Introductory Phase Research Articles

Efficacy of a combined exercise and nutrition intervention study for outpatients with possible sarcopenia in community-based primary care clinics (ENdSarC): study protocol for a multicenter single-blinded randomized controlled trial

BackgroundSarcopenia is a geriatric disease characterized by loss of muscle mass and strength. Although combined exercise and nutrition intervention are known to be effective for sarcopenia, clinical trials involving outpatients with sarcopenia in primary care are scarce. We describe a protocol for a trial to examine the effects of a 12-week combined exercise and nutrition intervention in Korean older adults with possible sarcopenia in community-based primary care.MethodsThis multicenter, randomized, controlled trial will include 94 community-dwelling older outpatients aged 65–85 years with possible sarcopenia (47 participants in the intervention and control groups each). Resistance exercises, which incorporate concentric and eccentric exercises, will consist of an introductory phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; contraction exercises), an expanded phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; eccentric exercises), and a maintenance phase (6 weeks: once-weekly supervised exercise sessions and twice-weekly home exercises; power/eccentric exercises). Nutritional supplementation will be provided according to the nutritional status of the participants using a Mini-Nutritional Assessment. Participants will be assessed at baseline, 12 and 24 weeks, and the primary outcome will be the 5-times chair stand test results.DiscussionTo the best of our knowledge, this will be the first clinical trial to evaluate the efficacy of a combined exercise and nutritional supplementation intervention in older outpatients with possible sarcopenia in community-based primary care clinics. These findings will provide new insights to clinicians regarding the long-term usability for doctors and outpatients with possible sarcopenia in community-based primary care.Trial registrationThis trial was prospectively registered at ClinicalTrials.gov on September 16, 2023 (registration number: NCT06049914).

Abstract B061: Bridging the gap in inequality in timely cancer diagnosis: GLORIA network Colombia

Abstract Introduction: In Latin American countries, survival rates for highly malignant tumors show disparities in access to diagnosis and treatment between small and big cities. Colombia is an example where the rate of pathologists is 0.88 per 100,000 inhabitants. Oncopathologists are predominantly situated in major cities, being a minimal percentage of this specialty. Whole slide imaging (WSI) technology can be used to mitigate disparities by facilitating diagnostic support for less-experienced pathologists in distant locations from expert centers. Telepathology brings a solution in bridging these gaps, enabling connectivity and facilitating timely diagnoses and treatments. To achieve this goal, a Colombian research group developed the GLORIA Colombia Network, which will provide WSI scanners and a telepathology network in small cities connecting them to an expert central laboratory. This will facilitate decision-making for oncopathological diagnoses. We aim to show a preliminary phase of the project; knowledge, attitudes, and practices of general pathologists operating the scanners are explored to delve into fears and expectations so that an introduction of this technology can be made. Methods:Introductory phase consisted of a semi-structured survey piloted by the research group and conducted via Google Forms for general pathology laboratories in Colombia, through the network ASOCOLPAT (Colombian pathologist association). There were 23 close questions related to context recognition, and an open question to explore qualitative aspects related to telepathology. ResultsA total of 51 responses from general pathologists were obtained, 100% stated they had needed assistance of a subspecialist in high complexity cases; 47% noted soft tissue tumors were challenging diagnoses, 35.2% affirmed hematological tumors were also challenging. The 25.5% reported stress high levels in complex diagnoses. 64% reported 1-10 complex cases/month in capital cities. The most frequently requested type of tumor for consultation was lymph nodes (21.3%), followed by melanocytic tumors (23.5%). Furthermore, 27.4% stated the response time for interconsultation ranged from one week to one month. Additionally, 79.2% of pathologists attempt to diagnose the case themselves, but if unable to do so, they refer it to a specialist. The open question revealed doubts about general pathologists' roles, and their feeling of undervalue compared to subspecialists. This question highlighted the need for training, and telepathology emerged as an alternative to facilitate communication between general pathologists and subspecialists. Emphasizing the importance lies in improving diagnostic times, which affects patients’ quality of life. Conclusion GLORIA network, bridges healthcare gaps by connecting general pathologists with specialists, enabling faster and accurate diagnoses. This initiative reduces stress, offers training, and improves diagnostic reliability, benefiting patients in remote areas with complex malignant tumors. Citation Format: Gabriela Guerron-Gomez, Maria C. Restrepo-Guarnizo, Andres Mosquera-Zamudio, Oscar Mendoza, John J. Sprockel, Arley Gomez, Laura D. Olarte Suarez, Merideidy Plazas Vargas, Rafael Parra-Medina, Marcela Gomez-Suarez. Bridging the gap in inequality in timely cancer diagnosis: GLORIA network Colombia [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B061.

