Preliminary Impact Research Articles

Targeting Patients' Cognitive Load for Telehealth Video Visits Through Student-Delivered Helping Sessions at a United States Federally Qualified Health Center: Equity-Focused, Mixed Methods Pilot Intervention Study.

The task complexity involved in connecting to telehealth video visits may disproportionately impact health care access in populations already experiencing inequities. Human intermediaries can be a strategy for addressing health care access disparities by acting as technology helpers to reduce the cognitive load demands required to learn and use patient-facing telehealth technologies. We conducted a cognitive load theory-informed pilot intervention involving warm accompaniment telehealth helping sessions with patients at a Federally Qualified Health Center (FQHC). We demonstrate how to design and report recruitment methods, reach, delivery process, and the preliminary impact of a novel equity-focused intervention. Early into the COVID-19 pandemic a telehealth helping session was offered to patients at FQHC via phone. Graduate students led the sessions on conducting a telehealth video test run or helping with patient portal log-in. They systematically recorded their recruitment efforts, intervention observations, and daily reflection notes. Following the intervention, we asked the intervention participants to participate in an interview and all patients who had telehealth visits during and 4 weeks before and after the intervention period to complete a survey. Electronic health records were reviewed to assess telehealth visit format changes. Descriptive and inferential statistical analyses of the recruitment records, electronic health record data, and surveys were performed. Through integrative analysis, we developed process-related themes and recommendations for future equity-focused telehealth interventions. Of the 239 eligible patients, 34 (14.2%) completed the intervention and 3 (1.2%) completed subsequent interviews. The intervention participants who completed the survey (n=15) had lower education and less technological experience than the nonintervention survey participants (n=113). We identified 3 helping strategies for cognitive load reduction: providing step-by-step guidance for configuring and learning, building rapport to create confidence while problem-solving, and being on the same page to counter informational distractions. Intervention participants reported increased understanding but found that learning the video visit software was more difficult than nonintervention participants. A comparison of visit experiences did not find differences in difficulty (cognitive load measure) using telehealth-related technologies, changes to visit modality, or reported technical problems during the visit. However, the intervention participants were significantly less satisfied with the video visits. Although a limited number of people participated in the intervention, it may have reached individuals more likely to need technology assistance. We postulate that significant differences between intervention and nonintervention participants were rooted in baseline differences between the groups' education level, technology experience, and technology use frequency; however, small sample sizes limit conclusions. The barriers encountered during the intervention suggest that patients at FQHC may require both improved access to web-based technologies and human intermediary support to make telehealth video visits feasible. Future large, randomized, equity-focused studies should investigate blended strategies to facilitate video visit access.

A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol

BackgroundPediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families’ access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children’s and caregivers’ acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data.MethodsIn our 2.5-year study, 108 6–17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families’ barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive.DiscussionOur trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition.Trial registrationThis trial was registered prospectively at ClinicalTrials.gov (#NCT05403658; first posted: June 3, 2022).

Feasibility and Preliminary Impact of a Community-Based Intervention for Maternal PTSD and Parenting: Parenting-STAIR Pilot.

Trauma exposure and post-traumatic stress disorder (PTSD) impact emotional and physical well-being, social functioning, and parent-child relationship quality. The effect of parental trauma on parenting and child maltreatment is often overlooked by current child welfare (CW) services. The novel intervention, Parenting-STAIR, was created to address maternal mental health, parenting skills, and child well-being outcomes. Parenting-STAIR is a combination of Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy and Parent-Child Care (PC-CARE). This open pilot study aimed to examine the feasibility and preliminary impact of Parenting-STAIR in reducing maternal PTSD and increasing positive parenting skills for mothers and families involved in the child welfare system. Parenting-STAIR was delivered to 111 mothers receiving family preservation services in New York City. Of these, 70 completed treatment; statistical and clinically significant changes were observed for maternal PTSD and depression as well as in parenting stress, parenting skills, and child behaviors. These findings provide encouraging initial evidence for the feasibility and impact of this novel PTSD intervention. An evaluation of maltreatment recidivism is needed, as well as implementation of a randomized controlled trial to establish efficacy of the intervention.

