Implementation Of Optimal Strategy Research Articles

Resilience Assessment in a Seawater Pumping Station Using Ordinal Patterns and Permutation Entropy Approach

The increasing demand for water in arid regions has driven the adoption of seawater desalination plants as critical infrastructure for industrial and domestic applications. However, these plants face unique challenges, including high operational costs, environmental vulnerabilities, and system reliability concerns. The critical nature of these infrastructures demands maintaining elevated levels of availability and demonstrating robust resilience. Resilience is framed as the system’s capacity to recover from disruptions and maintain operational efficiency under varying conditions. Quantitative assessment of resilience is essential to facilitate the development and implementation of optimal strategies that ensure operational continuity. This paper puts into practice a novel approach to evaluate the resilience of a seawater intake and pumping system using permutation entropy computed using time series availability data derived from different maintenance strategies. The methodology integrates reliability block diagrams (RBD) and symbolic time series analysis to identify critical components and evaluate maintenance strategies. A case study of a seawater pumping station demonstrates the application of the proposed resilience index. The analysis explored four scenarios to evaluate how these changes improved the system’s resilience: the first three hypothetical scenarios involved testing improvements in the maintainability and reliability indexes of the critical pump. These improvements matched the values of these parameters to the benchmark of the pump, historically showing the best indicators, first one by one, separately, and then both changes simultaneously. The initial resilience index was 0.652 in the baseline scenario. Scenario 1 (reduction in MTTR) showed a negligible impact, while scenario 2 (reduction in downtime) increased the resilience index to 0.682. The combination of both (scenario 3) maintained the index at 0.682, emphasizing the importance of reducing downtimes. Scenario 4, which consisted of reducing and standardizing the frequency of planned maintenance to 100 h, significantly raised the resilience index to 0.778. The results highlight how adjustments in maintenance strategies, including the reduction in preventive interventions, impact the system’s resilience and availability. The study also underscores the importance of aligning maintenance strategies with resilience goals to enhance the operational reliability of marine infrastructure. By providing a quantitative tool for resilience assessment, this work contributes to the sustainable management of desalination plants and offers practical insights for engineers and decision-makers in the marine engineering and water management sectors.

Global research trends in music therapy for surgery: a bibliometric analysis (2009–2023)

Music therapy, known for its profound impact on human emotions and physiology, has gained increasing attention for its applications in medical settings, particularly in surgery. This study conducted a bibliometric analysis of publications on the application of music therapy in surgery from 2009 to 2023, utilizing the Web of Science Core Collection (WoSCC) as the primary database. A total of 479 publications were analyzed using VOSviewer, CiteSpace, Microsoft Excel, and online bibliometric tools. Findings indicate a steady increase in annual publications since 2009, peaking in 2021. The USA leads global research efforts with 31.7% of publications, followed by China (17.7%) and Italy (10%). Harvard University was identified as the top contributing institution, while the Journal of Perianesthesia Nursing was the primary publishing journal, and the Cochrane Database of Systematic Reviews was the highest co-cited journal. Cao Hua contributed the most publications, and Nilsson U was identified as the most co-cited author (n = 131). Keyword analysis highlighted anxiety, therapy, music therapy, and pain as primary research trends. This study provides valuable insights into the evolving landscape of music therapy research in surgical contexts. Future efforts should focus on expanding interdisciplinary collaborations, exploring advanced technologies for personalized interventions, and investigating optimal implementation strategies to enhance the integration of music therapy into surgical practice.

A review of the therapeutic effects of traditional Chinese therapies on hypertension and cancer using qigong as an example