Safety of robotic double-flap technique following proximal gastrectomy in the introductory phase compared with laparoscopic procedure: a propensity score-matched analysis.

Proximal gastrectomy (PG) is recommended for upper-third gastric cancer and esophagogastric junction (EGJ) cancer, preserving organ function while reducing postoperative symptoms. The double-flap technique (DFT) is one approach to minimize reflux after PG. However, laparoscopic PG with DFT (LPG-DFT) has drawbacks of increased complexity, such as hand sutures for anastomosis. Robotic surgery offers potential advantages for DFT reconstruction, but the safety of robotic DFT following PG (RPG-DFT) in the introductory phase is unknown. This retrospective study compared the outcomes of RPG-DFT with LPG-DFT. Data from 402 patients (321 LPG-DFT, 81 RPG-DFT) between 2009 and 2023 were analyzed. Propensity score matching balanced patient demographics and tumor characteristics. Surgical parameters, complications, and long-term outcomes were assessed. The surgery time of LPG-DFT has stabilized in patients since 2016. Thus, LPG-DFT from 2016 was defined as a stable procedure. RPG-DFT was started in 2019, after minimally invasive DFT reconstruction had been mastered at our center. Therefore, we compared the surgical outcomes of introductory RPG-DFT with stable LPG-DFT. Matched analysis revealed that RPG-DFT in the introductory phase had significantly longer surgery times but less bleeding and shorter reconstruction times and hospital stays than stable LPG-DFT. Frequencies of short-term complications and reflux esophagitis were comparable in both groups. Although RPG-DFT in the introductory phase exhibited higher incidence of anastomotic stenosis than stable LPG-DFT, the incidence of anastomotic stenosis decreased over time. This study demonstrated the safety of RPG-DFT in the introductory phase for EGJ and upper-third stomach tumors, with outcomes comparable to stable LPG-DFT. RPG-DFT offers shorter reconstruction time and less blood loss compared with LPG-DFT. However, anastomotic stenosis is a complication to monitor in early robotic surgery.

Building the Empirical Puzzle on Impact of Macroeconomic Determinants on GST Revenue: An Empirical Investigation via ARDL Bound Test Perspective

ABSTRACTThe revenue mobilization remains a challenge for many countries, especially developing countries such as India. Therefore, this study explores the macroeconomic determinants of Goods and Service Tax (GST) revenue of the government in India as GST constitutes a major share in the Own Tax Revenue (OTR) of the government in India. The current study has employed the Auto Regressive Distributed Lag (ARDL) model to examine the macroeconomic determinants of GST taxation revenue of the government in India. The results reveal that foreign direct investment, depreciation in the exchange rate and foreign exchange reserves have a favorable impact on the GST revenue of the government in India. Furthermore, the gross fiscal deficits of the government and inflation have a detrimental effect on the GST revenue collection of the government in India. The results of the study are supported by the Tanzi effect and the Tanzi–Olivera effect for the detrimental effect of inflation and gross fiscal deficit on the GST revenue of the government in India. The current study has major policy implications for the government, policymakers, and researchers. The empirical results illustrates that the government may put a stringent check on inflation and gross fiscal deficit of the country to improve their GST collections. Moreover, the government should try to focus on foreign direct investment, trade openness, and foreign exchange reserve in India to increase their GST revenue. Meanwhile, the current study can be used as a base for conducting future studies at national and international levels for examining the determinants of other taxation revenue of the government by incorporating other country specific variables. This study may act as a novel contribution to the available literature on the macroeconomic determinants of taxation revenue in India. To the knowledge, it will be the first study in India to especially explore the determinants of GST revenue of the government in India. However, the findings of the study need to be generalize in future by incorporating a larger sample size as GST is still in its introductory phase in India.

Efficacy of Supersets Versus Traditional Sets in Whole-Body Multiple-Joint Resistance Training: A Randomized Controlled Trial.

