Long-term Gain Research Articles

Digital therapeutics in hypertension: How to make sustainable lifestyle changes.

Various digital therapeutic products have been validated and approved since 2017. They have demonstrated efficacy and safety as a new therapeutic modality in various disorders or conditions. Hypertension is a common but serious condition that can be prevented or controlled with lifestyle changes and medicines. Although a digital therapeutic in hypertension is validated and approved in Japan, whether digital therapeutics (DTx) can significantly improve sustainable lifestyle changes is still a controversial topic. Most studies did not discuss the long-term gain challenges. In this review, the authors discuss the definition of DTx, and analyze the motivation, engagement and adherence challenges of DTx in hypertension. Some ongoing artificial intelligence (AI)-enabled or cognitive behavioral therapy (CBT)-based digital interventions and behavioral strategies for implementing sustainable lifestyle changes are identified and analyzed. With AI-enabled interventions and behavioral strategies, DTx might be one of the effective approaches to make sustainable lifestyle changes.

Genomic-inferred cross-selection methods for multi-trait improvement in a recurrent selection breeding program

The major drawback to the implementation of genomic selection in a breeding program lies in long-term decrease in additive genetic variance, which is a trade-off for rapid genetic improvement in short term. Balancing increase in genetic gain with retention of additive genetic variance necessitates careful optimization of this trade-off. In this study, we proposed an integrated index selection approach within the genomic inferred cross-selection (GCS) framework to maximize genetic gain across multiple traits. With this method, we identified optimal crosses that simultaneously maximize progeny performance and maintain genetic variance for multiple traits. Using a stochastic simulated recurrent breeding program over a 40-years period, we evaluated different GCS methods along with other factors, such as the number of parents, crosses, and progeny per cross, that influence genetic gain in a pulse crop breeding program. Across all breeding scenarios, the posterior mean variance consistently enhances genetic gain when compared to other methods, such as the usefulness criterion, optimal haploid value, mean genomic estimated breeding value, and mean index selection value of the superior parents. In addition, we provide a detailed strategy to optimize the number of parents, crosses, and progeny per cross that can potentially maximize short- and long-term genetic gain in a public breeding program.

Singular effect of linkage on long-term genetic gain in Fisher's infinitesimal model.

During the founding of the field of quantitative genetics, Fisher formulated in 1918 his "infinitesimal model" that provided a novel mathematical framework to describe the Mendelian transmission of quantitative traits. If the infinitely many genes in that model are assumed to segregate independently during reproduction, corresponding to having no linkage, directional selection asymptotically leads to a constant genetic gain at each generation. In reality, genes are subject to strong linkage because they lie on chromosomes and thus segregate in a correlated way. Various approximations have been used in the past to study that more realistic case of the infinitesimal model with the expectation that the asymptotic gain per generation is modestly decreased. To treat this system even in the strong linkage limit, we take the genes to lie on continuous chromosomes. Surprisingly, the consequences of genetic linkage are in fact rather singular, changing the nature of the long-term gain per generation: the asymptotic gain vanishes rather than being simply decreased. Nevertheless, the per-generation gain tends to zero sufficiently slowly for the total gain, accumulated over generations, to be unbounded.

Short-term pain for long-term gain? A longitudinal meta-analysis of downsizing-financial performance relationships

IntroductionDownsizing, and the mass layoff upheavals that ensue, has been euphemistically referred to as a short-term pain, long-term gain strategy. But is that so? Do its financial outcomes over time justify the short-run harm? And, to what extent has its adoption been driven by economic or social rationales over time?MethodsTo examine these questions, we conducted the most comprehensive meta-analysis on downsizing-financial performance relationships to date, summarizing a total of 905 effect sizes. Using a new meta-analytic method multi-level longitudinal meta-analysis (MLLMA) we analyze temporal dimensions of these relationships.ResultsResults for downsizing adoption suggest shifting rationales over time, from a defensive response to decline in the 1980s, to a socially legitimate management convention in the 1990s, and back to a defensive response in the 2000s. Short-run market outcomes mirror these shifting rationales, with more negative reactions to defensive downsizing. Across a diverse range of lead/lag times and moderators, we find many negative and heterogeneous performance outcomes. Most importantly, little long-term gain is found.DiscussionOur MLLMA helps to address prior criticisms on the lack of temporality in extant downsizing research, while many equivocal relationships, despite almost 40 years of downsizing research, illustrate that considerable avenues for future research remain.