This review examines the therapeutic effects of Qigong, a traditional Chinese practice, on hypertension and cancer-related symptoms. Qigong, characterized by regulated breathing, meditation, and coordinated physical movements, has gained attention as a potential complementary therapy in modern healthcare. For hypertension management, multiple studies indicate that Qigong has effects similar to those of conventional treatments, and it can significantly lower blood pressure (BP) on both the SBP and DBP levels. The practice appears to modulate the sympathetic nervous system and enhance patients' self-efficacy in health-promoting behaviors. In cancer care, Qigong shows promise in alleviating symptoms such as pain, strain, depression, and fatigue, thereby improving overall living quality. Studies point to possible advantages for immunological response and specific biomarkers in cancer patients. However, methodological flaws in many of the current studies limit the evidence, like those with small sample sizes and absence of uniformity in Qigong interventions. While Qigong demonstrates potential as a complementary therapy for symptom management, its direct impact on disease progression, particularly in cancer, remains unclear. Future research should focus on large-scale, rigorous randomized controlled trials to validate these effects and explore optimal implementation strategies. Despite limitations, the non-invasive nature, low cost, and self-administration potential of Qigong make it an attractive option for integration into comprehensive treatment plans for hypertension and supportive cancer care.

“You know, it feels like you can trust them”: mixed methods implementation research to inform the scale up of a health disparities-responsive COVID-19 school testing program

BackgroundHealth disparities lead to negative COVID-19 outcomes for Hispanic/Latino communities. Rapid antigen testing was an important mitigation tool for protecting schools and their communities as in-person learning resumed. Within the context of a 3-middle-school non-inferiority trial we assessed acceptability and appropriateness of at-home and school-based COVID-19 antigen testing and implementation barriers and facilitators to facilitate district-wide scale up.MethodsGuided by the Consolidated Framework for Implementation Research (CFIR) and acceptability and appropriateness implementation outcomes, we collected post-implementation qualitative (n = 30) and quantitative (n = 454) data in English and Spanish from trial participants, in-depth feedback sessions among program implementers (n = 19) and coded 137 project meeting minutes. Verbatim transcripts were thematically analyzed. We used multivariate linear models to evaluate program acceptability and appropriateness by COVID-19 testing modality and mixed qualitative and quantitative findings for interpretation.ResultsQuestionnaire respondents closely matched school demographics (> 80% Hispanic/Latino and 8% Filipino/Asian Pacific Islander). While both testing modalities were rated as highly acceptable and appropriate, at-home testing was consistently favorable. Qualitative findings provided actionable areas for at-home testing program refinement, guiding district-wide scale up including: maintaining a learning climate to accommodate modifications as guidelines changed, needs of the school community, and implementation challenges; ensuring an engaged school leadership and sufficient human resources; improving educational communication about COVID-19 and technology ease of use; and increased time for pre-implementation planning and engagement.ConclusionsResults underscore the value of the CFIR to inform program implementation, particularly programs to reduce disparities during a public health emergency. Results support optimal testing implementation strategies centering the needs and perspectives of Hispanic/Latinos.

Medical students as teachers: impact of peer-led teaching sessions on NBME exam performance

Introduction/BackgroundPeer-led teaching sessions (PLTS) supplement conventional medical education, allowing students to share knowledge effectively. PLTS have shown significant academic benefits for student instructors. However, the impact on attendees, especially concerning NBME-style examinations, remains underexplored.MethodsThis study analyzed de-identified data from 67 first-year medical students at Kirk Kerkorian School of Medicine, divided into PLTS attendees (study group) and non-attendees (control group) based on session participation. Data were collected before two NBME examinations, with attendees defined as those attending at least five Peer-led teaching sessions. Academic performance was measured using NBME Customized Assessment Services (CAS) exam scores. Statistical analyses, including p-tests, chi-square, and t-tests, assessed differences in performance and potential biases based on MCAT scores, first-generation status, and socioeconomic background.ResultsThe study group initially had 26 students, and the control group had 31 students. Post-first examination, the study group adjusted to 22 students, and the control group to 35 students. MCAT scores and demographics showed no significant differences between groups. The first examination revealed a significant higher score in PLTS attendees’ scores (4.28% increase, p = 0.036), indicating a positive impact of PLTS on basic science knowledge. The second examination on organ systems physiology showed no significant difference (p = 0.722).DiscussionPLTS effectively enhance foundational science understanding but may be less impactful for advanced topics. The diminishing effect may result from increased use of diverse study resources and adaptation to medical school. Future research should explore long-term benefits, optimal implementation strategies, and the impact of instructor quality and engagement. Therefore, the overall conclusion is that PLTS positively influence NBME-style exam performance in early medical education, but benefits decrease over time.