Iversen, VM, Eide, VB, Unhjem, BJ, and Fimland, MS. Efficacy of supersets versus traditional sets in whole-body multiple-joint resistance training: A randomized controlled trial. J Strength Cond Res 38(8): 1372-1378, 2024-Time constraints often hinder exercise engagement, necessitating exploration of time-efficient resistance training methods. Superset training, where 2 exercises are performed successively with minimal rest, nearly halves session duration but is metabolically demanding, possibly reducing strength gains. In a randomized controlled trial with blinded test leaders, we examined the efficacy of supersets versus traditional sets in a full-body, multiple-joint resistance training workout on maximal strength in the trained exercises. Subjects took part in a 3-week introductory training phase before baseline testing to ensure they were thoroughly familiarized. Next, they were randomized to a superset- or a traditional-set group, performing 10 weeks of heavy multiple-joint resistance training twice per week. The exercise programs consisted of leg press, bench press, lat pull-down, and seated rows. The traditional training group had a 5.2-kg higher improvement in pull-down than the superset group (p = 0.033), and a close to significant 4.8-kg higher improvement in seated rows (p = 0.073). The improvements in leg press and bench press were quite similar for both groups (p = 0.507-0.527). There were no changes between groups in body composition outcomes (0.151-0.640), but both groups increased muscle mass and reduced fat mass (p < 0.05). In conclusion, superset training of multi-joint exercises hampered maximal strength gains somewhat compared with traditional-set training. However, there were very similar improvements in body composition, and strength gains were observed for all exercises in the superset group. Thus, whole-body, multiple-joint superset resistance training could be a viable time-saving approach.

Risk Assessment of Banks and Financial Institutions When Interest Rate Hikes

This article delves into the multifaceted risks precipitated by a bank's decision to increase interest rates. It commences with an overarching overview contextualized within The Times, elucidating the significance of the subject matter. Subsequently, it delineates various extant risks, each accompanied by a succinct exposition and an outline of corresponding mitigation strategies. Following this introductory phase, the article conducts a meticulous analysis of these identified risks, methodically dissecting liquidity risk, reputation risk, market risk, and systemic risk. Each risk is meticulously defined, substantiated with historical precedents, and elucidated with comprehensive management methodologies. This paper underscores the myriad risks attendant to a bank's interest rate hike. This synthesis serves to underscore the overarching theme that such policy decisions not only reverberate through the financial ecosystem but also necessitate vigilant risk management protocols to safeguard against potential ramifications. Finally, the article concludes by summarizing the numerous risks posed by a bank's interest rate hike. It emphasizes the need for careful consideration and proactive risk management to mitigate potential consequences.

Production Arrangement of Cachaça: Comparative Study Between Morretes in the Paraná Coast and Luiz Alves in Itajaí Valley - Santa Catarina

Objective: The research sought to promote a characterization of the cachaça LPA in Morretes, Paraná in comparison to an LPA in another Brazilian region, whose production is similar and is classified as one of the most developed in Brazil. Theoretical Framework: Studies about Local Productive Arrangements have been relevant to proposals and regional development, so the basis of the research was inserted in the introductory phase. Method: Between May 2022 and February 2023, an exploratory descriptive study was carried out with leaders of two cachaça production arrangements located in the south of Brazil, one consolidated in Santa Catarina and the other one under development in Paraná. Results and Discussion: The results obtained revealed that despite the similar number of producers, the Morretes LPA has a production capacity equivalent to 35% of what is produced in the Luiz Alves LPA. The difference in productivity is not linked to factors such as proximity to the consumer market, distribution logistics, labor or even geoclimatic characteristics. The main factors limiting the easier development of LPAs were the degree of difficulty in regularizing production, the lack of technical assistance and the almost non-existence of public policies, with the Morretes LPA on the coast of Paraná being most impacted. It is concluded that the insertion of tourism associated with beverage consumption, investment in marketing actions and public policies that facilitate the regularization of informal producers can strengthen the Morretes LPA and promote its consolidation as an economic activity that generates regional development. Research Implications: The Morretes LPA has all the favorable and synergistic conditions for the development of the cachaça LPA, and in this context the offer of new services and products arising from production and trade activities can generate a set of entertainment offered as a new experience for tourists, in addition from visits to stills and the creation of parties and fairs with the drink theme. Originality/Value: Comparative studies between local productive arrangements are still little explored in scientific literature and may guide regional development in a more organized way.

Influence of proficiency in conventional laparoscopic surgery in colorectal cancer on the introduction of robotic surgery.