The Effects of Contextual Interference Learning on the Acquisition and Relatively Permanent Gains in Skilled Performance: A Critical Systematic Review with Multilevel Meta-Analysis

The paradoxical effects of contextual interference (CI) assume that high CI practices hinder performances during the acquisition phase of learning, while providing more permanent enhancement during the retention phase. This meta-analysis evaluates the possible generalizability of the CI phenomenon in physical education (PE) and sports contexts, with regard to the acute and relatively permanent gains in performance outcomes. A total of 933 records from five electronic databases were screened using the PICOS criteria, of which 36 studies were selected. Outcomes evaluating the performance changes (Δ) from pre-post, post-retention, and pre-retention tests were included. Out of 183 overall pooled outcomes, Δ in only 37 performance outcomes (20%) agreed with the paradoxical CI effects on the acquisition or the relatively permanent gains. No statistically significant overall difference was detected for “Δ pre-post” between low (blocked) (28.9 ± 59.5%) and high (random/serial) (27.9 ± 52.8%) CI (effect size (ES) = 0.1, p = 0.35). An overall significant difference (p = 0.001) in favor of high CI practice was detected in “Δ post-retention.” However, this difference was not large enough (ES = − 0.35) to produce an overall greater long-term gain following high (24.56 ± 4.4%), compared to low (21.9 ± 9.8%) CI (ES = − 0.13, p = 0.18). Out of 10 tested variables, only the age significantly moderated both CI effects (p < 0.0001 for both Δ pre-post and Δ pre-retention) and the female proportion significantly moderated only the first CI effect (p = 0.009 for Δ pre-post). These findings found very limited evidence supporting the recommendation to employ high CI practices to gain a longer-term performance advantage, calling into question the generalization of the CI model to PE and sports practices. High-quality follow-up research evaluating alternative motor-learning models are therefore needed.

Evolutionary computing to assemble standing genetic diversity and achieve long-term genetic gain.

Loss of genetic diversity in elite crop breeding pools can severely limit long-term genetic gains and limit ability to make gains in new traits, like heat tolerance, that are becoming important as the climate changes. Here, we investigate and propose potential breeding program applications of optimal haplotype stacking (OHS), a selection method that retains useful diversity in the population. OHS selects sets of candidates containing, between them, haplotype segments with very high segment breeding values for the target trait. We compared the performance of OHS, a similar method called optimal population value (OPV), truncation selection on genomic estimated breeding values (GEBVs), and optimal contribution selection (OCS) in stochastic simulations of recurrent selection on founder wheat genotypes. After 100 generations of intercrossing and selection, OCS and truncation selection had exhausted the genetic diversity, while considerable diversity remained in the OHS population. Gain under OHS in these simulations ultimately exceeded that from truncation selection or OCS. OHS achieved faster gains when the population size was small, with many progeny per cross. A promising hybrid strategy, involving a single cycle of OHS in the first generation followed by recurrent truncation selection, substantially improved long-term gain compared with truncation selection and performed similarly to OCS. The results of this study provide initial insights into where OHS could be incorporated into breeding programs.

An empirical analysis of the effects of nudge-based measures on job seekers' participatory behavior in the Care Worker Initial Training

Objectives The study aim was to explore effective measures to promote job seekers' participation in the Care Worker Initial Training course provided by Hello Work.Methods In this study, we adopted the nudge approach as a method to promote behavioral changes based on a knowledge of behavioral economics. Additionally, we tested the effectiveness of nudge-based measures compared to that of conventional measures. The survey was conducted through two rounds of Web distribution. In the first Web distribution, we consistently implemented the following, in order: 1) recruited individuals who agreed to participate in the study, 2) distributed the first Web questionnaire regarding basic attributes and eligibility criteria in terms of the target individuals, and 3) distributed course guidance. Individuals who responded to the first Web questionnaire (n=50,000) were randomly assigned to eight groups. The intervention groups were presented with course guidance based on loss-aversion nudge, empathy nudge, long-term gain nudge, and their combinations. The control group was presented with traditional course guidance used by the Ministry of Health, Labour and Welfare over the Web. Two weeks after the intervention, we identified 2,404 individuals who met the eligibility criteria and assessed their behavioral changes (pre-contemplation, contemplation/preparation, information-gathering, action); we received responses from 1,995 individuals. Binomial logistic regression analyses were performed using nudge-based interventions and behavioral change stages as dependent and independent variables, respectively. Sex, age, education level, marital status, interest in caregiving before the intervention, and behavioral change stages before the intervention were included as moderator variables.Results A total of 1,995 individuals were included in the analysis. Among the 1,756 participants in the intervention groups, 321 (18.3%) took on contemplation/preparation behavior, 102 (5.8%) took on information-gathering behavior, and 50 (2.8%) took action by participating in the course. Among the 239 individuals in the control group, 38 (15.9%) took on contemplation/preparation behavior, 31 (13.0%) took on information-gathering behavior, and 2 (0.8%) took action by participating in the course. Binomial logistic regression analyses showed that while traditional measures were effective in promoting information-gathering behavior toward participation, nudge-based measures combining loss-aversion nudge, long-term gain nudge, and empathy nudge were effective in motivating individuals to participate in the course (odds ratio: 5.39, 95%CI: 1.18-24.74, P=0.03).Conclusion The introduction of measures combining multiple types of nudges is necessary to promote participation in the Care Worker Initial Training course, rather than traditional measures or a nudge in isolation.