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The article describes the provisions of regulatory legal acts that define the principles of normative and legal, service and combat application of the Kubotan technique by the servicemen of the National Guard of Ukraine for performing the task of protecting public safety and order. The analysis of regulatory legal acts and subordinate regulatory documents governing the list of special means, is carried out that are used by military personnel of the National Guard in the performing of official tasks and the rules for the use of special means by servicemen of the National Guard in the performance of authorised tasks in general and for the protection of public safety and order in particular. The legal essence and formation of the Kubotan, the characteristics and parameters of the Kubotan, the purpose and types of the Kubotan, and the technique of using the Kubotan by the servicemen of the National Guard of Ukraine to perform the task of protecting public security and order are described. The author defines the prohibition of the use of special means of Kubotan against women with obvious signs of pregnancy, minors, persons with obvious signs of disability or old age, except in cases of armed or group attack, armed resistance to a serviceman of the National Guard of Ukraine, threatening his life and health and/or other persons, if it is impossible to repel such attack or resistance by other means. The servicemen of the National Guard of Ukraine are required to undergo special training and periodic testing of their ability to perform actions related to the use of the special means of the Kubotan and to provide first aid to victims. The use of Kubotan as a special means, the time of start and the intensity of its use shall be determined taking into account the current circumstances, the nature of the offence and the personality of the offender. When on duty as part of a group, the decision to use special means is taken by a duly appointed official responsible for ensuring public safety and order, or by the head of the operation or the commander of the relevant military unit (subdivision, group) of the National Guard of Ukraine. Servicemen acting individually shall make such decisions on the use of Kubotan independently. It is concluded that it is advisable to use the Kubotan technique by the National Guard of Ukraine to perform the task of protecting public safety and order if other forms of preliminary impact on offenders have not yielded the desired results.

Assessing the Risk of Damages by Wild Boars (Sus Scrofa) in Italian Apennines. Preliminary Report

Wildlife, particularly wild ungulates, has experienced a significant demographic increase throughout Europe, especially in the last 30 years. The objective of this study was to create a preliminary impact map of wild boars (Sus scrofa) in the Molise region of the Italian Southern Apennines, and their correlation with road accidents. A GIS software was used to process a map, and the impact of wild boars was categorized based on land use. An analysis of the environmental characteristics of the neighboring raster was conducted, considering the presence of roads, particularly with respect to accident events. The georeferenced damages were superimposed onto the impact risk map. The geo-referenced damages caused by wild boars indicate that they are primarily concentrated in areas where road accidents have occurred and where there is a high risk of impact. These maps serve as a valuable starting point for managing wild boars in the region by optimizing strategies from technical and economic perspectives. This process must include population control by evaluating the Annual Useful Increase index (IUA), based on processes related to birth-immigration and mortality-emigration of the species.

THE IMPACT OF A DIGITAL CANCER SURVIVORSHIP PATIENT ENGAGEMENT TOOLKIT ON OLDER CANCER SURVIVORS’ HEALTH OUTCOMES

Abstract Cancer is a disease that predominantly affects older adults. The median age at diagnosis is 66 years and 62% of the 15.5 million American cancer survivors are age ≥65 years. Provision of supportive care after treatment is critical to this group due to their complex care needs; however, limited resources are available to them. As increasing numbers of older survivors adopt technology, digital health programs have significant potential to help them improve their health and communicate with their providers. Previously, we developed/tested a digital Cancer Survivorship Patient Engagement Toolkit program for older adults, CaS-PET Silver. The aim was to examine the preliminary impact of CaS-PET Silver on older survivors’ health outcomes. This was a 2-armed RCT with two observations (baseline, 8 weeks) on a sample of 60 survivors age ≥65 years (mean age, 70.1±3.8), who were treated with curative intent within 12 months from enrollment (02/2020-01/2022, COVID-19 pandemic). Outcomes included health-related quality of life (HRQoL), self-efficacy for coping with cancer, symptom burden, health behaviors, and patient-provider communication. Data were analyzed using descriptive statistics, linear mixed models, and content analysis. The majority of participants were black (68.3%, n=41) and female (56.6%, n=34). At 8 weeks, CaS-PET Silver group showed significantly improved physical HRQoL (p < .001, ES=0.64) and symptom burden (p=.053, ES= -0.41). Self-efficacy (ES=0.56), mental HRQoL (ES=0.26), and communication (ES=0.40) showed a tendency to improve. Most participants reported benefits from the program on health management (mean, 19.41±2.6 [3–21]). Further research is needed with larger, diverse older cancer populations.

Acceptability, feasibility and preliminary impact evaluation of a pilot text-message study on improving the health of Aboriginal people with, or at risk of, chronic disease in Australia.