Although there have been many reports on learning curves for robotic surgery, it is unclear how surgeons' conventional laparoscopic surgical skills influence their ability in performing robotic surgery for colorectal cancer (CRC). The aim of this study was to determine the surgical outcomes of robotic surgery for CRC during the induction phase by skilled laparoscopic surgeons. Surgical outcomes of consecutive CRC cases between January 2021 and March 2023 following the skilled phase of laparoscopic surgery and introductory phase of robotic surgery performed by three skilled laparoscopic surgeons were compared. Overall, 77 consecutive patients diagnosed with sigmoid colon or rectosigmoid cancer were analysed, including 50 in the laparoscopy group (LAP) and 27 in the robotic group (Ro). Patient characteristics, including age, sex, body mass index, and tumour progression, did not differ between the groups. The median operation time was 204min in the robotic group and 170min in the laparoscopic group (p < 0.001). Blood loss was significantly lower in the robotic group (p = 0.0059). The incidence of grade 2 or higher complications did not differ between the two groups (LAP, 10.0% vs. Ro, 7.4%, p = 1). In the robotic group, the time required for lymph node dissection had a greater impact on operative duration. Skills acquired from performing conventional laparoscopic surgery may contribute to the safe and reliable performance of robotic surgery for CRC. UMIN000050923.

Empagliflozin for treating neutropenia and neutrophil dysfunction in 21 infants with glycogen storage disease 1b

Empagliflozin has been successfully repurposed for treating neutropenia and neutrophil dysfunction in patients with glycogen storage disease type 1b (GSD 1b), however, data in infants are missing. We report on efficacy and safety of empagliflozin in infants with GSD 1b.This is an international retrospective case series on 21 GSD 1b infants treated with empagliflozin (total treatment time 20.6 years). Before starting empagliflozin (at a median age of 8.1 months with a median dose of 0.3 mg/kg/day) 12 patients had clinical signs and symptoms of neutrophil dysfunction. Six of these previously symptomatic patients had no further neutropenia/neutrophil dysfunction-associated findings on empagliflozin. Eight patients had no signs and symptoms of neutropenia/neutrophil dysfunction before start and during empagliflozin treatment. One previously asymptomatic individual with a horseshoe kidney developed a central line infection with pyelonephritis and urosepsis during empagliflozin treatment. Of the 10 patients who were treated with G-CSF before starting empagliflozin, this was stopped in four and decreased in another four. Eleven individuals were never treated with G-CSF.While in 17 patients glucose homeostasis remained stable on empagliflozin, four showed glucose homeostasis instability in the introductory phase. In 17 patients, no other side effects were reported, while genital (n = 2) or oral (n = 1) candidiasis and skin infection (n = 1) were reported in the remaining four.Empagliflozin had a good effect on neutropenia/neutrophil dysfunction–related signs and symptoms and a favourable safety profile in infants with GSD 1b and therefore qualifies for further exploration as first line treatment.

How Thai Universities Can Better Prepare Graduates For The Workplace

Thai universities play a crucial role in preparing learners to be productive members of society. This study looks at how universities prepare students for work and what can be done to improve the process. Using a mixed method approach involving a survey of university students’ opinions, a focus group of hiring managers interviews, and interviews with lecturers, a holistic view is achieved from the main stakeholders. The stakeholders show significant dissonance among expectations. These differences stem from many sources, mainly, the lack of shared and open information. Students enter university without a clear goal or a realistic informed prospectus. Lecturers try to bridge the gap between what is expected to be delivered and what industry needs. However, lecturers are working against a tide of reluctance from students’ aptitude and abilities, faculty realities and fractured industries that do not share. Human resources personnel seem not to have a clear idea of what is expected from graduates, especially in a dynamic environment. What employers want varies widely, making training difficult. Even when students enter the workforce with the creative energies required, the established systems stifle growth. Having greater interaction among the parties would help reduce the differences in expectations. The interactions need to be continual throughout the students’ time at university. Flexible programs and more internships would allow students to better understand how what is taught can be applied. Lecturers would have access to more relevant data and with class discussions being more informed. Companies can structure onboarding programs better as students would have experienced an introductory phase. More exchanges among stakeholders are required.

Impact of Advance Care Planning Support on Patients Treated in the Intensive Care Unit After High-Risk Surgery.