Effects of Steel Slag on the Hydration Process of Solid Waste-Based Cementitious Materials.

Aiming to enhance the comprehensive utilization of steel slag (SS), a solid waste-based binder consisting of SS, granulated blast furnace slag (BFS), and desulfurization gypsum (DG) was designed and prepared. This study investigated the reaction kinetics, phase assemblages, and microstructures of the prepared solid waste-based cementitious materials with various contents of SS through hydration heat, XRD, FT-IR, SEM, TG-DSC, and MIP methods. The synergistic reaction mechanism between SS and the other two wastes (BFS and DG) is revealed. The results show that increasing SS content in the solid waste-based binder raises the pH value of the freshly prepared pastes, advances the main hydration reaction, and shortens the setting time. With the optimal SS content of 20%, the best mechanical properties are achieved, with compressive strengths of 19.2 MPa at 3 d and 58.4 MPa at 28 d, respectively. However, as the SS content continues to increase beyond 20%, the hydration process of the prepared binder is delayed. The synergistic activation effects between SS and BFS with DG enable a large amount of ettringite (AFt) formation, guaranteeing early strength development. As the reaction progresses, more reaction products CSH and Aft are precipitated. They are interlacing and overlapping, jointly refining and densifying the material's microstructure and contributing to the long-term strength gain. This study provides a reference for designing and developing solid waste-based binders and deepens the insightful understanding of the hydration mechanism of the solid waste-based binder.

Optimal open nucleus breeding system for long-term genetic gain in the Pacific white shrimp using genomic selection

The open nucleus breeding system (ONBS) has been widely employed in livestock breeding and has demonstrated a desirable genetic gain compared to the traditional closed nucleus breeding system (CNBS). However, no related study and application for ONBS exist on aquatic animal breeding. The present investigation simulates the family-based ONBS with different proportions of introduced multiplier individuals used as parents of the nucleus population (NP) and CNBS schemes for the harvest body weight of the Pacific white shrimp (Litopenaeus vannamei). The multiplier population (MP) comprised progenies from eight families with high estimated breeding value (EBV) or genomic EBV (GEBV) of NP of the previous generation. ONBS was assigned three proportions (10%, 30%, and 50%) of the introduced MP individuals. The short-term selection (G0 to G10) and long-term selection (G0 to G20) were performed for CNBS and ONBS schemes using pedigree-based best linear unbiased prediction (PBLUP) with the A relationship matrix from the pedigree or single-step genomic BLUP (ssGBLUP) with the H relationship matrix integrating SNP markers and pedigree. The genetic gain of body weight and inbreeding coefficient of NP for eight breeding schemes with CNBS_PBLUP (CP), CNBS_ssGLUP (CS), ONBS_PBLUP (OP10, OP30, OP50), and ONBS_ssGBLUP (OS10, OS30, OS50) with three proportions of the introduced MP individuals were calculated. Compared to CP, genetic gains for the three OP schemes increased by 7.68 to 11.27% after short-term selection, and by 2.51 to 5.79% after long-term selection. In comparison to CS, genetic gains for the three OS schemes increased by 8.21 to 8.96% after short-term selection, and from 4.46 to 5.87% after long-term selection. The ONBS schemes achieved higher genetic gains than the corresponding CNBS schemes whether using genomic or pedigree information. The advantage of ONBS over CNBS is reduced after long-term selection. Genetic gains for the three OS schemes increased by 9.77 to 14.06% after long-term selection compared with the corresponding OP schemes. Furthermore, no significant difference (P > 0.05) in genetic gain was revealed among the ONBS schemes after either pedigree-based or genomic selection. Inbreeding coefficients for the three OP schemes increased from 59.45 to 70.98% compared with CP, whereas inbreeding coefficients for the three OS schemes increased from 24.72 to 32.22% compared with CS. Besides, after long-term selection, inbreeding coefficients for the three OS schemes decreased from 13.13 to 14.79% compared with the corresponding OP schemes. In a nutshell, ONBS using introduced MP individuals has great promise in the selective breeding program of L. vannamei. Genomic information has more potential to improve selection response and control inbreeding level than pedigree information when applying ONBS.