Aboriginal people experience higher rates of chronic disease than other Australians, largely due to modifiable risk factors. This study aimed to evaluate the acceptability, feasibility and preliminary impact of a pilot text-message program on improving the health of Aboriginal people with, or at risk of, chronic disease. A before and after study using a convenience sample of Aboriginal Australian adults determined the impact of a 6-month healthy lifestyle text-message intervention on lifestyle behavioural measures including nutrition, physical activity and smoking. Process evaluation of participants and program facilitators determined program acceptability and feasibility. Twenty Aboriginal people enrolled in the study, with high study completion and program acceptability. The two program facilitators reported the low-cost automated text-message program to be highly acceptable, feasible to deliver and led to environmental program changes. Preliminary impact data showed significant improvements in vegetable consumption at 3 and 6months, but not for other health outcome measures. The text-message program was highly acceptable and feasible to deliver, and has potential as an adjunct to usual care. Further research is required to determine program efficacy with a larger sample size. SO WHAT?: Text-messages to improve the health of Aboriginal people are highly acceptable, feasible to deliver and can complement existing community-led group programs. Further testing of this low-cost program is warranted to determine program efficacy.

The Effect of Robot-Led Distraction during Needle Procedures on Pain-Related Memory Bias in Children with Chronic Diseases: A Pilot and Feasibility Study.

The current study evaluated the feasibility and preliminary clinical impact of robot-led distraction during needle procedures in children with chronic diseases on pain-related memories. Participants were 22 children (8-12 years old) diagnosed with a chronic disease (e.g., chronic immune deficiency) and undergoing a needle procedure as part of their routine treatment. Children were randomized to the experimental group (i.e., robot-led distraction) or control group (i.e., usual care). For feasibility, we evaluated study- and needle-procedure-related characteristics, intervention fidelity and acceptability, and nurse perceptions of the intervention. Primary clinical outcomes included children's memory bias for pain intensity and pain-related fear (1 week later). Results indicated that intervention components were >90% successful. Overall, the robot-led distraction intervention was perceived highly acceptable by the children, while nurse perceptions were mixed, indicating several challenges regarding the intervention. Preliminary between-group analyses indicated a medium effect size on memory bias for pain intensity (Hedges' g = 0.70), but only a very small effect size on memory bias for pain-related fear (Hedges' g = 0.09), in favor of the robot-led distraction intervention. To summarize, while feasible, certain challenges remain to clinically implement robot-led distraction during needle procedures. Further development of the intervention while accounting for individual child preferences is recommended.

Using synchronous thermal analysis to study characteristic features of a developing fire

Introduction. The purpose of the work is to estimate the temperature of impact on the material under study using the results of synchronous thermal analysis. This task is solved to achieve the pre-set purposes: studying the process of the thermal-oxidative destruction of the material under study, developing thermal impact assessment criteria, and deriving equations to determine the temperature of impact.Materials and methods. Specimens of ROTBAND gypsum finishing putty, frequently used for the interior decoration of walls of buildings and premises, have been studied. Before testing, putty samples were subjected to the preliminary thermal impact of 200, 300, 400, 500, 600, 700, and 800 °С for 30 min. The tests were carried out using the method of synchronous thermal analysis (Netzsch STА 449 F5 Jupiter) in corundum crucibles at a heating rate of 20 °С/min and with an air flow rate of 75 ml/min.Research results and discussion. Mass loss at a temperature of 200 °C and ash residue at a temperature of 900 °C can be expediently used as the criteria for assessing the temperature of impact on the gypsum putty using thermal analysis methods. Equations are obtained to calculate the temperature of impact on the gypsum putty composition according to the thermos-analytical characteristics of putty specimens. Conclusions. The study demonstrates that synchronous thermal analysis can be applied to determine the temperature of impact on the material under study, which is vital for the analysis of a developing indoor fire.

Enforcement of a Formal Conception of the Rule of Law as a Potential Way Forward to Address Backsliding: Hungary as a Case Study

The rule of law as a foundational value of European integration has been taken for granted in the Member States, along the presumption that “once a democracy, always a democracy”. This optimistic presumption proved to be wrong, when in the 2010s a top-down and systemic decline in the rule of law started, first in Hungary, then in Poland. Even though EU action against rule of law backsliding in the Member States is of existential importance for the whole European project, EU institutions seem to be either silent or too slow and inefficient when tackling the problem. In this paper we are focusing on the Court of Justice of the EU, which was emphasizing violations of a substantive understanding of the rule of law. Against this background we argue that adherence to a formal understanding or at the minimum incorporating arguments related to a formal concept of the rule of law would have been beneficial both in terms of speed and desired effect. Taking Hungary as an example we show that the lack of preliminary consultations and impact assessments during lawmaking, the enactment of significant legislative reforms in accelerated procedures without any adequate justification, the adoption of ad hominem laws, or the unclarity and unpredictability of legislation are all manifest violations of the formal understanding of the rule of law. There is significant potential in this approach that we believe the EU institutions have not exploited fully.

