Primary Course Research Articles

Evaluation of a Point-of-Care Feline Immunodeficiency Virus (FIV) Test Kit (RapidSTATUS™ FIV) to Determine the FIV Status of FIV-Vaccinated and FIV-Unvaccinated Pet Cats in Australia.

Feline immunodeficiency virus (FIV) is a retrovirus that can cause immunosuppression, co-morbidities, and neoplasia in infected cats, and is commonly tested for in veterinary clinics and animal shelters in Australia. FIV diagnosis using point-of-care (PoC) kits to detect FIV antibodies in Australia is complicated by the commercial availability of an inactivated whole-FIV vaccine. The aim of this study was to determine the accuracy of the RapidSTATUS™ FIV antibody test kit in FIV-vaccinated and FIV-unvaccinated cats in Australia. Plasma from pet cats of known FIV vaccination and FIV infection statuses (n = 361), comprised of 57 FIV-uninfected cats annually vaccinated against FIV, 10 FIV-uninfected cats with lapsed FIV vaccination histories, 259 FIV-unvaccinated/FIV-uninfected cats, and 35 FIV-infected cats, was tested. RapidSTATUS™ FIV testing had sensitivity of 97.1% (34/35) and specificity of 100% (326/326), with an overall accuracy of 99.7% (360/361). Additional testing was undertaken using plasma from FIV-uninfected cats recently administered a primary FIV vaccination course (n = 12) or an annual booster FIV vaccination (n = 10). RapidSTATUS™ FIV was 98.8% (81/82) accurate and 100% (32/32) accurate in cats recently administered primary or annual FIV vaccinations, respectively. The high level of accuracy of RapidSTATUS™ FIV (98.8-100%) therefore establishes this PoC kit as a DIVA (differentiating infected from vaccinated animals) test. RapidSTATUS™ FIV is recommended to aid animal shelters, veterinarians, and researchers in Australia to accurately determine FIV infection status, irrespective of FIV vaccination history.

Envisioning nutrition teaching as a three-course meal: a blended approach to knowledge, application and assessment

ABSTRACT Medical students receive inadequate training in nutrition counselling, but the best way to teach this topic is unknown. To address this research gap, we developed a longitudinal blended programme – combining physical classroom experiences with online education – to teach nutrition counselling in a primary care clinical course. The learning experience comprised a pre-class online module to convey knowledge; a formative, ungraded standardised patient exercise on dietary modification to practise skills; and a written exam on nutrition knowledge and an Objective Structured Clinical Exam assessing nutrition counselling skills. We likened this three-part curriculum to a complete meal, with its self-paced online ‘appetiser’, in-class ‘entrée’ of clinical practice with patients, and ‘dessert’ of an assessment. We ascertained feasibility, discovered positive student reactions, and, via exam performance analysis, noted achievement of the learning objectives. This three-course meal model can be applied to any learning experience that teaches and assesses skills.

Preservice Teachers’ Views about the Use of Mind and Intelligence Games in Education

Games, which are fun activities, have some benefits for learning environments when used educationally; they play an essential role in children’s physical, mental, social, emotional, and language development. Similarly, mind and intelligence games can improve the cognitive abilities of individuals by improving their basic reasoning and problem-solving skills. This qualitative case study examines preservice teachers' views on the use of mind and intelligence games in education and their effects on individuals. Researchers collected the data using a semi-structured interview guide they developed, through focus group interviews with twenty-seven preservice teachers who were enrolled in and completed an elective course offered at the faculty of education in the fall of 2021. According to the findings, preservice teachers mentioned the advantages and disadvantages of mind and intelligence games according to the type of media. The findings showed that mathematics is a more appropriate course for using the mind and intelligence games, followed by primary school courses, psychological counseling, and social sciences courses. The preservice teachers found mind and intelligence games eligible to support primarily cognitive skills involved in remembering, understanding, applying, analyzing, evaluating, and creating. Furthermore, co-operation and sociability are the skills that were more frequently referred to by preservice teachers, along with other skills, including persistence, achievement motivation, and self-efficacy.