APCs in sinus floor augmentation.

After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.

Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania

Acceptance-enhanced behavior therapy for trichotillomania (AEBT-TTM) is effective in reducing trichotillomania (TTM) symptoms, but the durability of treatment effects remains in question. This study analyzed 6-month follow-up data from a large randomized clinical trial comparing AEBT-TTM to an active psychoeducation and supportive therapy control (PST). Adults with TTM (N=85; 92% women) received 10 sessions of AEBT-TTM or PST across 12 weeks. Independent evaluators assessed participants at baseline, post-treatment, and 6 months follow-up. For both AEBT-TTM and PST, self-reported and evaluator-rated TTM symptom severity decreased from baseline to follow-up. TTM symptoms did not worsen from post-treatment to follow-up. At follow-up, AEBT-TTM and PST did not differ in rates of treatment response, TTM diagnosis, or symptom severity. High baseline TTM symptom severity was a stronger predictor of high follow-up severity for PST than for AEBT-TTM, suggesting AEBT-TTM may be a better option for more severe TTM. Results support the efficacy of AEBT-TTM and show that treatment gains were maintained over time. Although AEBT-TTM yielded lower symptoms at post-treatment, 6-month follow-up outcomes suggest AEBT-TTM and PST may lead to similar symptom levels in the longer term. Future research should examine mechanisms that contribute to long-term gain maintenance.

Influences of foreign direct investment and carbon emission on economic growth in Vietnam

Over the course of the previous three decades, Vietnam has seen a phase of economic growth, resulting in the influx of foreign direct investment (FDI). However, it is essential to note that there was an extensive rise in carbon dioxide (CO2) emissions throughout this period. The objective of this research is to analyze the impact of FDI and CO2 emissions on Vietnam's economic growth, utilizing time series data from 1990 to 2021. The stationarity of the data was assessed using unit root tests, while an autoregressive distributed lag (ARDL) procedure was utilized to examine the long- and short-run associations between the components. Based on the research outcomes, it is seen that a marginal rise of one percent in both FDI and CO2 emissions is associated with a corresponding long-term gain of 1.36 percent and 1.11 percent in gross domestic product (GDP). Furthermore, in the short term, these increments yield an increase of 0.61 percent and 0.29 percent in GDP. The conclusions of this study will provide valuable insights for policymakers in crafting policies that effectively promote sustainable development. Specifically, these policies would aim to strike a balance between capital growth derived from foreign investments and economic expansion, while concurrently mitigating carbon emissions.

Postural control deficits due to bilateral pyramidal tract lesions exemplified by hereditary spastic paraplegia (HSP) originate from increased feedback time delay and reduced long-term error corrections.

Pyramidal tract lesions determine the clinical syndrome of Hereditary Spastic Paraplegia (HSP). The clinical impairments of HSP are typically exemplified by their deficits in mobility, leading to falls and injuries. The first aim of this study was to identify the cause for postural abnormalities caused by pyramidal tract lesions in HSP. The second aim was to specify the effect of treadmill training for postural abnormalities. We examined nine HSP patients before and after treadmill training, as well as nine healthy control subjects during perturbed and unperturbed stance. We found that HSP was associated with larger sway amplitudes and velocities. Body excursions following platform tilts were larger, and upper body excursions showed a phase lead. Model-based analysis detected a greater time delay and a reduced long-term error correction of postural reactions in the center of mass. HSP patients performed significantly better in clinical assessments after treadmill training. In addition, treadmill training reduced sway amplitudes and body excursions, most likely by increasing positional and velocity error correction gain as a compensatory mechanism, while the time delay and long-term error correction gain remained largely unaffected. Moreover, the upper body's phase lead was reduced. We conclude that HSP leads to very specific postural impairments. While postural control generally benefits from treadmill training, the effect seems to mainly rely on compensatory mechanisms, whereas the original deficits are not affected significantly.