Development and implementation of a process safety competency development program (PSCDP) for process safety engineers: A unique collaboration between industry (SABIC) and academia (MKOPSC)

Process Safety Competencies are demonstrable knowledge,skills,behaviors and attitudes required to perform process safety related jobs. They are critical to the successful implementation of any process safety management program in the process industry.This paper shares the experience of the collaboration between a major multinational chemical manufacturing company, Saudi Basic Industries Corporation (SABIC) and an academic institution, the Mary Kay O'Connor Process Safety Center (MKOPSC) of Texas A&M University at Qatar (TAMU-Q) for the development and implementation of a comprehensive and long-term Process Safety Competency Development Program (PSCDP) for SABIC process safety engineers. It outlines the fundamental guiding principles and mechanism for building the PSCDP and provides a description of the structure and content of the program as well as its implementation in the 2017–2021 period. The preliminary results and impact of the program on the trainee engineers at SABIC are highlighted along with the benefit of engaging in such a program for both the company and the academic institution.

Multifaceted understanding of human nerve implants to design optimized electrodes for bioelectronics

Bioelectronic medicine is a promising venue for treatment of disabilities using implantable neural interfaces. Peripheral neurostimulation of residual nerves recently enabled multiple functional benefits in amputees. Despite the preliminary promising impact on patients' life, the over-time stability of implants and the related nerve reactions are unclear. To unveil the mechanisms and inform the design of better nerve-electrode interfaces, we engaged a multifaceted approach, merging functional responses from patients, their histological data, and corresponding computational modelling. Neurostimulation evoked different selective sensation locations and qualities over-time, with respective perceptual thresholds, that showed different degree of time stabilities dependent from the stimulating active sites. The histological analysis after explant showed mild tissue reactions, while electromechanically active sites and substrates remained conserved. Computational models, based on patients' histology, revealed the direct influence of the simulated tissue reaction to change of thresholds and type of perceived sensations. Novel insights of electrode biocompatibility was observed compared to animals and the increase of thresholds could be predicted computationally. This multifaced framework suggest that future intraneural implants should have easier implantation and higher biocompatibility counteracting the sensations changes through AI-based stimulations and electrode coatings.

Feasibility, Acceptability, and Preliminary Impact of Full-Body Interaction on Computerized Cognitive Training Based on Instrumental Activities of Daily Living: A Pilot Randomized Controlled Trial with Chronic Psychiatric Inpatients.

Objective: To conduct a pilot randomized control trial to assess the feasibility and acceptability of full-body interaction cognitive training (FBI-CT) inspired by instrumental activities of daily living in chronic psychiatric inpatients and to explore its preliminary impact on cognitive and noncognitive outcomes. Materials and Methods: Twenty psychiatric inpatients met the inclusion criteria and were randomly allocated to the FBI-CT group (n = 10) or the tablet-based CT group (T-CT) (n = 10). Neuropsychological assessments were performed at baseline, postintervention, and 3-month follow-up. Results: Both groups presented high completion rates at postintervention and follow-up. Participants reported high satisfaction following the interventions, with the FBI-CT group exhibiting slightly higher satisfaction. A within-group analysis showed significant improvements in the FBI-CT group for processing speed and sustained attention for short periods (P = 0.012), verbal memory (P = 0.008), semantic fluency (P = 0.027), depressive symptoms (P = 0.008), and quality of life (P = 0.008) at postintervention. At 3-month follow-up, this group maintained verbal memory improvements (P = 0.047) and depressive symptoms amelioration (P = 0.026). The T-CT group revealed significant improvements in sustained attention for long periods (P = 0.020), verbal memory (P = 0.014), and executive functions (P = 0.047) postintervention. A between-group analysis demonstrated that the FBI-CT group exhibited greater improvements in depressive symptoms (P = 0.042). Conclusions: Overall, we found support for the feasibility and acceptability of both training approaches. Our findings show promise regarding the preliminary impact of the FBI-CT intervention, but due to study limitations such as the small sample size, we cannot conclude that FBI-CT is a more effective approach than T-CT for enhancing cognitive and noncognitive outcomes of chronic psychiatric inpatients. Clinical trials (number: NCT05100849).