Tracking OAR Volume and DVH Variability in the Initial Cohort of Pelvic Patients Treated with CBCT-Guided, Online Adaptive Therapy

<h3>Purpose/Objective(s)</h3> We have recently commissioned and began treatment using a novel, CBCT-guided, online adaptive radiotherapy (ART) platform. We have evaluated the volumetric and dosimetric variation in our initial cohort of patients. <h3>Materials/Methods</h3> We have tracked our 6 initial online adaptive pelvis patients for 208 delivered fractions. A custom script was developed to extract volume and dosimetry data from our second check software. Target and organ-at-risk (OAR) volumes were gathered for every fraction. Structure volume variations were computed relative to the reference plan for each fraction and averaged per patient. Dose-volume histogram (DVH) data was collected for the primary treatment plan for our four prostate patients, all treated to 45 Gy in 25 fractions. The range of OAR DVH values at 20, 30, and 40 Gy and PTV V45 Gy over the primary course of each patient's treatment was computed for both scheduled and daily adapted plans. <h3>Results</h3> OAR variability was very patient dependent. Bladder volumes showed the largest variation, with most patients unable to replicate their bladder filling from simulation. Mean deviations in bladder volume ranged from -47% to +12%, with standard deviations >20% for two-thirds of patients. Rectal volume was also variable, but to a lesser extent, with mean variations ranging from -31% to +16%. DVH data demonstrates that ART produces a much tighter distribution of DVH curves compared to the scheduled plan for all structures while maintaining PTV coverage to within 1% of the reference value. The variability of V40Gy, V30Gy, and V20Gy showed reductions of 13.9%, 29.8%, 30.9% for bladder and 52.6%, 48.9%, and 24.6% for rectum relative to the scheduled plan, respectively. Using only the scheduled plan would result in reductions of up to 8% of target coverage compared to the reference plan. <h3>Conclusion</h3> We have observed considerable OAR interfraction volume variations during the course of pelvic radiation that can be highly patient dependent. Use of ART maintains adequate target coverage while reducing the variability in dose delivery to these nearby OARs. Combined with the large variability in OAR filling, we have demonstrated that ART enables clinicians to have a higher likelihood of delivering their intended doses to targets and OARs compared to standard-of-care radiotherapy.

Long-term immunity after HBV vaccine: shall we consider a change? A 20-year-follow-up study

Abstract Introduction Although vaccines against HBV have been available since the 1980s, the long-term immunity is still debated. When assessing immune persistence, a number of clearly defined variables must be taken into account. Often the expression ‘infant vaccination’ means the administration within the first year of life at any age, but a difference of a few months may imply a different antibody persistence over the years. This study assessed the anti-HBs titre 20 years after the primary vaccination course and estimated the effect of age at 1st dose and time interval between doses on long-term protection. Methods Data on age, sex and date of administration were collected. Inclusion criteria: born to negative mother, 3-dose schedule, no previous HBV infection, age at enrolment 18-24 years; age at 1st dose 2-12 months. Titres ≥10IU/l were considered protective. A logistic regression was performed, adjusting for sex, follow-up time and date of 1st dose and analysis. Results We included 5,485 participants (64% female). The mean anti-HBsAg increased from 46, 52, 85 to 193IU/l when the 1st dose was administered in the I, II, III or IV trimester of life, respectively. Similarly, the proportion of individuals with titre &amp;lt;10IU/l decreased from 51 to 18% between the two extreme quarters. The risk of a titre &amp;lt;10IU/l decreased with age at the 1st dose (AOR: 0.84; 95%CI: 0.78-0.91 per one-month increase) and time between the 2nd and 3rd doses (AOR: 0.89; 95%CI:0.85-0.94). Conclusions The mere presence of a titre &amp;lt;10IU/l does not equate lack of protection. However, antibody levels are very different depending on the actual age of vaccination. One-month delay within the first year is associated with a -18% chance of a titre &amp;lt;10IU/l 20 years later. Although this information needs to be combined with local epidemiology and surveillance to obtain an informed risk-benefit balance, the implications from a public health and economic perspective may be diverse and worth considering. Key messages • Still within the first year of life, a delay in the administration of the 1st dose of HBV vaccine and a longer time between the 2nd and 3rd dose imply a higher antibody persistence even 20 years later. • Considering the local circulation of HBV and surveillance, this result could be taken into account to obtain an informed risk-benefit balance.

