This study explores the role of discourse markers (DMs) in enhancing listening comprehension among English as a Foreign Language (EFL) learners. A quasi-experimental design was employed involving 60 undergraduate students in Sudan, divided into control and experimental groups. The experimental group received explicit instruction on macro and micro discourse markers over a six-week period, while the control group engaged in standard listening practice. Pre-test and post-test results indicated a statistically significant improvement in the listening scores of the experimental group. Qualitative data from questionnaires and classroom observations supported the quantitative findings, suggesting increased student awareness, confidence, and attention during listening tasks. The study concludes that discourse markers are powerful tools that aid comprehension by signaling transitions, organizing speech, and reducing cognitive load. Recommendations include integrating DM instruction into EFL curricula and conducting further research into long-term effects and application in digital learning contexts.

ABSTRACT Childhood maltreatment is associated with enduring emotional and cognitive outcomes. This study examines Layered Voice Analysis (LVA) as an objective method for detecting vocal biomarkers of childhood maltreatment. A quasi-experimental design was used with a sample of (N = 30) young adults. Participants were screened using the Adverse Childhood Experiences–International Questionnaire and interviewed regarding childhood experiences. Audio recordings were analysed using LVA. Participants with childhood maltreatment histories showed higher stress levels, stronger emotional involvement, strong visual imagery during recall, reduced expectation of response from the interviewer while sharing their experiences, and narrower cognitive focus. Findings indicate lasting vocal effects.

Integrating the crowdsourced image-based morbidity hotspot surveillance for neglected tropical diseases (CIMS-NTDs) into Nigeria's healthcare system: a mixed methods study.

ABSTRACT Little is known about the effect of implementing a long-term care insurance (LTCI) program on long-term institutional care admissions. This study employs a quasi-experimental design to examine the impact of China’s LTCI pilot program on institutional care admissions among older adults. Using four waves (2013, 2015, 2018, and 2020) of the China Health and Retirement Longitudinal Study with 8,005 observations, difference-in-differences was applied to compare institutional care utilization between pilot and non-pilot cities before and after the 2016 policy implementation. Results demonstrate that LTCI significantly increases institutional care admission probability by 0.5%, indicating a profound behavioral impact despite modest absolute changes. The magnitude and direction of effect varies considerably across population subgroups. Age emerges as a key moderating factor, with older individuals showing stronger policy responsiveness. Functional disability presents a more complex pattern: while insurance coverage facilitates access for those with moderate care needs, the effect diminishes among severely disabled individuals for whom institutional care represents an unavoidable necessity. Metropolitan areas demonstrate substantially greater policy effectiveness compared to rural regions. The findings provide crucial evidence on how enabling factors in healthcare utilization operate within different demographic and geographic contexts, offering insights for policymakers designing LTCI systems in aging societies.

BackgroundPoint-of-care ultrasound is a valuable bedside tool that, with adequate training, can reduce diagnostic uncertainty and improve clinical accuracy. Abdominal pain is a frequent complaint in emergency departments and often requires imaging for appropriate management.ObjectiveThis study aims to assess the impact of bedside clinical ultrasound performed by family physicians on length of stay, number of basic radiological tests, and need for further diagnostic evaluations in adult patients with abdominal pain.MethodsThis is a pilot quasi-experimental study assessing feasibility and viability, with a nonrandomized control group, to be conducted in the Emergency Department of Hospital Comarcal de Riotinto. Adult patients (≥18 y) presenting with abdominal pain will be included. Both groups will receive standard care. In the intervention group, bedside ultrasound will be performed by trained family physicians; in the control group, ultrasound will be performed by radiologists only if deemed necessary. The primary outcome is the improvement in quality of care, assessed through a reduction in emergency department length of stay, fewer basic radiology tests requested, and diagnostic concordance. Secondary outcomes include the need for additional diagnostic studies and the appropriateness of referrals, evaluated through 1-month follow-up and reconsultation.ResultsThe first phase of the project began in 2023 with the validation of the data collection form. Subsequently, the patient satisfaction questionnaire was validated, and the results were published in the journal Care Primary. The study has received external funding, and patient recruitment is currently ongoing and expected to be completed in December 2025.ConclusionsThis study aims to demonstrate the clinical and organizational benefits of implementing bedside ultrasound by family physicians in emergency care.