The effect of functional exercise program on physical functioning in older adults aged 60 years or more: A systematic review and meta-analysis of randomized controlled trials

In this systematic review and meta-analysis, we assessed the impact of functional exercise training on physical functioning parameters in older adults 60 years and older. Databases including PubMed, MEDLINE, CINAHL, SPORTDiscus, and Cochrane Library were systematically searched. Sixteen articles were included. Meta-analysis demonstrated that functional training significantly improved Barthel index (p = 0.01), gait speed (p = 0.002), gait cadence (p = 0.0002), Berg Balance Scale (p = 0.0003), Timed Up and Go test (TUG; p = 0.02), step length (p < 0.0001), Five Chair Stand (p < 0.0001) and physical activity questionnaire for the older adults score (p < 0.00001). However, hand grip strength remained unchanged. These findings underscore the significance of incorporating functional exercises in interventions for healthy aging and maintaining independence among older individuals. Further investigation is needed to explore long-term effects and optimal implementation strategies for functional exercise regimens in this populations.

VIRTUAL FLIPPED CLASSROOM FOR DEVELOPING EFL STUDENTS’ SPEAKING SKILLS: DESIGN AND IMPLEMENTATION

developing speaking skills due to limited classroom time and cultural tendencies towards passive learning. This study investigated the effectiveness of a virtual flipped classroom in addressing these challenges and enhancing EFL students' speaking abilities. The research involved 40 Indonesian university students, divided equally into experimental and control groups. The experimental group participated in a virtual flipped classroom, completing pre-class online activities and engaging in in-class speaking exercises, while the control group received traditional instruction. Pre- and post-tests assessed speaking skills, supplemented by student surveys. Results revealed significantly higher post-test scores in the experimental group compared to the control group. Furthermore, survey data indicated that students perceived the virtual flipped classroom as effective in promoting active learning and enhancing their speaking skills. This approach shows promise in overcoming cultural barriers to active participation and maximizing limited class time for speaking practice in Indonesian EFL contexts. However, further research is needed to explore long-term effects and optimal implementation strategies across diverse EFL settings.

Analysis of an Accurate Iterative Technique with Attenuation Compensation in Planar Laser Induced Fluorescence

Abstract Iterative techniques in Planar Laser Induced Fluorescence (PLIF) evaluations are theoretically analysed. Correction for laser light attenuation is also incorporated in the analysis. Conditions for the convergence of the results and the scalings for the errors are derived. The results are validated against experiments. It is shown that the optimal strategy for implementation of iterative PLIF evaluation with attenuation correction is on the ensemble mean of the fluorescence field. Compared to the implementation with instantaneous fluorescence images, this approach is not only far more efficient computationally, but also is assured to converge monotonically and extremely rapidly, with minimal errors. This is suggested to be a viable and useful technique for PLIF in general, but especially for cases where a reference cell is unfeasible for explicit attenuation correction.

Effectiveness of a 12-week combining tai chi and yoga program on pulmonary function and functional fitness in COPD patients

Chronic obstructive pulmonary disease (COPD) poses significant challenges to both patients and healthcare providers due to its progressive nature and adverse impact on respiratory function and quality of life (QoL). While pulmonary rehabilitation remains a cornerstone of non-pharmacological COPD management, additional interventions are needed to address patients' diverse needs and preferences. This study investigated the feasibility and potential benefits of a 12-week combining Tai Chi and Yoga (TY combining) program on cardiorespiratory and lung functions, functional fitness, and QoL in older males diagnosed with COPD. Twenty-four male COPD patients (age: 70±6 years) with moderate to severe disease were recruited and randomized into the TY combining group (n=12) or control group (n=12). Assessments were conducted at baseline and at week 12, including pulmonary function tests, quality of life measures, dyspnea, and fatigue. Functional fitness tests were assessed at baseline, week 4, week 8, and week 12. The TY combining program significantly improved pulmonary functions, functional fitness, quality of life, and fatigue over the 12-week intervention period. Notably, improvements in functional fitness parameters were observed after just four weeks of training, emphasizing the rapid benefits of the intervention. Moreover, the program exhibited high safety and feasibility, with no reported complications. The 12-week TY combining program represents a safe, feasible, and effective adjunctive therapy for COPD management in older male patients. By addressing multiple dimensions of health and functioning, including pulmonary and cardiovascular health, functional fitness, and quality of life, this holistic approach holds promise for optimizing outcomes in COPD patients. Further research is warranted to validate these findings and explore optimal implementation strategies in clinical practice.