Interprofessional Primary Care Course Impact on Knowledge, Attitudes, and Careers.

Our innovative, highly rated, interprofessional Primary Care Course (PCC) engaged learners in dentistry, medicine, nursing, physician assistants, pharmacy, public health, and social work. PCC used a low-resource, flexible classroom format, earned 99% high student ratings, and increased PC career plans in 56% of students. This study assessed changes in PC knowledge and attitudes and tracked PC career outcomes over 5 years. We conducted before-and-after surveys of PCC students at baseline, 1-year, and 5-year follow-up, using anonymous online surveys. An additional controlled study compared PCC students with similar students from the course waitlist. Surveys yielded responses from 100% (84) at baseline, 81% (68) at 1 year, 57% (48) at 5 years, and 34% (28/83) among waitlist students at year 5. Before-and-after matched pairs analyses documented significant increases at year 1, sustained through year 5, in knowledge of PC training and referral patterns and attitudes toward PC value and role in future US health care. Precourse, 56% of students planned PC careers. At year 5, PCC graduates reported working in PC (74%, 29/39), delivering direct PC patient care (48%, 19/39), and working with underserved communities (74%, 29/39). The PC knowledge and attitudes of waitlist students at year 5 were similar to PCC student baseline scores and were significantly lower at year 5. Only 27% (7/26) of waitlist students reported working in PC at year 5. PCC was associated with sustained increases in PC knowledge, attitudes, and careers across health professions. This low-resource, flexible format can contribute to building PC knowledge, attitudes, and workforce.

Review of an Initial Physician Assistant Training Program Orthopaedics Course Curriculum Using Kern's 6-Step Process

Graduating an average of 169 graduates per year, the Interservice Physician Assistant Program (IPAP) is the largest physician assistant training program in the world. The IPAP orthopedics course is a 4-credit hour course that started as approximately 60 hours of lecture, 9 hours of laboratory practice to prepare for an Objective Structured Clinical Examination, and 4 hours of splinting laboratory. After several cohorts performed poorly on the second block exam and student critiques voiced the need for course revision, the curriculum committee formed a sub-committee to review the course content and structure. The primary course instructor was familiar with Kern's 6-step approach to curriculum development and proposed using the Kern’s approach for the curriculum review and revision. This article aims to demonstrate the use of Kern's 6-step approach for review and revision of an introductory orthopedic course curriculum. This article shows how an IPAP curriculum sub-committee executed the 6 steps of the Kern’s process: (1) problem identification and general needs assessment, (2) targeted needs assessment, (3) development of goals and objectives, (4) development of educational strategies, (5) implementation, and (6) evaluation and feedback. To our knowledge, this is the first example of a physician assistant program using Kern's 6-step process to revise a curriculum. Thus far, the revisions show a positive change, indicating that other physician assistant programs could conduct similar reviews using the Kern’s 6-step approach.