Efforts to enhance support for advancecare planning (ACP) in patients requiring emergency and intensive care are currently being explored. In addition, few studies have reported the effects and impact of support for these patients and their families. The researcher developed a patient decision aid to initiate support for ACP for patients who plan to enter the intensive care unit after surgery and their families. This study aimed to provide ACP support to patients before high-risk surgery and to determine its impact. The study design was qualitative. The participants included 10 patients who were scheduled to be admitted to the intensive care unit after high-risk surgery at an acute-care hospital in Japan, and the patients' families. The researcher used decision aids to implement ACP support before the patients were admitted. Participants were interviewed in a semi-structured manner regarding their experiences and the impact of receiving ACP support after discharge. Interviews were recorded using an integrated circuit recorder, followed by verbatim transcripts. The analysis was performed in a qualitative descriptive manner. ACP support prior to treatment initiation led patients to think about life-sustaining treatments and consider ideal living. By understanding the risks of treatment, patients can calmly assume complications and discuss their mortality and life after surgery. Patients perceived receiving ACP support as a valuable benefit prior to undergoing treatment in the intensive care unit. After discharge, they wanted to promote shared decision-making among their physicians. On the other hand, family members were more anxious about ACP topics than patients. In addition, the patients and their families felt that it was difficult to discuss their thoughts and wishes regarding ACP before surgery. It is suggested that pretreatment ACP support could serve as an introductory phase for patients anticipating the need for intensive care, allowing them to contemplate their preferences regarding life-sustaining treatment. However, it is difficult for patients and their family members to openly discuss their thoughts on life-sustaining treatment, even if they are aware of the risk of a sudden crisis. Therefore, when patients and their families discuss ACP, the inclusion of healthcare coaching and counseling may be more effective. These measures of ACP support could add to increased family discussions, concordance, and shared decision-making with physicians.

Board characteristics, institutional ownership, and investment efficiency: Evidence from an emerging market.

This study investigates the impact of board governance mechanism on investment efficiency (IE) in PSX-listed firms. The study also examines the role of institutional ownership (IO) in board-IE relationships. In addition, we extend our analysis to re-examine this relationship by splitting the sample into two groups, i.e., the introductory phase of corporate governance (CG) i.e., 2004 to 2013, and revised codes of CG (2014 to 2018) to examine the impact of these separately on IE. The sample data comprises 155 non-financial PSX-listed firms from 2004 to 2018. IE is measured using firms' growth opportunities. The random effect model is used to test the study's hypotheses. A robustness test is also performed to validate the study's findings. The paired-sample t-test results show a significant improvement in IE after revising the CG codes in 2012. According to the regression results, board size has a significant direct, whereas board diversity has a significant inverse effect on IE. Regarding moderating effect, IO was found to moderate the relationship between board independence and IE significantly. Furthermore, it was discovered that following the issuance of revised CG codes-2012, the level of board independence and diversity increased in PSX-listed firms; however, only diversity positively impacted IE, and board independence had no impact on IE from 2014 to 2018. Despite the issuance of revised CG codes-2012, the level of CG among PSX-listed firms is low, which is a source of concern for regulators such as the Securities and Exchange Commission of Pakistan.

DIGITALIZATION OF FINANCIAL MANAGEMENT THROUGH TRAINING AND ASSISTANCE IN THE PREPARATION AND ANALYSIS OF COMPUTING SYSTEM-BASED FINANCIAL REPORTS FOR ISLAMIC BOARDING SCHOOL COOPERATIVES IN THE BLITAR DISTRICT

The cottage boarding school serves as an Islamic educational institution focused on studying, comprehending, deepening, appreciating, and practicing the teachings of Islam, placing particular emphasis on instilling religious morals as daily behavioral guidelines. Moreover, these Islamic boarding schools, in their role as agents of change, not only contribute to religious and societal education but also actively participate in societal development and social transformation. Recognizing the pivotal role of cottage Islamic boarding schools in the community, especially in economic development, this study proposes the reinforcement of Islamic boarding school cooperatives (Kopontren) as economic driving forces within their environments. Initial observations highlight two key challenges: 1) Manual financial reporting based on outdated methods without utilizing SAK ETAP guidelines, and 2) The lack of financial performance analysis by Kopontren managers. The research commences with an introductory phase involving a literature review, followed by an in-depth exploration through secondary data analysis. Subsequently, an internal focus group discussion (FGD) is organized to gain insights into the actual cooperative conditions of cottage boarding schools. This FGD engages with the Department of Cooperatives and Micro, Small, and Medium Enterprises (MSMEs). To ensure the seamless progress of the activities, the execution team will coordinate with the District Cooperatives and MSMEs Service in Blitar, serving as a governmental institution officially supporting the establishment of cooperative cottage boarding schools.

