Implementing meaningful activity facilitators to prevent hospital-acquired complications in French geriatric short-stay wards: A qualitative analysis of the context and stakeholder representations.

The capability of people to engage in meaningful activities declines with the progression of major neurocognitive disorders. Cognitive strategies can help them pursue such activities, thus maintaining their dignity. They build on procedural memory and implicit retrieval, both preserves abilities, to automate the correct action sequences during learning, with repetition and while providing cues. However, few studies have implemented cognitive strategies especially in seniors' residences. Thus, the feasibility of their implementation remains unknown. This study aims to document the facilitators and barriers to the implementation of cognitive strategies with people living with neurocognitive disorders housed in a private seniors' residence. This participatory action research included training and coaching to allow care staff to integrate personalized cognitive strategies with nine residents. Qualitative interviews with 20 care staff and a focus group with 2 managers were conducted. Key facilitators identified included personalized approach rooted in life history, team awareness and engagement, alignment with organizational values, and a calm, home-like environment. Barriers included the rapid progression of neurocognitive disorder symptoms related to comorbidities, staff shortages and turnover, and disparities between organizational decisions and clinical practice. The results showed encouraging avenues to integrate cognitive strategies in long-term care settings when the care team is supported by adequate training and coaching.

It has been a general consensus among EFL learners that reading is one of the most challenging skills to master fully through productive exposure to their target language. Its difficulty does not only lie in the ability to decode the meanings of certain words but also in interpreting the implicit meanings formed in the texts. For this reason, second language educators need to promote more interactive, joyful, and meaningful reading activities that enable EFL learners to experience a higher degree of enjoyment. This can be achieved through the conduct of extensive reading activities, in which language learners are deliberately given the freedom to select varied texts that interest them the most. The researchers initiated this qualitative library study to investigate the role of digital reading texts in promoting extensive reading activity. To do so, the researchers employed a thematic analysis approach in analysing the identical findings from 30 previously published digital reading texts and extensive reading articles. A thematic analysis approach was applied to generate more dependable, tenable, and sound research results, as the intended data would be grouped in similar themes. The research results, categorized thematically, revealed that digital reading texts are beneficial for promoting extensive reading activities in EFL classrooms, as they fostered exponential growth in reading proficiency and disseminated more lively literacy dynamics.

Introduction Some older adults cannot participate in community activities alone and their caregivers may be physically unable to assist them. In these circumstances, there is an opportunity to decrease caregiver workload through caregiver-targeted, mobility technology. We developed the Caregiver Assist Transport Chair (CATC), a motorised chair that responds to caregiver effort. Purpose To examine factors influencing design, operability, and perceived impact of the CATC. Methods We employed a mixed methods study with older Veterans and their caregivers at the Minneapolis Veterans Affairs Health Care System. Testing sessions included a functional assessment (Short Physical Performance Battery), participant trials of the CATC prototype, semi-structured interviews, and completion of two questionnaires (Community Mobility Priorities and Life-Space Assessment). Data were analysed using rapid qualitative methods and descriptive statistics. Results Five caregivers and three Veterans participated. All participants noted the potential of the CATC to allow them to resume participation in meaningful activities they have otherwise stopped or reduced. Room for improvement included (i) ease in traversing thresholds or uneven terrain, (ii) reduced weight for loading and unloading into a vehicle, and (iii) diminished choppy or jerky feeling described by caregiver participants when operating the CATC. Conclusions All participants spoke of the potential for the CATC to expand the number and types of places they visit. Design and operability features noted for improvement are addressable in the next stage of design. Caregiver-targeted mobile technologies—like the CATC—have the potential to ease caregiver physical burden and allow for better navigation of community settings.