Evaluation of the influence of preliminary low-velocity impacts on the residual fatigue life of CFRP composites

PurposeThe main purpose of this study was to evaluate the mechanical behaviour of layered fibrous carbon-fibre reinforced plastic (CFRP) under complex low-speed bending and impact loads and subsequent cyclic tensile loads.Design/methodology/approachA comprehensive approach was adopted to study the damage accumulation processes using state-of-the-art testing and diagnostic equipment. In the course of the study, a microstructure analysis of damages caused by a transverse impact and cyclic tension was performed.FindingsA dependence of residual fatigue life of the studied composite material on the intensity of the preliminary impact bending was established. Temperature field distribution fields on the surface of the sample during tests were shown. Data on damage accumulation processes were presented, which were obtained during the registration of acoustic emission signals.Originality/valueA connection was established between changes of registered acoustic response signals and thermal imaging camera data, which was supported by the results of an experimental study. The results of the comprehensive approach showed a qualitative correlation.

Safety assessment of existing RC bridge piers subjected to vehicle impact

Impact accidents between bridges and vehicles have great randomness, and the threat of various vehicles to bridge structures is also different. In this case, the vehicle impact shall be regarded as a risk event from the perspective of economic and safety requirements, but current studies mainly focus on the deterministic analysis of bridges subjected to vehicle impact. For this reason, this work aims to establish a probability-based safety assessment method for existing reinforced concrete (RC) bridge piers against potential vehicle impact based on the reliability theory. Firstly, a simplified approach is developed for the preliminary impact hazard analysis of RC piers using the probability method, in which the vehicle type and impact probability are considered. Then, the shear and flexural responses of RC piers under vehicle impact are numerically investigated, and the corresponding limit state functions are determined. Furthermore, a procedure to assess the safety level of RC piers is proposed, including preliminary hazard analysis, reliability analysis, and safety evaluation. Finally, a case example of a bridge pier against vehicle impact is given to demonstrate the proposed safety assessment procedure. This method could provide a reference and basis for the anti-impact decision-making of bridge structures in their service period.

Implementation of a re-designed pre-departure training program for global health advanced pharmacy practice experiences

Background and purposeThis article describes the re-design and preliminary impact of a pre-departure global health training program for nine advanced pharmacy practice experience (APPE) sites. Educational activity and settingThe program was re-designed from a half-day orientation to a six-week (six-hour total) program. Students explored global health, cultural competency, adaptability, safety, and travel logistics. The program's impact on student learning was indirectly assessed using closed- and open-ended items on pre- and post-program surveys. Students reported self-perceived agreement with eight statements regarding travel logistics and 17 statements regarding global health. FindingsFifty-five students took the pre-course survey, and 47 students took the post-program survey for response rates of 100% and 85%, respectively. Students indicated significant change on 23 out of 25 statements, demonstrating meaningful improvements in agreement in both global health, logistics, and safety. Students were most interested in learning about travel logistics and healthcare information about their specific country upon entry into the program. At the conclusion of the program, students most often reported learning about cultural competency and adaptability. Most students reported no remaining questions. Course design, delivery, and assessment experience was provided for two academic postdoctoral fellows through the implementation of the re-designed program. SummaryStudents perceived improved understanding and comfort with global health concepts and travel logistics after the pre-departure program, despite the diverse nature of rotation sites covered. More research is needed to understand what impact a pre-departure training program has on the overall global health student experience.

The preliminary impact of sanctions on cooperation between Russia and the Republic of Korea

This paper analysis the preliminary impact of the international sanctions against Russia on economic cooperation between Russia and the Republic of Korea. The state of the Korean economy is considered as well. The emphasis is placed on challenges and opportunities that stem from the current international environment characterized by the restructuring of value-added chains, rising food and energy prices, growing geostrategic competition. Unfolding trends in the Russia-Korea trade are identified through the analysis of the trade data from KITA. The data show a sharp decline in Korea’s export to Russia while imports remained rather stable, however, this could be due to an inertia eff ect. Overall, trade is expected to fall through the rest of 2022 and remain low in 2023. On the investment front cooperation will remain limited due to fi nancial restrictions and Korea’s continuing strategic aligning with the West. Overall, Korea which is highly dependent on the state of the world economy will have to tackle infl ation and falling growth rates carefully otherwise it risks facing social and consumer debt issues domestically. At the same time, the Korean government will try to off set negative tendencies through a wider cooperation with Southeast Asian countries that so far are showing positive economic dynamics. Also, Korea will form closer technological cooperation with the US in an attempt to contain China technologically. Geopolitical repercussions of anti-Russian sanctions will likely lead to a strengthening regional role of Korea as it will foster cooperative ties with various strategic alliances including NATO. The country will have to keep a delicate balance to preserve its alliance commitments and no to antagonize China, its main economic partner.