Digital Marketing in Developing and Emerging Economies: A Systematic Review of Introductory Phase Features

Digital Marketing in Developing and Emerging Economies: A Systematic Review of Introductory Phase Features

A41Implementation of virtual clinical experiences for Myanmar medical students: a pilot rollout of remote-synchronous simulation

Severe disruptions have plagued Myanmar’s undergraduate and postgraduate medical education – firstly with the Covid-19 pandemic and later with a military coup d’état in February 2021. In the wake of the current humanitarian and political crisis, many medical students partaking in civil disobedience have been driven underground for fear of retribution. Foregoing bedside teaching and crucial clinical learning opportunities in hospitals – for online education through teleconferencing and live broadcast via social media. To scale up these efforts the Global Health Education Group’s (GHEG) novel XR platform was piloted to provide remote clinical experiences streamed to Myanmar students with the help of diaspora doctors and virtual patients in the UK [1]. The pilot held over a 4-day period in February comprised 4 Virtual Clinical Experience (VCE) sessions each covering two simulated patient scenarios related to the following disciplines: Medicine, Surgery, Obstetrics and Gynaecology, and Paediatrics. Each session had an introductory, consultation, and debrief phase that ran for 1.5 – 2 hours altogether. This was held on GHEG’s newly developed Virtual CP platform [2], which enabled the students to view a live stream of the consultation with the patient-actor through the clinician’s smart glasses and provided the opportunity for real-time interaction. The sessions were successfully delivered to 400 students from across 5 Myanmar Universities. The student’s satisfaction was assessed using an anonymous feedback form that was disseminated; a total of 38 responses was obtained which was overwhelmingly positive. 76.3% of the respondents rated the session to be ‘helpful’ or ‘extremely helpful’ and 68.4% rated the session to be representative of a real clinical experience. On a scale out of 10, 57.8% of respondents rated the VCE platform a 6 and above on ease of use. Technical difficulties did arise affecting 68.4% of respondents, although free text feedback purported they were promptly addressed in subsequent sessions. Synchronous remote learning through virtual clinical experiences can be used to address the dearth of clinical opportunities afforded to medical students in Myanmar. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Development and Effectiveness of a University Student Coaching Program Using Metaverse Space

This study aims to develop and implement a coaching program in the metaverse space to address issues faced by university students during their life stage and verify their effectiveness. The overall program consists of four sessions: "Opening," "Metaverse-based Coaching Clinic (2 sessions)," and "Coaching Clinic Reflection and Feedback." A total of 20 participants were selected through S University's extracurricular program system. To assess the effectiveness of the program, surveys, as well as focus group interviews (FGIs) were conducted. Using SPSS 26.0, significant differences were observed in the participants' career decision self-efficacy and resilience. The FGIs were conducted with a total of four participants divided into two groups, with each group lasting for one hour. The analysis revealed key phases, including the introductory phase comprising participants' motivation and expectations, the main phases consisting of program operation, coaching perception and outcomes, metaverse environment, and metaverse coaching perception and outcomes, as well as the concluding phase in which recommendations are suggested for subsequent programs. The study confirmed the significant impact of coaching in the metaverse space and highlighted the maximization of coaching effectiveness through mutual anonymity facilitated by avatars. This research holds significance as an exploratory study that practically verifies the potential expansion of the metaverse environment in the coaching field.

Effectiveness and clinical application of multidisciplinary combined exercise and nutrition intervention for sarcopenic older adults with metabolic syndrome: study protocol for a multicentre randomised controlled trial

IntroductionAmong chronic diseases affecting older adults, metabolic syndrome (MetS) is known to be closely related to sarcopenia. Insulin resistance may play a key role in the increased frequency of sarcopenia...