To evaluate whether tongue base motion patterns, assessed by submental ultrasonography during unilateral hypoglossal nerve stimulation (HNS), are associated with treatment response in obstructive sleep apnea patients. This cross-sectional study included 64 patients with unilateral HNS. Standardized submental B-mode ultrasound was performed to assess tongue-base motion under awake stimulation. Two independent, blinded raters evaluated the magnitude of anterior tongue base movement in the axial and sagittal planes. Further, the symmetry of bilateral tongue protrusion and tongue shape was classified. The primary endpoint was the correlation between apnea-hypopnea (AHI) reduction and ultrasonographic findings. Ultrasonographic assessment showed substantial to excellent agreement between the two raters. No significant correlation was found between AHI reduction and anterior tongue displacement in either the axial (Spearman's ρ = 0.20, p = 0.12) or sagittal plane (ρ = -0.08, p = 0.64). Clinically meaningful bilateral activation was present in 33% of patients but was not associated with treatment outcome (ρ = 0.03, p = 0.84). Neither tongue shape was predictive of AHI improvement (buckling p = 0.13 and trough sign p = 0.79). Tongue movement patterns were not associated with stimulation voltage. Ultrasonographic assessment of tongue base motion under HNS does not correlate with treatment response. Neither symmetry, magnitude, nor qualitative shape was associated with AHI reduction. These findings suggest that visible tongue motion may not reliably reflect functional improvement in the airway. Future research should define the role of ultrasound in HNS evaluation and optimization. 3b. ClinicalTrials.gov Identifier: NCT06154577.

The effect of horticultural activity program on internet addiction, social skills, and stress levels in children: A randomized controlled trial.

Mesothelin (MSLN) is a cell-membrane-anchored glycoprotein overexpressed in several cancers including pancreatic cancer, ovarian cancer, and mesothelioma. MSLN is protease-cleaved at the membrane-proximal region, releasing shed MSLN (sMSLN) into the tumor microenvironment, leaving behind a membrane-bound stub. sMSLN in the tumor microenvironment is hypothesized to create a 'sink' that could limit tumor binding of MSLN-targeted anticancer therapies. We describe JNJ-79032421, a bispecific antibody targeting cluster of differentiation (CD)3 on T cells and the membrane-restricted, non-shed region of full-length MSLN on cancer cells. Crystal structure analysis confirmed JNJ-79032421 binding to the membrane-restricted, non-shed C-terminal region of MSLN. Using Western blot, enzyme-linked immunosorbent assay, fluorescence-activated cell sorting, and immunohistochemistry, elevated levels of sMSLN were detected in blood, serosal fluids, and tumor tissue of patients and tended to increase with MSLN tumor expression. Binding and cytotoxicity of JNJ-79032421 against cancer cell lines was unaffected by the presence of sMSLN. In cancer cell lines and cell-line-derived and patient-derived xenograft mouse models, increasing levels of MSLN expression led to increased JNJ-79032421 potency. In contrast, MSLNxCD3 bispecific antibodies whose binding is non membrane restricted demonstrated a loss of cytotoxicity in the presence of sMSLN. This 'sink' effect was most pronounced for high-affinity non-membrane-restricted bispecific antibodies. Increases of CD45+ and CD8+ T-cell infiltrates, as well as CD8+ T-cell activation, observed in xenograft tumor tissues were time and JNJ-79032421 dose dependent. Overall, these data suggest that JNJ-79032421 may offer meaningful clinical activity by avoiding binding to sMSLN.

This study aims to evaluate destination brand awareness, brand image, quality, trust, satisfaction, and brand equity at TeBa Majalangu agrotourism, as well as analyze the influence of the first five factors on brand equity. This study is driven by the importance of destination branding in sustainable and culturally rooted agrotourism. TeBa Majalangu represents a unique case because it integrates cultural heritage, particularly the subak system, with educational and environmentally friendly tourism. Data werecollected from 96 visitors through structured questionnaires, while qualitative and quantitative descriptive analysis wasused to interpret the data with the application of Generalized Structured Component Analysis (GSCA) to explore the relationships between variables. The results show that brand awareness, brand image, and perceived quality do not have a significant influence on destination brand equity. Conversely, brand trust and visitor satisfaction exhibit significant positive effects, underscoring their pivotal role in enhancing destination brand value. These results suggest that emotional and experiential dimensions, including trust and satisfaction, have a greater impact on shaping brand equity than traditional marketing attributes, such as awareness and image. The theoretical contribution of this study is a deeper understanding of brand equity development in environmentally and culturally based agrotourism. It highlights that maintaining trust and satisfaction is crucial for long-term brand value, especially in destinations that depend on cultural heritage and ecological sustainability. Practically, these findings suggest that TeBa Majalangu managers should prioritize service quality, environmental conservation, the development of meaningful educational activities, and enhanced promotional strategies. Expanding agriculture-based activities such as hydroponics and diversifying flora and fauna can further increase visitor engagement and satisfaction. Promotion through local influencers and social media is also recommended, to strengthen public awareness and position TeBa Majalangu as a leading agrotourism destination. Overall, this study shows that destination brand equity in agrotourism is driven by the ability to build and maintain visitor trust and satisfaction. Strengthening these aspects not only improves competitive positioning but also contributes to the preservation of cultural heritage and the sustainability of the subak system through educational tourism initiatives. Key words: Agriculture, Agrotourism, Branding, Destination, Education, Environment, Trust, Visitor Satisfaction