Spatial targeting and integration across vaccination, vitamin A and deworming programs throughout India 2019-21.

Currently, most large-scale public health programs, such as immunization or anti-parasitic deworming, work in relative isolation. Integrating efforts across programs could potentially improve their efficiency, but identifying populations that could benefit from multiple programs has been an operational challenge. We analyzed a nationally representative survey conducted in India between 2019 and 2021 to assess and map coverage of seven vaccines [Bacillus Calmette-Guérin (BCG), hepatitis B, polio, diphtheria-tetanus-pertussis (DTP), haemophilus influenza type b (Hib), rotavirus and measles-containing vaccine (MCV)], plus Vitamin A supplementation and anti-parasitic deworming treatment among 86761 children aged 1-3 years old. National coverage varied widely by program, from 42% (rotavirus) to 95% (BCG). There was high correlation between district-level coverage estimates (r ≥ 0.7) and extensive spatial overlap in low-coverage populations. In simulated implementation strategies, we show that an integrated strategy that targets full immunization coverage for four core vaccines (BCG, polio, DTP, MCV) would achieve similar coverage to an optimal (but unrealistic) implementation strategy and far better coverage than multiple efforts focused on individual vaccines. Targeting the most under-vaccinated districts within states based on spatial clustering or coverage thresholds led to further improvements in full coverage per child targeted. Integration of anti-parasitic deworming or rotavirus vaccination into a core vaccine delivery mission could nearly double their coverage (from ∼45% to ∼85%). Integrated delivery and geographic targeting across core vaccines could accelerate India's progress toward full immunization coverage. An integrated platform could greatly expand coverage of non-core vaccines and other child health interventions.

Contextual factors associated with successful alcohol screening and brief intervention implementation and sustainment in adult primary care

Hazardous drinking is a public health problem affecting approximately 20% of the U.S. primary care population. Clinical trials have documented the efficacy and effectiveness of Alcohol Screening and Brief Intervention (ASBI), yet widespread implementation remains elusive, and questions remain regarding optimal implementation and sustainment strategies. Kaiser Permanente Northern California (KPNC) implemented systematic ASBI in adult primary care in mid-2013. We used 8years of electronic health record (EHR) data, combined with surveys which captured primary care provider perceptions organized into PRISM (Practical, Robust Implementation and Sustainability Model) implementation framework domains (Intervention, External Environment, Implementation Infrastructure, and Recipients), to characterize ASBI implementation and sustainment and test how various factors are associated with ASBI rates. Using EHR data, we calculated yearly screening rates of adults with a primary care visit, and brief intervention (BI) rates among those with a positive hazardous drinking screen, (exceeding the age and sex-specific daily and weekly low-risk NIH guidelines (≤3 per day and≤7 per week for women and older men; ≤4 per day and≤14 per week for men 18-65)), across KPNC, from 2014 to 2021. We collected web-based survey data, informed by the PRISM domains, from primary care providers (n=796; 35.5% RR) to assess perceptions on ASBI implementation and sustainability. Between 1/1/2014 and 12/31/21 there were 5,072,270 completed screenings and 624,167 BIs. After adjusting for patient panel characteristics, we found that facilities with higher Implementation Infrastructure domain scores, indicating more robust implementation capacity, had higher screening and BI rates; facilities with higher Intervention domain scores, indicating positive perceptions of SBIRT evidence, and facilities with higher Recipients domain scores, indicating perceived organizational robustness, clinician culture and management support; and greater perceived patient needs and their likely benefit from SBIRT, had higher BI rates. Results provide information on factors which may facilitate successful ASBI implementation and sustainability and could inform future ASBI implementation efforts in healthcare system settings. In particular, efforts toward bolstering an organization's implementation infrastructure capacity, prior to embarking on implementation of a systematic ASBI program, could potentially help pave the way for successful implementation.