FORMATION OF STRATEGIC COMPETENCES OF STUDENTS IN GERMAN AS A SECOND FOREIGN LANGUAGE

The article examines characteristic features of teaching strategic competence as a way to reduce the number of communicative failures. Strategic competence is one of the components of communicative competence and is defined as a set of verbal and non-verbal communication strategies that serve to compensate for gaps in communication. It involves planning further speech actions, including the ability to self-correct. The object of the study is the process of teaching foreign language strategic competence to students of primary courses. The subject of the research is the content, means, methods of forming communicative strategies of word use. The purpose of the study is to identify and select the most appropriate strategies of word use for educational purposes, as well as to develop a method of organizing the teaching of strategic competence in the initial courses of language faculties. The realization of this goal involves solving the following tasks: to determine the place and role of strategic competence in the structure of communication and to describe different approaches to its consideration; to analyze the peculiarities of the formation of foreign language strategic competence among elementary school students studying German as a second foreign language; to conduct experimental training in order to determine the dependence of the quantity and quality of communicative strategies on the organization of training; to develop a method of forming communicative strategies of word use and to reveal its effectiveness. Different types of communicative strategies are divided into reductive strategies (avoidance of the topic, avoidance of conveying the intended content), achievement strategies (compensatory strategies, switching to another code, verbatim retelling, replacement, paraphrase, explanation in other words, word creation, restructuring, direct or indirect question about help) and correction strategies (waiting, using the semantic field). After analyzing of the use dynamics of strategies by the students of the control and experimental groups, we found that the number of positive achievement strategies began to increase as students learned to use strategies. At the same time, the number of used reductive strategies decreased and reached minimum values in the last classes. The total number of used strategies first began to increase, then slightly decreased and stabilized at an average level (26.8 units), while the use of reductive strategies significantly decreased to minimum values, which is the result of teaching students the methodology of strategic competence and their application of strategies in practice when answering in lessons.

Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK).

BackgroundLittle is known about how demographic, behavioural, and vaccine-related factors affect risk of post-vaccination SARS-CoV-2 infection. We aimed to identify risk factors for SARS-CoV-2 infection after primary and booster vaccinations.MethodsThis prospective, population-based, UK study in adults (≥16 years) vaccinated against SARS-CoV-2 assessed risk of breakthrough SARS-CoV-2 infection up to February, 2022, for participants who completed a primary vaccination course (ChAdOx1 nCoV-19 or BNT162b2) and those who received a booster dose (BNT162b2 or mRNA-1273). Cox regression models explored associations between sociodemographic, behavioural, clinical, pharmacological, and nutritional factors and test-positive breakthrough infection, adjusted for local weekly SARS-CoV-2 incidence.Findings1051 (7·1%) of 14 713 post-primary participants and 1009 (9·5%) of 10 665 post-booster participants reported breakthrough infection, over a median follow-up of 203 days (IQR 195–216) and 85 days (66–103), respectively. Primary vaccination with ChAdOx1 (vs BNT162b2) was associated with higher risk of infection in both post-primary analysis (adjusted hazard ratio 1·63, 95% CI 1·41–1·88) and after an mRNA-1273 booster (1·26 [1·00–1·57] vs BNT162b2 primary and booster). Lower risk of infection was associated with older age (post-primary: 0·97 [0·96–0·97] per year; post-booster: 0·97 [0·97–0·98]), whereas higher risk of infection was associated with lower educational attainment (post-primary: 1·78 [1·44–2·20] for primary/secondary vs postgraduate; post-booster: 1·46 [1·16–1·83]) and at least three weekly visits to indoor public places (post-primary: 1·36 [1·13–1·63] vs none; post-booster: 1·29 [1·07–1·56]).InterpretationVaccine type, socioeconomic status, age, and behaviours affect risk of breakthrough infection after primary and booster vaccinations.FundingBarts Charity, UK Research and Innovation Industrial Strategy Challenge Fund.

Serological responses to Anthrax Vaccine Precipitated (AVP) increase with time interval between booster doses