Introduction: The study investigates the relationship between nomophobia and occupational balance among high school students. Nomophobia, or the fear of being without a mobile phone, is increasingly prevalent among adolescents, potentially impacting their daily routines and well-being. This study aimed to examine the relationship between nomophobia levels and occupational balance among high school students. Methods: Sociodemographic data were obtained with a sociodemographic form. The Adolescent Occupational Balance Scale was used to measure occupational balance. The Nomophobia Questionnaire was used to determine nomophobia levels. A total of 258 students participated in the study. Results: Findings reveal that as nomophobia levels increase, students’ ability to manage time and participate in various activities significantly decreases. This study found that students with severe nomophobia showed lower scores in occupational diversity and harmony, indicating that excessive reliance on digital platforms may reduce participation in social and academic activities. Conclusions: The study suggests that high levels of nomophobia may limit individuals’ ability to engage in a variety of meaningful activities, thereby disrupting their occupational balance. Considering occupational balance in future research and intervention strategies is crucial for promoting healthier technology use and improving the overall well-being of high school students. Trial registration: Clinical trial number: not applicable.

To investigate the QoL of nursing home residents on overall, domain, and item levels. This descriptive study used the brief Older People's Quality of Life questionnaire (OPQOL-brief). The domain level 'Home and neighbourhood' scored highest out of dimensions with two items. In our study, nearly 90% (strongly) agreed that they felt safe where they live. The lowest score on the item level was obtained for the item 'I have social or leisure activities/ hobbies that I enjoy doing'. Family, friends, or neighbours seemed to act as resources for the residents. We recommend that researchers investigate the residents' perspectives as well as those of their families and friends to determine how they could become more deeply involved in the daily nursing practice. Moreover, studies on meaningful activities are warranted, and not only for persons with dementia, but for all nursing home residents.

Immune checkpoint inhibitors (ICIs) have reshaped cancer treatment, offering durable remissions for a minority of patients. Yet their success has come with a difficult trade-off: a large proportion of patients develop immune-related adverse events (irAEs), sometimes severe, and often without gaining clinical benefit. These reactions signal a disruption of peripheral tolerance that is not easily explained by traditional models in which negative selection of autoreactive T cells maintains self-restraint. Under ICI therapy, patients' own T cells can behave in ways that resemble the alloreactive responses seen in chronic graft-versus-host disease (cGVHD), producing a pattern of tissue injury that mirrors this well-studied transplant complication. This parallel offers a fresh way to think about why irAEs occur and how they might be prevented. Despite arising from fundamentally different immunologic triggers, comparative transcriptomic analyses reveal that cGVHD and irAEs induced by ICIs converge on a common molecular ecosystem dominated by interferon-conditioned tissue states. Early clinical experience with ultra-low-dose ICI regimens supports this idea, showing that meaningful antitumor activity can be preserved while dramatically reducing toxicity. We suggest that viewing ICI-induced autoimmunity through a cGVHD-like lens may help guide safer dosing strategies and broaden access to immunotherapy worldwide.