Effectiveness of game-based VR simulation on nursing students' mastery of level D PPE: A quasi-experimental design.

Healthcare systems are becoming increasingly complex. Systems thinking can help us understand this complexity and apply that understanding to design and evaluate interventions that improve health outcomes. Enhancing relationship management abilities and promoting systems thinking might be effective ways to improve nurse managers' resilience. High resilience enhances nurse managers' ability to cope with job-related stressors, increasing job satisfaction and, consequently, their retention. This study aimed to investigate the effectiveness of systems thinking training on the organizational resilience of nurse managers. This is a quasi-experimental (before-and-after) study involving a total of 105 nurse managers who were randomly selected. The educational program was designed and then provided during ten two-hour sessions. Data were collected at two time points, before and after, using a demographic questionnaire, the Connor-Davidson Resilience Scale, and the Systems Thinking Scale. The data were then analyzed using Statistical Package for the Social Sciences (SPSS) software, version 17. The results showed that the mean resilience score of the nurse managers in the study was 75.06 (standard deviations [SD]=9.01) before the intervention and 80.70 (SD=12.15) after the intervention. The difference in the mean and SD of the resilience score before and after the intervention was significant (P<0.001). Additionally, the mean systems thinking score of the nurse managers was 64.53 (SD=14.72) before the intervention and 66.40 (SD=10.37) after the intervention. The difference in the mean and SD of the systems thinking score before and after the intervention was not significant (P<0.314). The results showed that systems thinking training improved the organizational resilience of nurse managers. Given that improving resilience in nurse managers enables them to resist and overcome stressful and anxiety-provoking factors, as well as factors that cause many psychological problems, this finding is significant. Therefore, systems thinking training is recommended as an essential skill in nursing management.

Mothers of premature infants experience high levels of stress, and emotional intelligence skills are helpful for stress management. This study aimed to determine the effect of emotional intelligence skills training on the stress of mothers with premature infants hospitalized in the neonatal intensive care unit. This quasi-experimental study with a control group pretest-posttest design was conducted on mothers of premature infants in Shiraz, Iran. The research sample consisted of 90 mothers of premature infants, who were selected conveniently. Emotional intelligence training was provided to the intervention group in six 90-minute sessions. The control group received no intervention. A posttest was conducted for both intervention and control groups one week after the completion of the sessions. The data collection tool in this study was the Parental Stressor Scale: neonatal intensive care units (PSS: NICU). The pretest mean anxiety score in the intervention group (48.89 [standard deviations (SDs)=19.02]) was higher than that in the control group (44.92 [SD=18.55]), but this difference was not statistically significant. The posttest mean anxiety score in the intervention group (13.29 [SD=13.15]) showed a statistically significant decrease compared to that in the control group (47.84 [SD=22.56]) (P=0.050, t=0.001). The results showed that emotional intelligence training had a significant impact on the stress levels of mothers caring for premature infants. To reduce anxiety in mothers of premature infants, experienced clinical nurses and counselors should deliver emotional intelligence training.

The effect of the magic glove technique on pain and anxiety in children during leuprolide injection: A quasi-experimental study.

This study aimed to compare the effects of music and memory writing therapy on fatigue and resilience in patients with Multiple Sclerosis (MS). In this quasi-experimental study, a total of 80 patients with MS who met the inclusion criteria were selected and assigned to three groups: music therapy, memory writing therapy, and control. Data were collected before and after the intervention using the Connor–Davidson Resilience Scale and the Fatigue Severity Scale. Regarding resilience, the mean score in the music therapy group increased by 2.05 points after the intervention; however, paired t-test results showed that this difference was not statistically significant (P=0.719). In the memory writing therapy group, the mean resilience score increased by 7.23 points post-intervention, which was statistically significant (P=0.047). The control group showed a slight increase in resilience scores, which was not statistically significant (P=0.581). Analysis of variance (ANOVA) results indicated no statistically significant differences in mean resilience scores among the three groups (music therapy, memory writing therapy, and control) before and after the intervention (P>0.050). For fatigue, the mean score in the music therapy group decreased by 0.81 points after the intervention, and this reduction was statistically significant (P=0.001). In the memory writing therapy group, a slight decrease in fatigue scores was observed post-intervention, but this change was not statistically significant (P=0.090). Similarly, paired t-test results for the control group showed no significant difference in mean fatigue scores before and after the intervention (P=0.321). The results indicated that both music therapy and memory writing therapy are effective methods for reducing fatigue and increasing resilience in patients with MS. Due to their simplicity and low cost, these approaches can improve both psychological and physical symptoms in these patients, thereby enhancing their overall quality of life.