We undertook a Phase 4 clinical trial to assess the effect of time interval between booster doses on serological responses to AVP. The primary objective was to evaluate responses to a single booster dose in two groups of healthy adults who had previously received a complete 4-dose primary course. Group A had received doses on schedule while Group B had not had one for ≥2 years. Secondary objectives were to evaluate the safety and tolerability of AVP booster doses, and to gain information on correlates of protection to aid future anthrax vaccine development. Blood samples were taken on Day 1 before dosing, and on Days 8, 15, 29 and 120, to measure Toxin Neutralisation Assay (TNA) NF50 values and concentrations of IgG antibodies against Protective Antigen (PA), Lethal Factor (LF) and Edema Factor (EF) by ELISA.For each serological parameter, fold changes from baseline following the trial AVP dose were greater in Group B than Group A at every time-point studied. Peak responses correlated positively with time since last AVP dose (highest values being observed after intervals of ≥10 years), and negatively with number of previous doses (highest values occurring in individuals who had received a primary course only). In 2017, having reviewed these results, the Joint Committee on Vaccination and Immunisation (JCVI) updated UK anthrax vaccination guidelines, extending the interval between routine AVP boosters from one to 10 years.Booster doses of AVP induce significant IgG responses against the three anthrax toxin components, particularly PA and LF. Similarly high responses were observed in TNA, a recognised surrogate for anthrax vaccine efficacy. Analysis of the 596 TNA results showed that anti-PA and anti-LF IgG make substantial independent contributions to neutralisation of anthrax lethal toxin. AVP may therefore have advantages over anthrax vaccines that depend on generating immunity to PA alone.

Veterinary-led puppy parties: A cross-sectional survey to quantify the methods and approaches undertaken within UK veterinary practices

In the United Kingdom, companion animal veterinary practices offer in-clinic puppy socialization programs, referred to as “Puppy Parties”. Studies examining puppy parties are limited, and minimal data is available on the delivery of these programs. This study aimed to describe the methods and approaches used by UK veterinary professionals providing in-clinic puppy parties. A cross-sectional descriptive survey was distributed via social media and by direct email to veterinary practices known to offer puppy parties on their public domain. Respondents were required to have worked in a UK veterinary practice offering parties or equivalent between January 2010 and March 2019. Descriptive data was collected on participant and practice demographics, puppy eligibility, program structure and environment, the inclusion of canine behavior and training, client education, and the effect of COVID-19. All (n = 81) respondents were included for analysis. Findings described variation in the structure of in-clinic puppy parties, particularly as they relate to puppy age, class size, and program duration. “Habituation to practice” was the most common reason for delivery (60.5%), with “Monetary gain” the least likely reason (50.6%). Puppy parties commonly began at 8-9 weeks of age (53.1%), and most (77.8%) persisted beyond the sensitive period of socialization (>12 weeks). Where some puppy parties did not permit intra-species interactions (6.2%), others provided the opportunity for socialization through controlled play (53.1%). Program duration ranged from a singular session (28.4%) to cumulative sessions of ≥4 weeks (34.6%). The “first vaccination of the primary course” was the minimum requirement to attend most parties (75.3%) and deworming was rarely required (24.7%). While behavior topics (87.2%) were commonly discussed, staff generally lacked training and behavior qualifications (65.4%). Finally, all parties were discontinued following COVID-19 restrictions. In conclusion, the results of the study provided a descriptive framework of puppy party programs run by UK veterinary practices. Future researchers may seek to examine which methods used in the delivery of puppy programs best promote canine welfare and behavioral wellness.

Relative effectiveness of COVID-19 vaccination with 3 compared to 2 doses against SARS-CoV-2 B.1.1.529 (Omicron) among an Australian population with low prior rates of SARS-CoV-2 infection

BackgroundWe estimate effectiveness of 3 versus 2 vaccine doses against SARS-CoV-2 B.1.1.529 Omicron in a mostly infection-naiive but highly vaccinated Australian population. MethodsCohort study of adults aged 40+ years resident in Sydney followed from 1 January 2022 for SARS-CoV-2 infection and COVID-19 hospitalisation or death using linked immunisation, disease notification and hospitalisation registers. Adjusted hazard ratios (aHR) and corresponding relative vaccine effectiveness (rVE) were estimated comparing 3 to 2 vaccine dose recipients by time since dose receipt, vaccine brand, and prior infection. Absolute risk reductions and numbers needed to boost by age groups were calculated. Results2,053,123 infection-naiive individuals (mean age 59 years) were followed for 327,272 person-years for infection and 224,269 person-years for severe outcomes (hospitalisation/death). There were 175,849 infections and 4113 hospitalisations/deaths. Compared to individuals receiving dose 2 within the last 3 months, rVE in dose 3 recipients was 7% (95% CI 5–9%) against infection and 65% (95%CI 61–69%) against hospitalisation/death. Almost all dose 3 recipients had an mRNA vaccine; there was little difference in dose 3 rVE by primary course vaccine brand (ChAdOx1 versus BNT162b2). Over the 6-week follow-up, we estimated one hospitalisation/death was avoided for every 192 adults aged ≥70 years boosted with dose 3 in the infection-naiive cohort. The aHR for hospitalisation/death from Omicron was 0.12 (95 %CI 0.07–0.23) for 2-dose recipients with a prior Delta infection compared with 2-dose recipients with no prior infection. ConclusionsReceipt of a third COVID-19 vaccine dose in adults aged 40 years and above significantly reduced hospitalisations and deaths from SARS-CoV-2 Omicron infections in a primarily infection-naiive population.