Corpus-Aided Language Learning for Chinese EFL Learners

Effective language instruction is essential for ESL/EFL students’ language development and improvement. Language researchers, educators, and professionals have investigated the preliminary impact of input that has been purposefully maneuvered to implement language instruction. It seems that effective language instruction has been explored from teachers' perspectives. However, learners’ perceptions of language learning seem to be under-researched. For this reason, this study aims at exploring EFL learners’ perceptions of corpus-aided instruction through qualitative research. Thirty-seven Chinese EFL college students at a Midwestern university in the United States participated in this study. Writing conferences and interviews were collected and analyzed through thematic analysis. Findings showed that the Chinese EFL learners felt corpus-aided instruction was helpful in terms of two things: (1) clarifying logic and (2) organizing the structure in academic writing. However, they also reported some challenges in corpus-aided instruction. This study offers new insight into the usefulness of corpus-aided instruction by drawing much-needed attention to EFL learners' L2 writing development and improvement. Based on the preliminary findings, suggestions and implications are discussed.

Refining a Multicomponent Intervention to Increase Perceived HIV Risk and PrEP Initiation: Focus Group Study Among Black Sexual Minority Men.

BackgroundIncreased preexposure prophylaxis (PrEP) initiation is needed to substantially decrease HIV incidence among Black sexual minority men (BSMM). However, BSMM perceive others as PrEP candidates instead of themselves and are less likely than other groups to use PrEP if prescribed. Peers and smartphone apps are popular HIV prevention intervention tools typically used independently. However, they could be useful together in a multicomponent strategy to improve perceived HIV risk and PrEP initiation for this group. Information regarding attitudes and preferences toward this multicomponent strategy is limited.ObjectiveThe goal of this study is to obtain attitudes and perspectives regarding the design of a multicomponent intervention that uses a smartphone app and a peer change agent (PCA) to increase perceived HIV risk and PrEP initiation. The intervention will be refined based on thematic findings for a culturally responsive approach.MethodsData were obtained guided by life course theory and the health belief model using 12 focus groups and 1 in-depth interview among HIV-negative BSMM from Baltimore, MD, between October 2019 and May 2020 (n=39). Groups were stratified by the following ages: 18 to 24 years, 25 to 34 years, and 35 years and older. Participants were provided details regarding an existing mobile app diary to self-monitor sexual behaviors and a hypothetical PCA with whom to review the app. Facilitators posed questions regarding perceived HIV risk, attitudes toward the app, working with a PCA, and preferences for PCA characteristics and approaches.ResultsMost participants identified as homosexual, gay, or same gender-loving (26/38, 68%), were employed (26/38, 69%), single (25/38, 66%), and interested in self-monitoring sexual behaviors (28/38, 68%). However, themes suggested that participants had low perceived HIV risk, that self-monitoring sexual behaviors using a mobile app diary was feasible but could trigger internalized stigma, and that an acceptable PCA should be a possible self for BSMM to aspire to but they still wanted clinicians to “do their job.”ConclusionsHIV-negative BSMM have dissonant attitudes regarding perceived HIV risk and the utility of a mobile app and PCA to increase perceived HIV risk and PrEP initiation. Future research will explore the feasibility, acceptability, and preliminary impact of implementing the multicomponent intervention on perceived HIV risk and PrEP initiation among BSMM in a pilot study.

Comprehensive evaluation of fatigue damage accumulation and failure of specimens with operational stress concentrators

The paper presents the results of studying the mechanical behavior of laminated carbon-fiber-reinforced plastic under complex low-velocity impact three-point bending followed by cyclic tension. An integrated approach to studying damage accumulation patterns is implemented with the use of state-of-the-art testing and diagnostic equipment. The residual fatigue life of the composite is related to the intensity of preliminary impact bending. The fields of temperature distribution in the active zone of the samples during the tests are shown. Data on damage accumulation obtained by recording acoustic emission signals are presented. Relation of the change in the recorded acoustic response signals to infrared thermal scanning data has been detected, which is supported by the results of an experimental study. The use of additional equipment for infrared thermal scanning and recording of acoustic emission signals gives a complete picture of damage accumulation and failure in composite materials, with a good agreement with experimental data.