494 Background: Von Hippel-Lindau (VHL) disease manifests with tumors including renal cell carcinoma (RCC), central nervous system hemangioblastomas (CNS-HB), pancreatic neuroendocrine tumors (pNET), pheochromocytomas/paragangliomas (PPGL), and retinal hemangioblastomas (R-HB). The LITESPARK-004 trial conducted in the US and Europe demonstrated robust clinical activity of belzutifan in VHL disease-associated RCC, CNS-HB and pNET. We report the results of China and Japan participants (pts) with VHL disease-associated tumors from Cohort B1 of LITESPARK-015 trial. Methods: This global single-arm phase 2 trial enrolled adult pts with VHL disease-associated localized tumors with ≥1 measurable RCC, pNET or PPGL to receive 120 mg belzutifan Q1D until disease progression, unacceptable toxicity, or withdrawal. For R-HB, ophthalmic evaluations including color fundus photography were performed. The primary endpoint was objective response rate (ORR) for VHL disease-associated RCC per RECIST v1.1 by blinded independent central review (BICR) in pts from China and Japan; the hypothesis was ORR >15% tested once at 20 months (mo). Other key endpoints included duration of response (DOR), disease control rate (DCR) and progression-free survival (PFS) (RECIST 1.1, BICR), time to surgery by tumor type, overall survival (OS) and safety. Results: At data cut-off (April 22, 2025), 44 pts (23 China, 21 Japan) were enrolled and treated. The median age was 38 years, 59% pts had family history of VHL disease, and 59% had type 1 VHL disease. Overall, 34 (77%) pts had RCC, 22 (50%) solid and cystic CNS-HB, 16 (36%) solid CNS-HB, 21 (48%) pNET and 6 (14%) PPGL. Seven pts had ≥1 R-HB by BIRC at baseline. At median follow-up of 25.1 mo (range, 20.7 to 28.1), the primary endpoint was met with ORR of 88.2% (95% CI, 72.5-96.7; p <0.001) in pts with RCC. ORR was 90.5% (95%CI, 69.6-98.8) in pNET, 59.1% (95% CI, 36.4-79.3) in solid and cystic CNS-HB, 81.3% (95% CI, 54.4-96.0) in solid CNS-HB, and 16.7% (95% CI, 0.4,64.1) in PPGL. DCR was 100% in all pts. The best overall response at pt level for R-HB was “improved” in 71% pts. Median DOR and PFS were not reached for all pts, with 24-mo PFS rates of 88.1% (RCC), 88.4% (pNETs), 90.4% (solid and cystic CNS-HB), 100% (solid CNS-HB), and 100% (PPGL). No pts had VHL tumor specific surgery or radiation while treated with belzutifan. All pts (100%) had a treatment-related adverse event (TRAE), with a serious TRAE in 1 (2%) pt. One (2%) pt discontinued and 28 (64%) had dose reduction due to TRAE. Nine (21%) pts had grade 3 TRAEs; the most common were increased alanine aminotransferase (9%) and anemia (4%). There were no grade 4 or 5 TRAEs. Conclusions: Belzutifan provided robust and clinically meaningful antitumor activity with durable responses in pts from China and Japan with VHL disease-associated tumors. Belzutifan had a manageable safety profile with no new safety signals. Clinical trial information: NCT04924075 .

Background: This study investigates how radically self-directed, democratic learning environments may relate to long-term development through autonomy and participation. Purpose: The research examines how everyday participation in community life within Sudbury schools is perceived by graduates as informing their personal, social, and professional capacities that persist into adulthood. Method: Drawing on cross-cultural interviews with 14 alumni from Sudbury schools in the Netherlands, Israel, and the United States, reflexive thematic analysis was used to explore graduates’ retrospective narratives of learning and development. Findings: Learning was described as developing through authentic engagement in meaningful activity, shared responsibility, and informal interactions with peers and adults—conditions that resonate with core principles of experiential education. Graduates described cultivating initiative, self-regulation, civic and organizational literacy, and confidence in communication. Implications: By situating Sudbury schooling within traditions of experiential education, Self-Determination Theory, and Evolutionary Developmental Psychology, this study suggests potential long-term associations between democratic participation, learner autonomy, and graduates’ reported developmental outcomes on learning, social development, and civic engagement. The findings suggest that educational pathways can be reimagined beyond formal instruction and standardized progression to foster lifelong adaptability, resilience, and social responsibility.