Beyond bedtime: Improving sleep and behavioral functioning in children with ADHD through targeted interventions.

Sickle cell disease (SCD) is one of the most common chronic blood diseases found among individuals of African heritage. Hydroxyurea (HU) has remained the mainstay pharmacological therapy for SCD, given its disease-modifying effects. Still, its use is limited by a lack of adherence, particularly among adolescents and young adults. Telemedicine has been beneficial in addressing patient nonadherence to chronic conditions but underexplored in the SCD population. To assess the impact of telehealth-based interventions on HU adherence and clinical outcomes in patients with SCD. We conducted a comprehensive literature search from January 2014 to March 2025 across PubMed, Web of Science, PsycINFO, and Embase. The included studies were randomized controlled trials and quasi-experimental studies assessing the effect of telemedicine intervention on SCD and clinical outcomes. A random effects model was used to conduct the meta-analysis in R Statistical Software, version 4.4.2. Five studies (n = 353 participants) met the inclusion criteria: 1 cluster randomized controlled trial and 4 quasi-experimental designs. The pooled effect of telehealth for HU adherence (standardized mean difference, 0.91; 95% CI, 0.62-1.20) with moderate heterogeneity (17.8%) was observed alongside increased mean corpuscular volume and fetal hemoglobin in some studies. Telehealth programs improved HU adherence in the SCD population. However, findings should be interpreted cautiously, given the small number of studies and reliance on quasi-experimental studies. Prospective investigations to evaluate the effect of these telehealth interventions on the diverse SCD genotypes are needed to individualize and optimize strategies to improve HU adherence. PROSPERO International Prospective Register of Systematic Reviews CRD420251037623.

This study evaluated the forensic integrity of digital images transferred from Dropbox to iPhones via Safari, a practical scenario for evidence collection when specialized tools are unavailable. Using a quantitative, quasi-experimental design, we analyzed 60 images across three iPhones (running iOS 14.2 and 14.4) to compare downloads to the Files folder and the Photos application. Controlled tests validated measurement sensitivity, while results revealed consistent image content integrity: cryptographic Secure Hash Algorithm256 (SHA256) stream hashes matched control copies (100%), confirming unchanged pixel data. Additionally, Multiscale Structural Similarity Index (MS-SSIM) scores remained at 1.0, indicating no perceptible degradation in image quality. However, file container hashes were altered within the Photos application (100%) but remained unchanged in the Files folder (0%), reflecting iOS structural modifications. Uniform MS-SSIM scores precluded meaningful regression analysis. Based on our test conditions, the findings suggest forensic workflows comply with standards like Daubert because the transfer preserves content integrity. Limited to specific configurations, future work should explore diverse iOS versions, cloud platforms, and devices for broader applicability.

The current study was conducted in order to determine whether the utilization of a self-monitoring checklist, concrete manipulatives and video modelling (VM) influenced the degree to which 40 pupils attending primary school diagnosed as having autism spectrum disorder (ASD) were able to find accurate solutions to fraction-related problems. A quasi-experimental design was used involving a single-case multiple probe between participants to identify whether significant relationships existed among the study variables. According to the study findings, compared to the baseline, after the implementation of the intervention, all participating students exhibited increased accuracy in solving problems involving simple proper fractions, while 32 were capable of solving whole proper fraction problems. Consequently, it is recommended that to meet the specific needs of ASD learners in a variety of conditions, educators should evaluate whether interventions consisting of concrete manipulatives and VM can be implemented in combination with specific behavioral techniques.