Meningkatkan Hasil Belajar Peserta Didik Melalui Metode Problem Based Learning pada Peserta Didik Kelas 2 Fase A SD Mardi Waluya Cibinong

At Elementary School Mardi Waluya Cibinong, it was found that the critical thinking ability and learning achievement targets of Catholic Religious Education especially in grade 2 were not optimal. This could be due to the use of less varied learning methods and the less optimal implementation of strategies that encourage active student participation. This research aims to improve the character dimension of critical thinking and student achievement targets by applying the Problem-Based Learning method in phase A of especially in grade 2. This classroom action research was conducted in two cycles with materials on the safety of God’s work through Kain and Habel, with each cycle consisting of four stages: planning, implementation, evaluation, and reflection. The research subject is students from Elementary school Mardi Waluya Cibinong with a total of 34 peoples. The results of the research show that the use of the PBL learning model can increase the character dimension of critical thinking in the Pancasila student profile (P3) from 70% to 84%. There was also an increase in student achievement outcomes, with mastery increasing from 20% to 68%, proficiency from 50% to 32%, and a decrease in appropriateness from 18% to 0%, which then increased to 12%. This indicates a significant decrease in the critical thinking dimension of the Pancasila students profile, which overall improves the critical thinking process and students achievement in grade 2 phase A. Recommendation: Teachers can focus on one dimension of P3 in the character development process by applying problem-solving learning methods.

Effectiveness of Mirror Therapy, Electrical Stimulation, and CIMT in Restoring Upper Extremity Function after Stroke

Objective: This study aimed to compare the effectiveness of mirror therapy (MT), electrical stimulation (EMS) combined with MT, and Constraint-Induced Movement Therapy (CIMT) in improving upper extremity function among stroke survivors. Methodology: A randomized controlled trial was conducted involving n=45 stroke patients undergoing rehabilitation at Wah International Hospital. The inclusion criteria for the study required participants to be above 45 years of age, to have survived either an ischemic or haemorrhagic stroke, and to have at least 10° wrist extension. Participants were excluded if they had an implanted electrical device such as an artificial pacemaker, paresis instead of paralysis, hemiplegia due to causes other than ischemic or haemorrhagic stroke (such as trauma, tumor, or coordination problems), or impaired sensory integration. Participants were divided into three groups: EMS combined with MT, CIMT alone, and Mirror therapy alone. Treatment sessions were administered four times a week for three months. Outcome measures included the Fugl-Meyer Assessment Scale (FMA) and Motor Assessment Scale (MAS). Results: Analysis revealed significant improvements in upper extremity function across all groups. However, the CIMT group exhibited the most substantial enhancement, with a mean difference of -68.5 (p &lt; 0.05) on the FMA and -24.1 (p &lt; 0.05) on the MAS compared to the other groups. Conclusion: The findings highlight the superior efficacy of CIMT in improving upper extremity function among stroke survivors. Incorporating CIMT into rehabilitation protocols is crucial for optimizing outcomes in this patient population. Further research is warranted to explore the long-term benefits and optimal implementation strategies of CIMT in diverse rehabilitation settings

Using Duolingo in Teaching and Learning Vocabulary: A Systematic Review

This systematic review examines the extant literature on the efficacy of the Duolingo application for vocabulary development in instructed second language (L2) contexts. Drawing on several empirical studies, the review synthesises findings related to (a) the comparative effectiveness of Duolingo versus traditional pedagogies, (b) the impact of Duolingo on learner motivation and engagement, and (c) practical implications for classroom integration. While the majority of evidence attests to measurable gains in receptive vocabulary knowledge, the findings must be interpreted with caution due to methodological limitations, including small sample sizes, short intervention periods, and construct underrepresentation. The motivational appeal of Duolingo's gamified interface emerges as a prominent theme, corroborated by self-report data. However, the limited research employing psychometrically robust motivational measures precludes definitive conclusions about the temporal stability and transferability of this motivational effect. Theoretically, the provision of individualised feedback aligns with interactionist theories, yet the restricted opportunities for the negotiation of meaning raise doubts about the depth of lexical engagement. Pedagogically, the reviewed studies advocate the careful integration of Duolingo as a supplementary tool within formal instructional contexts. However, optimal implementation strategies remain unspecified, necessitating further classroom-based research employing mixed-methods designs. Significant gaps are identified, including the lack of investigations into the differential impacts of Duolingo's features, vocabulary transfer to authentic communication, and the development of self-regulated learning strategies.