Major neurocognitive disorders (MNCDs) frequently lead to difficulties in performing activities. Several studies have shown that people living with an MNCD benefit from the use of learning optimization methods from cognitive rehabilitation, such as error-free learning, motor encoding, spaced retrieval, and fading, which promote the safe pursuit of their meaningful activities. However, while the principles of learning optimization methods are relatively straightforward, the personalized application of these methods to the specific situations encountered can be more difficult. The aim of this study was to describe the codevelopment process, including the validation of a web application called "Aide-Mémoire-Interactif (AMI)," a tool to help in personalizing learning optimization methods. To design the web application, participatory action research based on a codevelopment and validation process was carried out. The various stages leading to the codevelopment of the AMI web application were grouped into 3 phases: (1) assessment of caregivers' needs (identification of situations frequently encountered by people living with an MNCD); (2) production of the first version of the AMI web application; and (3) validation of the AMI application. Individual interviews and workshops were conducted with 20 participants (caregivers, health and social service professionals, and community organization workers) to obtain a diversity of viewpoints and application contexts of use. The AMI web application was developed through an iterative, participatory process involving caregivers and professionals. Participants identified daily situations requiring the use of learning optimization methods and provided feedback that guided successive refinements to the content, answer choices, navigation, and personalization features. The logical architecture was built according to the rationale underlying learning optimization methods. The final version enables users to generate tailored strategies for specific situations, access educational capsules, and save personalized strategies. Participants reported improved clarity, usability, and relevance. This participatory action research enabled the codevelopment and validation of the AMI web application to support the operationalization of learning optimization methods for people living with an MNCD by personalizing them to the situations encountered daily as well as to the underlying cognitive difficulties. By involving caregivers, professionals, and users, this process contributed to the development of a web application that meets user needs and their appreciation.

The low level of fine motor development in early childhood, evident in suboptimal abilities to hold writing tools, cut, paste, and perform accurate eye–hand coordination, remains a classroom challenge due to learning activities that tend to be monotonous and lack variation. This study aimed to determine the effect of batik activities using natural materials on the fine motor development of young children. A quantitative approach was employed with a quasi-experimental design, using fine motor skill tests as the data collection technique and data analysis conducted with a t-test using SPSS version 26. The results showed that children’s fine motor skills in the experimental class improved more than those in the control class. The t-test yielded a significance value of 0.000 < 0.05, indicating that H₀ was rejected and Hₐ was accepted. Thus, batik activities using natural materials have a significant effect on the fine motor development of young children and can be recommended as a varied and meaningful alternative learning activity to support fine motor stimulation in PAUD institutions.

Objectives Maintaining functional ability is central to healthy aging. However, prior research overlooks psychosocial adaptation and relies on retrospective assessments. This study examined intrinsic capacity, environmental resources, and functional ability under varying agency and belonging among 312 Hong Kong older adults (aged 65–86) using momentary assessment. Method A seven-day intensive longitudinal study was conducted in 2024. Intrinsic capacity included cognition, affect, locomotion, sensory capacity, and vitality. Environmental resources measured perceived walking accessibility. Functional ability assessed daily meaningful activities, physical activity intensity, and life space. Agency and belonging were housing-related control beliefs and sense of community. Direct associations and moderation models were tested. Results Intrinsic capacity positively associated with all functional ability dimensions. Environmental resources linked positively to meaningful activities but negatively to life space. These links were generally weaker with high agency and belonging, except high belonging strengthened one relationship, revealing nuanced psychosocial adaptation mechanisms. Conclusion Agency and belonging emerged as key psychosocial resources buffering functional decline, highlighting their value as targets for prevention and intervention efforts promoting healthy aging.

Grade 1-2 pancreatic neuroendocrine tumors exhibit considerable biological and clinical diversity, which translates into a broad range of available therapeutic approaches. Given the absence of a universally accepted treatment sequence, treatment selection requires a practical framework based on tumor biology and clinical presentation. Clinical management should be individualized by integrating the histologic grade, disease extent, symptom burden, and somatostatin receptor (SSTR) expression. For patients with low-volume, SSTR-positive, and clinically indolent disease (Ki-67 < 10%), long-acting somatostatin analogues, including octreotide and lanreotide, are commonly used as initial therapies to control hormonal symptoms and delay tumor progression. In patients with radiologic progression requiring systemic disease control, targeted agents such as everolimus and sunitinib represent established subsequent options, particularly when disease stabilization is the primary therapeutic goal. Peptide receptor radionuclide therapy with 177Lu-DOTATATE has demonstrated meaningful antitumor activity and is generally considered in patients with SSTR-positive tumors with progressive disease (Ki-67 ≥ 10%) or increasing tumor burdens, especially when tumor reduction is desirable. Combination cytotoxic chemotherapy, most notably the capecitabine-temozolomide (CAPTEM) regimen, remains an important consideration for patients with higher tumor burdens or more aggressive tumor biology. This review summarizes current evidence and provides a practical overview of treatment selection and sequencing for the systemic management of Grade 1-2 pancreatic neuroendocrine tumors, while also highlighting emerging therapeutic strategies, including targeted alpha therapy and SSTR2 antagonist-based approaches.