A Review of the Halo Effect and Its Applications at the Corporate Level

The halo effect is a cognitive bias that twists peoples judgment in the rating process and has a significant influence on HRM(human resource management) practices. However, as a heuristic, the halo effect has shown much potential for improving the economic outcomes of corporate business and management as well. This essay gives a review of the halo effect and its applications at the corporate level based on the literature from 1920 to 2022. While the concept of the halo effect has been fully developed throughout the century, the problem of distinguishing true halo from illusory halo remains unsolved, which leads to the stagnation of further research on HRM practice. However, the study of the halo effect in brand marketing is rather mature, providing diverse advertising, sales, and crisis strategies for corporations to increase long-term gain. Furthermore, the literature on the halo effect has been focusing on more contemporary fields of application, such as the promotion of cultural products in the context of globalization, which could be a trend for researchers in the near future.

Influence of the mating design on the additive genetic variance in plant breeding populations

Key messageMating designs determine the realized additive genetic variance in a population sample. Deflated or inflated variances can lead to reduced or overly optimistic assessment of future selection gains.The additive genetic variance {V}_{A} inherent to a breeding population is a major determinant of short- and long-term genetic gain. When estimated from experimental data, it is not only the additive variances at individual loci (QTL) but also covariances between QTL pairs that contribute to estimates of {V}_{A}. Thus, estimates of {V}_{A} depend on the genetic structure of the data source and vary between population samples. Here, we provide a theoretical framework for calculating the expectation and variance of {V}_{A} from genotypic data of a given population sample. In addition, we simulated breeding populations derived from different numbers of parents (P = 2, 4, 8, 16) and crossed according to three different mating designs (disjoint, factorial and half-diallel crosses). We calculated the variance of {V}_{A} and of the parameter b reflecting the covariance component in {V}_{A}, standardized by the genic variance. Our results show that mating designs resulting in large biparental families derived from few disjoint crosses carry a high risk of generating progenies exhibiting strong covariances between QTL pairs on different chromosomes. We discuss the consequences of the resulting deflated or inflated {V}_{A} estimates for phenotypic and genome-based selection as well as for applying the usefulness criterion in selection. We show that already one round of recombination can effectively break negative and positive covariances between QTL pairs induced by the mating design. We suggest to obtain reliable estimates of {V}_{A} and its components in a population sample by applying statistical methods differing in their treatment of QTL covariances.

Behavior of drying and plastic shrinkage of Portland cement concrete prepared and cured under harsh field

The shrinkage of concrete is crucial under aggressive environmental conditions to avoid short and long-term deterioration. ACI committee for hot weather concreting specifies 35 °C as the maximum limit of fresh concrete to mitigate problems associated with that. This paper aims to investigate the plastic and drying shrinkage characteristics and compressive strength development of ordinary Portland cement (OPC) by varying w/c (0.3–0.45), casting temperatures (25–45 °C), and curing methods. The results demonstrated that the characteristics of concrete are significantly influenced by w/c, as well as the conditions at which they are cast and cured. In general, the plastic/drying shrinkage strains were observed to be minimum, while compressive strength was maximum when mixtures were cast at an ambient temperature of 32 °C. An increase in the w/c results in a corresponding rise in plastic/drying shrinkage strain, coupled with a decrease in the compressive strength of the mixtures. In addition, application of curing compound was found most effective in the field for enhancing the shrinkage characteristics whilst wet burlap practice was found beneficial in long-term compressive strength gain. These findings will enhance the optimization of mix designs for harsh conditions, improve construction efficiency, and support long-term concrete structure performance and sustainability.

The Effects of Changes in Tick Size and Tax Rates on the Tax-Timing Option and the Market Response to Stock Distributions

This study examines how changes in tick size and the differential between short-term and long-term capital gain tax rates affect the market response to the announcement of stock distributions. Prior research finds that a stock distribution increases the volatility of the stock, which in turn increases the value of the stock’s tax-timing option. We show that the minimum tick size established by the exchange where the stock is traded affects a stock’s volatility and, therefore, the value of the tax-timing option and the market response to the stock distribution. We document a stronger relation between the market response and changes in volatility among large distributions than among small distributions. We also find a positive relation between the market response and the tax rate differential, although it is only significant for small distributions. Finally, we show that the relationship between the market response and changes in both volatility and tax rate differential is primarily driven by tax-sensitive institutional investors in the distributing firm.