Post-extubation dysphagia (PED) negatively impacts respiratory and gastrointestinal function in post-extubation patients. Structured interventions-such as routine oral care, swallowing assessments and safe swallowing exercises initiated immediately after extubation-have received limited investigation regarding their effectiveness. To examine the impact of oral care intervention and safe swallowing education on PED among patients following endotracheal tube removal. A quasi-experimental design was employed. Four ICUs in a teaching hospital served as the study settings. Participants were consecutively recruited and randomly divided between study and control groups. Two interventions were implemented: oral care and safe swallowing education. For data collection, two instruments were used: a demographic data questionnaire and the Modified Standardised Swallow Assessment (MSSA). The study was conducted over 10 months and included three main stages: assessment, implementation and evaluation. Descriptive (e.g., mean, frequency, percentage) and inferential statistics (e.g., chi-squared, Pearson's r tests) were used for data analysis. A total of 50 adult patients (study group [n = 25]; control group [n = 25]) participated in this study. The control group showed a modest improvement in MSSA scores from baseline (x̄=1.96, SD = 1.35) to day 5 (x̄=8.32, SD = 2.95). Study group demonstrated a significant increase in MSSA scores from baseline (x̄=2.60, SD = 2.85) to day 5 (x̄=13.0, SD = 4.08; F = 145.446, p < 0.001). Regarding MSSA satisfaction, control group scores declined on day 5, changes across phases were significant (F = 41.90, p < 0.001). The study group showed rapid improvement by day 5 (F = 75.00, p < 0.001). Previous medical history and MSSA in the study group had statistically significant associations on days 3 (F = 0.639, p = 0.031) and 5 (F = 0.676, p = 0.004). Significant connection between smoking behaviours and MSSA in the control group on day 3 (F = 2.531, p = 0.034), whereas it was on days 2 (F = 1.422, p = 0.043), 3 (F = 6.100, p = 0.022) and 4 (F = 9.558, p = 0.044) in the study group. On days 4 (F = 2.210, p = 0.014) and 5 (F = 0.325, p = 0.028), there was significant association between the MSSA and the oxygen treatment equipment in the control group, whereas for study, it was on days 2 (F = 0.091, p = 0.047) and 4 (F = 0.432, p = 0.003). The combined implementation of oral care and safe swallowing education for ICU patients and their caregivers was shown to be highly effective in reducing the incidence of PED in ICU settings. ICU nurses and other allied healthcare workers working with patients with swallowing difficulty or PED may use this practical intervention to improve swallowing strength, facilitating early recovery, preventing respiratory complications and improving nutritional intake.

This study aimed to evaluate the effectiveness of structured role-playing games in enhancing vocabulary development among preschool children, while also examining the impact of participation frequency and thematic context on learning outcomes. A quasi-experimental design was implemented with 60 participants from three Early Childhood Development Centers in Almaty, Kazakhstan. Children were randomly assigned to either an experimental group, which participated in structured, thematic role-playing sessions, or a control group that received traditional vocabulary instruction over an eight-week period. Vocabulary acquisition was assessed through the Peabody Picture Vocabulary Test (PPVT) and educator-completed observational checklists. The results showed that the experimental group improved their vocabulary significantly more than the control group, which supported the hypothesis that teaching through play is more effective than teaching with conventional methods. While a positive trend emerged between the frequency of participation and vocabulary growth, this relationship was not statistically significant. Moreover, vocabulary effects were tested condition-specifically, as some themes were above the mean while others were below. Our findings underscore the importance of using play-based learning, particularly structured role-playing, in early childhood education.

Effectiveness of a culturally responsive early intervention model for children with autism and family outcomes.

Traditional coca chewing and cortisol modulation in Andean miners: A pilot quasi-experimental repeated-measures study on stress physiology at high altitude.

This study examined the comparative effects of collaborative learning and the traditional learning strategy on senior high school students’ performance in circle theorems. The motivation stemmed from persistent concerns about low achievement in geometry among Ghanaian students, often attributed to reliance on teacher-centered instructional approaches. Guided by the principles of social constructivism, the study adopted a quantitative paradigm with a quasi-experimental design. Two intact classes were purposively selected from Senior High School B and Senior High School A. In total, 152 students participated, comprising 76 in the experimental groups (collaborative learning) and 76 in the control groups (traditional lecture method). A researcher-designed test consisting of 20 multiple-choice items on circle theorems served as the data collection instrument. Independent samples t-tests were employed to compare post-test scores. The findings revealed that students exposed to collaborative learning significantly outperformed their counterparts taught with the traditional method, suggesting that collaborative approaches promote deeper conceptual understanding and problem-solving skills in geometry. The study concludes that collaborative learning is a more effective instructional strategy for teaching circle theorems at the senior high school level. It recommends that mathematics teachers integrate structured peer interactions into classroom instruction to enhance learning outcomes.

Assessing clown therapy to reduce preoperative anxiety in hospitalized children: A quasi-experimental design.