Towards circular manufacturing systems implementation: An integrated analysis framework for circular supply chains

Towards circular manufacturing systems implementation: An integrated analysis framework for circular supply chains

Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory

BackgroundIn low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Education (PACE), an adaptive learning program to enhance provider competency in Tanzania’s guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal implementation strategies in LMIC settings are unknown.Objectives(1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential.MethodsMixed-methods study involving healthcare providers at three facilities. Quantitative data was collected using the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs).ResultsEighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrating that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study’s focus on PACE’s initial implementation.ConclusionThis study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation. Furthermore, the study underscores the value of the NPT as a framework for guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.

Strategies for Implementing GlobalConsent to Prevent Sexual Violence in University Men (SCALE): Study Protocol for a National Implementation Trial.

Globally, women 15-24 years are at heightened risk of sexual violence victimization, a risk factor for adverse mental, physical, and behavioral health outcomes. Sexual violence is common at universities and most often perpetrated by men, yet few evidence-based prevention strategies targeting men have been tested in low- and middle-income countries. GlobalConsent is a six-module, web-based educational program adapted from an efficacious U.S.-based program. Nine months post-treatment in a randomized trial in Vietnam, GlobalConsent reduced men's sexually violent behavior (Odds Ratio [OR] = 0.71, 95%CI 0.50-1.00) and increased prosocial intervening behavior (OR = 1.51, 1.00-2.28) relative to an attention-control. Evidence regarding optimal implementation strategies for scale up is needed. We will randomize six medical universities in North, Central, and South Vietnam to deliver GlobalConsent using two different packages of implementation strategies that vary in intensity. Higher-intensity strategies will include greater 1) pre- and post-implementation engagement with university leaders and faculty, and 2) greater pre-implementation outreach, follow-up, and incentives for students to promote engagement and completion of GlobalConsent. Higher intensity universities will receive additional training and support for their added activities. We will compare implementation drivers and outcomes, intervention effectiveness, and cost-effectiveness across the two implementation bundles. Our mixed-methods comparative interrupted time-series design includes 1) qualitative interviews and quantitative surveys with university leaders and implementation teams to assess implementation barriers and facilitators; 2) repeated surveys with leaders and faculty, implementation teams, and male students to assess multilevel implementation drivers and outcomes, 3) repeated surveys with male students to assess behavioral outcomes (sexual violence and intervening behavior) and mediating variables (knowledge, attitudes, affect, and capacities), and 4) time diaries and cost tracking to assess cost effectiveness of the two implementation-strategies bundles. This project is the first to assess packages of implementation strategies to deliver an efficacious web-based sexual-violence-prevention program for undergraduate men across all regions of Vietnam and synergizes with a violence-prevention training initiative (D43TW012188). This approach will produce rigorous evidence about how to disseminate GlobalConsent nationally, which holds promise to reduce gender-based health inequities linked to sexual violence as GlobalConsent is brought to scale. NCT06443541. Retrospectively registered with clinicaltrials.gov.

Analysis of Interactive Educational Puzzle Media to Improve Elementary School Students' English Language Skills

This study aims to analyze the effectiveness of interactive edugame puzzle media in improving English language skills of primary school students. The method used is a literature study that reviews various literature and previous research results related to using interactive learning media, especially edugame puzzles, in learning English at the primary school level. The results of the analysis show that interactive edugame puzzle media has significant potential to improve students’ English language skills, especially in the aspects of vocabulary, grammar, and reading comprehension. Factors contributing to this media’s effectiveness include interactive elements, immediate feedback, and fun aspects that increase students’ learning motivation. However, effective implementation requires careful design and support from teachers. This study concludes that interactive edugame puzzle media can be a valuable tool in English language learning in primary schools, with recommendations for further research into optimal design and implementation strategies in different learning contexts.