The impact of future climate on orange-fleshed sweet potato production in arid areas of Northern Ethiopia. A case study in Afar region

Sweet potato is in its introductory phase as a food-based approach to alleviate malnutrition in the Afar region, where, due to climate change, agricultural drought impedes crop production. This study assesses the impact of climate change on orange-fleshed sweet potato (OFSP) fresh storage root yield production over the Afar region using the Aqua Crop model. This model was fed with daily rainfall and minimum and maximum temperature datasets, for the baseline climate (1980–2009) as well as future (2010–2099) climate projections under two representative concentration pathways: RCP 4.5 and RCP 8.5. These datasets were statistically downscaled from twenty (20) general circulation models that are used in the Coupled Model Intercomparison Project Phase 5 (CMIP5). The impact of climate change on sweet potatoes was assessed by comparing the change in average sweet potato yields in the baseline climate condition against the average of simulated sweet potato yields in the Near-term (NT) (2010–2039), Mid-term (MT) (2040–2069), and End-term (ET) (2070–2099) under RCP 8.5 and RCP 4.5. Simulation shows increased future storage root yield production for NT (3.23%), MT (3.90%), and ET (7.25%) under RCP 4.5 and MT (5.88%) and NT (6.71%) from the observed yield data (32.0 t/ha) except for Near-term (−9.59%) under RCP 8.5. Similarly, projected climate shows increase in temperature Tmax (0.93–4.10 °C), Tmin (0.88–4.54 °C) and precipitation (28.9–37.8%) under both RCPs which will favor sweet potato yield production increase in near-term, mid-term reaching climax in end-term. Simulation with planting dates shows that normal planting date (July 01), gives better yields than early (April 22) or late planting (01 August). This finding may perhaps be used as preliminary data in adoption and upscaling of orange-fleshed sweet potato in Afar region.

Twelve tips for the pre-brief to promote psychological safety in simulation-based education

It is recognised that simulation-based education can be stressful, and this can impact negatively on learning. A fundamental aspect of facilitating simulation is creating a safe educational environment. Edmondson’s seminal work on creating psychological safety among interpersonal teams has been embraced by the healthcare simulation community. Psychological safety is an underpinning philosophy for creating simulation experiences in which learners can develop within a stimulating and challenging yet supportive social atmosphere. Through careful design and thoughtful delivery, the introductory phase of simulation, the pre-briefing, can effectively prepare learners for simulation, reduce learner anxiety, and promote psychological safety, to enhance learning experiences. These twelve tips provide guidance for conducting a pre-brief and promoting a psychologically safe environment for simulation-based education.

Seeing malaria through the eyes of affected communities: using photovoice to document local knowledge on zoonotic malaria causation and prevention practices among rural communities exposed to Plasmodium knowlesi malaria in Northern Borneo Island

BackgroundMany rural communities in Malaysian Borneo and Southeast Asia are at risk of Plasmodium knowlesi malaria. Multiple factors contribute to infection, however, a deep understanding of illness causation and prevention practices among at-risk communities remains limited. This study aims to document local knowledge on malaria causation and preventive practices of rural communities in Sabah, Malaysia, using photovoice—a participatory research method.MethodsFrom January to June 2022, a photovoice study was conducted with rural communities in Matunggong subdistrict, Malaysia, to explore their experiences with and local knowledge of non-human primate malaria and prevention practices. The study included (1) an introductory phase in which participants were introduced to the photovoice method; (2) a documentation phase in which participants captured and narrated photos from their communities; (3) a discussion phase in which participants discussed photos and relevant topics through a series of three focus group discussions (FGDs) per village; and (4) a dissemination phase where selected photos were shared with key stakeholders through a photo exhibition. A purposively selected sample of 26 participants (adults > 18 years old, male, and female) from four villages participated in all phases of the study. The study activities were conducted in Sabah Malay dialect. Participants and the research team contributed to data review and analyses.ResultsRural communities in Sabah, Malaysia possess local knowledge that attributes non-human primate malaria to natural factors related to the presence of mosquitoes that bite humans and which carry “kuman-malaria” or malaria parasite. Participants revealed various preventive practises ranging from traditional practises, including burning dried leaves and using plants that produce foul odours, to non-traditional approaches such as aerosols and mosquito repellents. By engaging with researchers and policymakers, the participants or termed as co-researchers in this study, showcased their ability to learn and appreciate new knowledge and perspectives and valued the opportunity to share their voices with policymakers. The study successfully fostered a balance of power dynamics between the co-researchers, research team members and policymakers.ConclusionThere were no misconceptions about malaria causation among study participants. The insights from study participants are relevant because of their living experience with the non-human malaria. It is critical to incorporate rural community perspectives in designing locally effective and feasible malaria interventions in rural Sabah, Malaysia. Future research can consider adapting the photovoice methodology for further research with the community toward building locally tailored-malaria strategies.