BackgroundSacituzumab govitecan (SG) has demonstrated efficacy in metastatic triple-negative breast cancer (mTNBC) in clinical trials, but real-world data from routine clinical practice remains limited. This study aimed to evaluate the effectiveness and safety of SG in mTNBC patients in Southern Spain.MethodsThis observational, multicenter, retrospective study included 159 mTNBC patients who received at least one cycle of SG between January 2022 and December 2023. Primary endpoints included real-world progression-free survival (rwPFS), overall survival (rwOS), and safety. Secondary endpoints explored treatment tolerability and management of adverse events. A pre-specified subset analysis focused on patients with central nervous system (CNS) metastases.ResultsThe median age of patients at diagnosis was 50 years (46.5% premenopausal). Median rwPFS was 4.6 months (95% CI 3.7-6.3) and rwOS was 10.9 months (95% CI 7.6-14.2). The objective response rate was 31.2%, with a disease control rate of 68.9%. Patients with CNS metastases (13.8%) had a median rwPFS of 2.3 months (95% CI 1.3-3.2). The most common adverse events were neutropenia (59.4%, grade 3-4: 30.4%) and diarrhea (49%, grade 3-4: 8.2%). Granulocyte colony-stimulating factor was administered as primary prophylaxis in 29.6% of patients and as secondary prophylaxis in 17.6%. Treatment discontinuation due to adverse events occurred in 5.7% of patients, while 43.4% required at least one dose reduction.ConclusionSG demonstrated effectiveness and tolerability in mTNBC patients treated in routine practice, including those with CNS metastases, consistent with ASCENT trial results. These findings support the use of SG in clinical practice for mTNBC patients and suggest clinically meaningful activity and a manageable safety profile in patients with CNS involvement, despite the clinical challenges presented by this subgroup.

Occupational therapy offers a holistic perspective regarding weight management. This study characterized occupational therapy's current role in preventive care for adult primary care patients with excess body weight (EBW). This exploratory sequential mixed methods design used semi-structured interviews (N = 27) with primary care occupational therapists exploring experiences working with patients with EBW. Interview findings guided development of a survey exploring unanswered interview questions (N = 62). A joint display compared the two data sources. Interviews demonstrated that occupational therapists (1) promote patient-led conversations surrounding weight, (2) focus on meaningful health-promoting activities versus weight loss, and (3) assess subjective participation change versus changes in body composition. Within the surveys, 50% reported avoiding the word "weight." Seventy-seven percent reported addressing meaningful participation in health management activities to support weight management. Occupational therapy demonstrates a unique and holistic approach to weight management that could support more respectful approaches to this topic.

This study investigates Indonesian learners’ attitudes toward using The Sims 4 to boost English vocabulary mastery, aiming to identify learners’ vocabulary learning challenges and examining how digital simulation games influence motivation and contextual vocabulary acquisition among English as a foreign language learners aged 18–25. The study employed a mixed-method explanatory sequential design, collecting quantitative data from 99 respondents through a Likert-scale questionnaire followed by semi-structured interviews with selected participants. Descriptive statistics and thematic analysis were used to analyze learners’ perceptions, experiences, and challenges related to vocabulary learning through gameplay. The findings reveal that learners generally perceive The Sims 4 as motivating, enjoyable, and effective in supporting contextual and daily-life vocabulary learning, particularly by providing meaningful exposure through simulated real-life activities. Therefore, while The Sims 4 enhances learners’ engagement, motivation, and incidental vocabulary acquisition, it should be used as a supplementary learning tool to boost students’ vocabulary mastery. It is recommended that educators combine digital games with traditional vocabulary teaching strategies to maximize meaningful learning activities.