Evaluating Case-Based Learning to Enhance Dental Student Performance in Cavity Preparation: A Pilot Study.

Background The transition from theoretical knowledge to clinical competency in operative dentistry is an ongoing challenge in dental education. Undergraduate students often face a significant gap between understanding theory and applying practical skills for diagnosing and preparing cavities, which leads to decreased confidence, increased stress, and potential errors in clinical practice. Case-based learning (CBL), an active learning strategy that emphasizes real-world scenarios, has shown promise for improving clinical skills and knowledge retention in other healthcare disciplines. This pilot study explored the potential of CBL to address the theory-practice gap and enhance confidence among undergraduate dental students in performing cavity preparations. Methods This pilot study utilized a pre and post-intervention design and involved 30 second-year dental students. Participants completed confidence surveys at three points: before CBL activity, immediately after CBL activity, and following their first clinical cavity preparation procedure. The CBL activity consisted of two components: interactive case discussions and hands-on laboratory exercises designed to simulate real-world dental procedures. The interactive discussions focused on diagnostic and treatment planningwhile laboratory exercises provided practical experience in cavity preparation. Data were analyzed using repeated-measures analysis of variance (ANOVA) to assess the changes in confidence levels across the three survey points. Results CBL significantly increased students' confidence across multiple dimensions (p < 0.05). Confidence in modifying cavity preparations increased from a mean of 2.91 (SD = 0.292) before CBL to 5.12 (SD = 0.331) post-CBL and further to 5.52 (SD = 0.556) after clinical practice. Similarly, confidence in understanding the basic concepts of caries removal improved from 4.82 (SD = 0.528) pre-CBL to 5.45 (SD = 0.564) post-CBL, and to 5.61 (SD = 0.556) post-clinic. However, confidence in performing cavity preparations without faculty guidance remained relatively low, increasing from a baseline mean of 2.67 (SD = 0.478) to 2.91 (SD = 0.384) post-CBL and 3.64 (SD = 0.603) post-clinic. Conclusion Incorporating CBL into the curriculum can significantly improve undergraduate students' confidence in performing cavity preparation. This approach may help bridge the theory-practice gap and better prepare students for the clinical environment. This pilot study provides promising initial data, and further research is needed to determine the long-term impact of CBL and the optimal implementation strategies.

S14 Physical activity promotion in healthcare settings: Designing and implementing physical activity referral schemes

Abstract Purpose This symposium will share findings, expertise and experiences from different countries on the design and implementation of physical activity referral schemes (PARS). Description Physical activity promotion by healthcare professionals is a key strategy to increase population physical activity levels. This strategy has been outlined in the World Health Organisation’s (WHO) ‘Global Action Plan on Physical Activity’ (GAPPA) and the ‘Physical activity strategy for the WHO European Region 2016-2025‘. PARS are a promising intervention that allow healthcare professionals to advocate for physical activity and integrate its promotion into routine clinical care. PARS are a heterogeneous group of interventions. Simpler PARS, for example, may consist only of a written description, while more complex PARS might include different healthcare professionals working together systematically, applying several behaviour change techniques in combination with physical activity practice, to connect patients to community resources. There is currently no consensus on the optimal PARS approach and implementation strategies. Implementers need specific knowledge, skills and methods; however, implementation is also influenced by structural and context-related factors in the healthcare system. Accordingly, a successful implementation of PARS needs co-productive capacity building within healthcare systems and proper support for healthcare professionals. The symposium includes four contributions (3 research-oriented and 1 practise-oriented) related to the design and implementation of PARS in different countries. 1) EUPAP Feasibility Study. Practice transfer of a HEPA prescription model to other nine EU countries. From theory to practice. Sebastià Mas-Alòs 2) The association of physical activity referral scheme’ components with physical activity level, scheme uptake and adherence rates: a systematic review, meta-analysis with meta-regression. Wolfgang Geidl 3) The adoption and implementation of a physical activity referral pathway integrated into a major U.S. health system. Mark Stoutenberg 4) Designing a physical activity pathway in healthcare model for Irish Health Services. Sarah O’Brien This symposium will provide guidance on the development of PARS and future successful implementation in other healthcare settings.