COVID-19 vaccinations and rates of infections, hospitalizations, ICU admissions, and deaths in Europe during SARS-CoV-2 Omicron wave in the first quarter of 2022.

The vaccination campaigns brought hope to minimizing the coronavirus disease 2019 (COVID‐19) burden. However, the emergence of novel, highly transmissible Omicron lineage of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and the waning of neutralizing antibodies a few months after vaccination has brought concerns over the vaccine efficacy. The present work analyzed the relationships between COVID‐19 vaccine coverage (completion of primary course and booster dose intake) in the European Economic Area and rates of infection, hospitalizations, admissions to intensive care units (ICU), and deaths during the Omicron wave in the first quarter of 2022 (January–April). As demonstrated, infection rates were not correlated to vaccine coverage in any considered month. For January and February, the rates of hospitalizations, intensive care unit (ICU) admissions, and death due to COVID‐19 were strongly negatively correlated (r =− 0.54 to −0.82) with the percentage of individuals who completed initial vaccination protocol and the percentage of those who received a booster dose. However, in March and April, the percentage of the population with primary vaccination course correlated negatively only with ICU admissions (r = −0.77 and −0.46, respectively). The uptake of boosters in March still remained in significant negative correlation with hospitalizations (r = −0.45), ICU admissions (r = −0.70) and deaths due to COVID‐19 (r = −0.37), although in April these relationships were no longer observed. The percentage of individuals with confirmed SARS‐CoV‐2 infection did not correlate with the pandemic indices for any considered month. The study indicates that COVID‐19 vaccination, including booster administration, was beneficial in decreasing the overwhelming of healthcare systems during the Omicron wave, but novel vaccine strategies may be required in the long term to enhance the effectiveness and durability of vaccine‐induced protection during future waves of SARS‐CoV‐2 infections.

Exploration of Labor Education Courses in Primary Schools: Problems and Redevelopment

At present, primary school labor education course in China is a powerful means to solve the problem of weak labor education awareness, cultivate students' core quality, and achieve the goal of comprehensive education. However, the labor education courses in primary schools have the problems of marginal position, separation of labor and practice, and insufficient teaching of labor knowledge and skills. Therefore, reconstructing a scientific and systematic labor education curriculum system is an urgent issue. Educators should consider the objectives, methods, implementation and evaluation of labor education courses to achieve the rapid development of labor education in primary schools.

Booster dose of COVID-19 mRNA vaccine does not increase risks of myocarditis and pericarditis compared with primary vaccination: New insights from the vaccine adverse event reporting system.