Active methods in electricity and magnetism courses: Influence of degree, academic level and gender on student performance

The performance of first-year students in electromagnetism (E&M) courses of different engineering degrees at a Spanish public university was measured using the Brief Electricity and Magnetism Assessment (BEMA), a standard research-based instrument to assess students' understanding after attending introductory courses in electricity and magnetism. In all cases, Flipped classroom (FC) built on information and communications technology was used. The objective of this paper is to analyse if the gain in the BEMA pre and post-test results is influenced by several factors such as the degree, the students' academic grade, and gender. Moreover, as some studies have shown that the students' retention of the concepts was significantly stronger in active learning than in traditional approaches, a third BEMA test was performed by the students to analyse the long-term retention gain dependence on the same factors. Students from different engineering degree programs were asked to complete two BEMA tests during the course and a third one after a few months. ANOVA tests were used to analyse the existence of significant differences in gain between student degree programs, student academic level and student gender. Results have shown no differences in the BEMA performance by degree program, but significant differences were found by academic level and gender. Retention did not depend on the degree course but on the academic level. Mean gain value by academic level, and gender was obtained and concluded that the best students presented the best gain results and that gain depends on the students' gender: males outperformed females in the BEMA tests, although there were no significant differences in the course grades. It is thus necessary to understand these differences and to implement measures in daily teaching work to improve women's performance.

Combining antidepressants and attention bias modification in primary health care (DEPTREAT): Protocol for a pragmatic randomized controlled trial

BackgroundMajor depressive disorder (MDD) is a highly prevalent psychiatric condition associated with significant disability, mortality and economic burden. A large proportion of MDD patients are treated in primary health care in the local community. Attentional Bias Modification (ABM) training in combination with antidepressants could be an effective treatment. Here we test the hypothesis that adding an ABM procedure to regular treatment with antidepressants in primary health care will result in further improvement of symptoms compared to treatment with antidepressants alone (treatment as usual, TAU) and as compared to an active comparison condition. MethodsA total of 246 patients with a diagnosis of MDD will be included in this study. The study is a three-armed pragmatic randomized controlled trial comparing the efficacy of ABM as add-on to treatment with antidepressants in primary care (ABM condition) compared to standard antidepressant treatment (TAU condition). In a third group participants will complete the same schedule of intermediate assessments as the ABM condition in addition to TAU, but no ABM, thus controlling for the non-training-specific aspects of the ABM condition (Antidepressant active comparison group). DiscussionThe clinical outcome of this study may help develop easily accessible, low-cost treatment of depression in primary health care. Moreover, the study aims to broaden our knowledge of optimal treatment for patients with a MDD by providing adjunct treatment to facilitate recovery and long-term gain.

Evaluating the Effectiveness of Interactive Virtual Patients for Medical Education in Zambia: Randomized Controlled Trial.

Zambia is facing a severe shortage of health care workers, particularly in rural areas. Innovative educational programs and infrastructure have been established to bridge this gap; however, they encounter substantial challenges because of constraints in physical and human resources. In response to these shortcomings, strategies such as web-based and blended learning approaches have been implemented, using virtual patients (VPs) as a means to promote interactive learning at the Levy Mwanawasa Medical University (LMMU) in Zambia. This study aimed to evaluate the students' knowledge acquisition and acceptance of 2 VP medical topics as a learning tool on a Zambian higher education e-learning platform. Using a mixed methods design, we assessed knowledge acquisition using pre- and posttests. In a randomized controlled trial setting, students were assigned (1:1) to 2 medical topics (topic 1: appendicitis and topic 2: severe acute malnutrition) and then to 4 different learning tools within their respective exposure groups: VPs, textbook content, preselected e-learning materials, and self-guided internet materials. Acceptance was evaluated using a 15-item questionnaire with a 5-point Likert scale. A total of 63 third- and fourth-year Bachelor of Science clinical science students participated in the study. In the severe acute malnutrition-focused group, participants demonstrated a significant increase in knowledge within the textbook group (P=.01) and the VP group (P=.01). No substantial knowledge gain was observed in the e-learning group or the self-guided internet group. For the appendicitis-focused group, no statistically significant difference in knowledge acquisition was detected among the 4 intervention groups (P=.62). The acceptance of learning materials exhibited no substantial difference between the VP medical topics and other learning materials. In the context of LMMU, our study found that VPs were well accepted and noninferior to traditional teaching methods. VPs have the potential to serve as an engaging learning resource and can be integrated into blended learning approaches at LMMU. However, further research is required to investigate the long-term knowledge gain and the acceptance and effectiveness of VPs in medical education. Pan African Clinical Trials Registry (PACTR) PACTR202211594568574; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=20413.