. The intervention was delivered through a combination of in-person and online sessions over four mounts. Posttest data and follow-up, were collected similarly to the pretest. Data were analyzed using SPSS version 22, and potential confounding variables were controlled for in the analysis.ResultsThe study included a total of 160 nursing internship students, with no exclusions. At baseline, no significant differences were observed between the intervention and control groups in terms of professional competency (PC) and its dimensions, except for age, which was adjusted as a covariate in the analyses. The intervention group showed a significant improvement in PC and its various domains (communication skills, physical examination, clinical judgment, health education, professionalism, and organizational efficacy) over time. The Generalized Estimating Equation (GEE) analysis confirmed significant interaction effects between time and group for all PC dimensions (p < 0.05). Post-test comparisons revealed that the intervention group scored 2.4 points higher than the control group in overall PC (p < 0.001), with sustained improvements in the follow-up phase. Significant within-group improvements were also found across all PC dimensions for both groups from pre-test to follow-up (p < 0.05).ConclusionsThe study found that the professional holistic reflective learning program was effective in developing professional competency among nursing internship students. The blended teaching–learning approach (face-to-face and online) during workshops and geriatric clinical practice is a practical, cost-effective, and time-efficient learning program during students' clinical practice in geriatric settings. Nurse educators are recommended to implement holistic reflective learning during clinical education.

Effectiveness of Ellis's Rational-Emotional Approach on Criminal Thinking and Law-Evasion in Male Prisoners.

This study aimed to investigate the effectiveness of Ellis's rational-emotional approach on criminal thinking and law-evasion in male prisoners. A quasi-experimental design utilizing pretest, post-test, and follow-up test and waiting-list control groups was conducted. Thirty male prisoners were selected by purposeful sampling and randomized into experimental and waiting list control groups. Participants of experimental group received 12 sessions of Ellis's rational-emotional approach intervention; and all participants answered to PICTS-L-SF and ABAWS as dependent variables at 3 time points (pretest, post-test, and 1 month follow-up). A repeated measures analysis of variance was used to analyze the data. Results showed criminal thinking and law-evasion in experimental group, as compared to control, at post-test phase was significantly decreased (p < .05); and improvement of dependent variables in the follow-up phase has also been continued (p < .05). Therefore, REBT can be beneficial for reducing criminal and illegal thoughts and behaviors among prisoners.

The 13-year long-term follow-up on the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in Chinese females vaccinated at 20–45 years of age

ABSTRACT The quadrivalent human papillomavirus (qHPV) vaccine demonstrated high efficacy against vaccine-type-related precancers in Chinese females through a 6.6-year double-blind, randomized control trial (V501–041, NCT00834106). We present results for its long-term follow-up (LTFU) phase, evaluating vaccine effectiveness and immunogenicity throughout 13 years post Dose 1. Participants receiving qHPV vaccines at ages 20–45 in the V501–041 study constituted the early vaccination group (EVG). Those who received the placebo in V501–041 but were vaccinated during 2018–2020 formed the catch-up vaccination group (CVG), while the control group (CG) comprised those remaining unvaccinated throughout V501–041 and LTFU. The primary endpoint was histopathologically-confirmed cervical intraepithelial neoplasia (CIN) 2+ tested PCR-positive for HPV-16/18. Antibodies against HPV-6, 11, 16, and 18 were assessed using an immunoglobulin G (IgG) Luminex immunoassay at year 13. A total of 1100 participants from V501–041, of whom 978 were followed in LTFU, were included with a median follow-up of 152.2 months. No cases of the primary endpoint were observed in the EVG during 5513.6 person-years of follow-up, while one case was observed in the CG over 2951.4 person-years of follow-up, indicating a 100% risk reduction in the EVG compared to the CG. In the CVG, no cases were detected from vaccination to the latest follow-up (0.0 per 10 000 person-years), contrasting with an incidence of 22.3 per 10 000 person-years prior to vaccination. Seropositivity rates at year 13 remained >92% (for HPV-6/11/16) and 84% (HPV-18). These findings demonstrated continued vaccine protection against cervical precancers and sustained immunogenicity through 13 years post-vaccination. Trial Registration The LTFU study was registered at the Chinese Clinical Trial Registry, ChiCTR2100052313.

Effectiveness of a Person-Centered Interdisciplinary Rehabilitation Treatment of Post-COVID-19 Condition: Protocol for a Single-Case Experimental Design Study.

Patients with post-COVID-19 condition (PCC) experience a wide range of complaints (physical, cognitive, and mental), sometimes with high levels of disability in daily activities. Evidence of effective interdisciplinary rehabilitation treatment is lacking. A person-centered, biopsychosocial, interdisciplinary rehabilitation program, adapted to expert opinions and the patient's needs, was therefore developed. This study aims to present a study protocol for a clinical trial to evaluate the effect of a new, person-centered, interdisciplinary rehabilitation treatment for PCC. It is aimed at improving participation in society and health-related quality of life in patients with PCC who perceive a high level of disability in daily activities or participation. A total of 20 Dutch adults, aged 18 years or older, with high levels of disability in daily activities and participation in society will be included in this replicated and randomized single-case experimental design study, from October 2023 onward. The replicated and randomized single-case experimental design consists of 3 phases. The baseline phase is the observational period, in which no specific treatment will be given. In the intervention phase, patients will receive the new outpatient treatment 3 times a week for 12 weeks, followed by a 12-week follow-up phase. During the intervention phase, the treatment will be personalized according to the patient's physical, mental, and cognitive symptoms and goals. The treatment team can consist of a rehabilitation physician, physiotherapist, occupational therapist, speech therapist, and psychologist. The primary outcomes of the study are daily diaries, which consist of 8 questions selected from validated questionnaires (Utrecht Scale for Evaluation of Rehabilitation-Participation, EQ-5D-5L, and the Hospital Anxiety and Depression Scale). The other primary outcome measurements are participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation) and health-related quality of life (EQ-5D-5L). The secondary outcomes are physical tests and validated questionnaires aimed at physical, mental, and cognitive complaints. Effect evaluation based on daily assessments will include visual analysis, calculation of effect sizes (Nonoverlap of All Pairs), randomization tests, and multilevel analysis. In addition, other analyses will be based on ANOVA or a 2-tailed Student t test. Data collection for this study started in October 2023 and is planned to be completed in July 2024. The results will be published in peer-reviewed journals and presented at international conferences. This is the first study investigating the effect of an interdisciplinary rehabilitation treatment with a person-centered, biopsychosocial approach in patients with PCC. Our findings will help to improve the treatment and support of patients with PCC. German Clinical Trials Register DRKS00032636; https://drks.de/search/en/trial/DRKS00032636. DERR1-10.2196/63951.