BackgroundDespite the likely association between coronavirus 2019 (COVID-19) mRNA vaccines and cases of myocarditis/pericarditis, the benefit–risk assessment by the Centers for Disease Control (CDC) still showed a favorable balance for the primary series of COVID-19 mRNA vaccinations. Since August 2021, a full-scale booster vaccination in certain recipients has been recommended. Great concerns about whether the COVID-19 mRNA booster vaccination could increase the risks of myocarditis/pericarditis have been raised since then. The present study aimed to compare the incidence rates and risks of myocarditis/pericarditis between booster and primary vaccination programs.MethodsThe CDC COVID Data Tracker and the Vaccines Adverse Event Reporting System (VAERS) were queried between December 11, 2020 and March 15, 2022. Incidence rates were calculated by cases of myocarditis/pericarditis divided by the number of vaccinated people or the total doses of COVID-19 mRNA vaccines. Disproportionality patterns for myocarditis/pericarditis of different COVID-19 mRNA vaccinations were accessed based on the reporting odds and proportional reporting ratios (ROR and PRR, respectively).ResultsA total of 2,588 reports of myocarditis/pericarditis were identified after administration of primary-series COVID-19 mRNA vaccination and 269 after the booster dose program during the study period. The incidence of myocarditis/pericarditis following booster COVID-19 mRNA vaccination was lower than that of primary series. The results showed significantly high reporting of myocarditis/pericarditis following the administration of primary COVID-19 mRNA vaccination, whereas the disproportional level was lower in the booster-dose vaccination.ConclusionThis study found that the booster dose of COVID-19 mRNA vaccination when compared with primary series course did not lead to an increase in the risks of myocarditis/pericarditis.

Lebanese University Non-English Speaking Students Experience with E-Technology-Driven Lectures Delivered in the English Medium of Instruction: Students’ Perspectives

The study’s objective was to investigate the challenges virtual online learning has on the English Foreign Language (EFL) students studying their primary course majors in the English Medium of Instruction (EMI) at the Lebanese University. The study aimed to explore the unprecedented implication brought on by COVID-19 on the immediate substitution of face-to-face in-class instruction to the synchronous virtual classroom. The study was concerned with students' overall attitude towards distance learning, the implications they may have faced that would have contributed to their lack of online attendance, challenges, and how confident they acquired the course content in its entirety. Lebanese university students from various faculty majors participated in the study. One hundred thirty-three students took part in the quantitative questionnaire with 22 question item statements to determine the hypotheses of this study. The data presented were analyzed regarding the profile of the Lebanese university student. The findings indicate that students favor face-to-face in-class learning over online learning. The results further highlight that the instructors dominate the lectures, students are either disqualified or are not initiating discussion or eliciting course-related questions, and their learning experience is interrupted by their lack of computer proficiency, motivation, or economic marginalization. In conclusion, the findings stipulate that in E-learning, students lacked learning autonomy, motivation, and commitment towards the course major of study delivered through a virtual classroom. In parallel to the findings, the study provided implications, limitations, and future directions.

Unfolding Case Studies: Improving Nurse Practitioner Students’ Self-Efficacy

Faculty use evaluative methods to assess students’ mastery of nurse practitioner competencies but seldom assess students’ self-efficacy. Self-efficacy is one’s belief that an activity can be competently performed, consequently having a positive impact on clinical performance. Graduating students may not feel confident in their ability to manage patients who require frequent treatment changes necessary to manage acute illness and exacerbation of chronic disease. Nurse practitioner students enrolled in their last adult-gerontology primary care didactic course were invited to participate in a study assessing their self-efficacy after completing a mandatory unfolding case study assignment. The participants demonstrated increased self-efficacy in several domains.

A Significance of Concomitant BRAFV600E and TERT Mutations in Polish Patients with Papillary Thyroid Microcarcinoma: A Retrospective Cohort Study Based on 430 Cases.

Background: The incidence of papillary thyroid cancer is increasing worldwide due to more frequent pathological detection of papillary thyroid microcarcinomas (PTMC), which are cancers measuring 1 cm or less in diameter. In rare cases, the course of PTMC can be aggressive, with an increased risk of recurrence/persistent disease. The aim of this study of Polish patients diagnosed with PTMC was to assess the impact of concomitant B-type Raf kinas-activating mutation in codon 600 of exon 15 (BRAFV600E) and telomerase reverse transcriptase (TERT) hotspot mutations on clinicopathological features, response to treatment, potential recurrence, and the final outcome. Methods: A retrospective analysis of the 430 PTMC cases diagnosed during 2001-2020 at a single center was performed. All PTMC cases were assessed histopathologically, and analyses of BRAFV600E and TERT promoter were performed based on DNA isolated from tumor blocks. Results: There were 29/430 (6.7% [confidence interval: 4.6-9.5]) patients in whom the TERTC228T and/or TERTC250T mutations coexisted with the BRAFV600E mutation. A statistical comparison between PTMC cases with concomitant BRAFV600E and TERT hotspot mutations and those without any of those mutations revealed no significant differences between the two groups with respect to risk stratification, response to primary treatment, clinical course, or final disease status. Conclusion: Regardless of the molecular background of PTMC, the overall response to therapy is excellent, and long-term disease-free survival rates can be achieved by most patients.

Eleven-month longitudinal study of antibodies in SARS-CoV-2 exposed and naïve primary health care workers upon COVID-19 vaccination.

We evaluated the kinetics of antibody responses to Two years into the COVID-19 pandemic and 1 year after the start of vaccination rollout, the world faced a peak of cases associated with the highly contagious Omicron variant of concern (VoC) of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) and nucleocapsid (N) antigens over five cross-sectional visits (January-November 2021), and the determinants of pre-booster immunoglobulin levels, in a prospective cohort of vaccinated primary health care workers in Catalonia, Spain. Antibodies against S antigens after a full primary vaccination course, mostly with BNT162b2, decreased steadily over time and were higher in pre-exposed (n=247) than naïve (n=200) individuals, but seropositivity was maintained at 100% (100% IgG, 95.5% IgA, 30.6% IgM) up to 319 days after the first dose. Antibody binding to variants of concern was highly maintained for IgG compared to wild type but significantly reduced for IgA and IgM, particularly for Beta and Gamma. Factors significantly associated with longer-term antibodies included age, sex, occupation, smoking, adverse reaction to vaccination, levels of pre-vaccination SARS-CoV-2 antibodies, interval between disease onset and vaccination, hospitalization, oxygen supply, post COVID and symptomatology. Earlier morning vaccination hours were associated with higher IgG responses in pre-exposed participants. Symptomatic breakthroughs occurred in 9/447 (2.01%) individuals, all among naïve (9/200, 4.5%) and generally boosted antibody responses. Additionally, an increase in IgA and/or IgM seropositivity to variants, and N seroconversion at later time points (6.54%), indicated asymptomatic breakthrough infections, even among pre-exposed. Seropositivity remained highly stable over almost a year after vaccination. However, gradually waning of anti-S IgGs that correlate with neutralizing activity, coupled to evidence of an increase in breakthrough infections during the Delta and Omicron predominance, provides a rationale for booster immunization.

Granular flow around a cylindrical obstacle in an inclined chute

Shock waves and granular vacua are important phenomena for studying the behavior of granular materials due to the dramatic change in flow properties across shock wave and the particle-free feature at the boundary of granular vacuum. In this paper, we use experiment and numerical simulation to study the granular free-surface flow past a cylindrical obstacle in an inclined chute, where the time-dependent development of the granular flow impacting the obstacle is analyzed at both microscopic and macroscopic scales using the discrete element method (DEM) and the depth-averaged granular model, respectively. Using high-speed camera results as a benchmark solution, the shock solutions are compared between experiment and simulation. The DEM simulation shows better agreement for its shock formation as it is capable of capturing solid, liquid, and gas behaviors for the shock region, while the depth-averaged model provides closer and simpler agreement for the jump solution across the shock. It is shown from the experiment and simulation that the granular shock wave can give rise to a solid–liquid–gas behavior following the propagation of the flow around the obstacle, where, at the front of the obstacle, the shock region can be regarded as a solid regime as the flow becomes stationary during the primary course of the granular flow. With the flow propagating to the downstream, the shock region extends significantly and exhibits strong liquid and gas behavior. Another mixed liquid and gas behavior of granular flow is also observed following the appearance of the granular vacuum, where a localized μ(I)-rheology is shown to be effective in resolving the vacuum boundary in the numerical simulation.