Regular Hours Research Articles

Opportunities for physical activity in the school environment and their association with physical activity and sedentary behavior in Brazilian adolescents

The school environment (SE) plays a crucial role in determining adolescents’ physical activity (PA), including physical education classes, sports spaces and facilities, and active recreation. This study aimed to evaluate the association between the SE and indicators of PA and sitting time (ST), while exploring Brazilian sociodemographic differences. The SE was characterized by PA practices, PA outside regular class hours, running/athletic track condition, use of the courtyard for PA with a professional, participation in inter-school games or physical-sports competitions, and the number of physical education classes per week. PA and ST were assessed via self-report questionnaires, categorizing participants as active or insufficiently active for PA and as having low or excessive ST. The study included a nationally representative sample of 155,019 Brazilian adolescents (50.9% female). Among them, 28.5% were classified as active and 47.3% had adequate ST. Taking two or more physical education classes was positively associated with being active (OR: 1.669; 95% CI: 1.665–1.673) and with having low ST (OR: 1.050; 95% CI: 1.048–1.052). The association between SE characteristics and PA varied by region and school type (rural/urban, public/private), emphasizing that SE impacts PA and ST differently depending on the sociodemographic context of the adolescents.

A Critical Analysis of the Proposed Law on the Employees' Right to Disconnect in Kenya

The right of employees to "disconnect" from work-related communications has emerged as a concern in employment laws in recent times. Many employees find it increasingly challenging to disconnect from their duties at the end of the workday, and in Kenya, this is no exception. In the contemporary era of advanced technology, employees are tethered to their workstations beyond regular working hours. Employers regularly request or direct employees to complete assignments, activities and other projects beyond their contractual working hours in modern workplace environments. This supplemental teleworking is often unpaid overtime. The practice significantly undermines employees' time for rest and privacy, jeopardises their safety and health, and hampers productivity and remuneration. Kenya has taken steps to address this increasing workplace hazard by proposing stringent regulatory measures to grant workers the right to disconnect from their workplace environment beyond the contractually agreed working hours. Although all employees deserve the right to disconnect, the question is whether the new legislation is necessary. This article analyses the recent draft of the bill that seeks to introduce the right to disconnect in Kenya in regard to its scope, efficiency and implications for employees. The article argues that the "right to disconnect" or "connect" is catered for under the current provisions of the Employment Act of 2007 in the scope of overtime regulation. The passage of the Employment Act (Amendment) Bill of 2022 into law in Kenya would, therefore, be an unnecessary duplication of the law.

A COMPARATIVE ANALYSIS: EVALUATING THE SAFETY AND FEASIBILITY OF 24/7 LAPAROSCOPIC CHOLECYSTECTOMY FOR VARIED GRADES OF CHOLECYSTITIS, SPANNING FROM MILD TO GANGRENOUS

Background: Acute cholecystitis is an extremely common surgical emergency, with gallbladder inflammation from mild to gangrenous forms. Early surgical intervention, often laparoscopic cholecystectomy, is required to minimize the chances of morbidity and to improve important patient outcomes. The introduction of laparoscopic services continuing 24/7 is designed to minimize surgical delays and improve care quality. Aim: The purposes of this study are to compare the safety and feasibility of laparoscopic cholecystectomy performed 24/7 for various grades of acute cholecystitis, ranging from mild to gangrenous. Methods: Four hundred patients diagnosed with acute cholecystitis were divided into three groups such as grade I (mild), grade II (moderate), and grade III (severe/gangrenous) according to the Tokyo Guidelines, and a comparative study was done. Patients were divided into two groups by simple fixed ratio allocation: one undergoing elective laparoscopic cholecystectomy during regular business hours (n = 200) or those who underwent 24/7 laparoscopic cholecystectomy (n = 200). Operative time, conversion rates to open surgery, complications rates, hospital stay duration and postoperative recovery metrics were assessed as outcomes. Chi-square tests were performed for categorical variables and t-tests for continuous variables, and a p value less than significant was taken as <0.05. Results: The elective group had a longer median hospital stay (5 days vs. 3 days, p<0.001) and higher complication rates than the 24/7 group (8% vs. 15%, p=0.02). There was no difference in conversion to open surgery in the two groups (5% vs. 6%, p=0.65). The 24/7 group had slightly longer operative times for Grade III cholecystitis (p = 0.04). There were no significant differences in postoperative recovery metrics. Results comparing 24/7 surgery versus surgery done only during normal operating hours did not differ meaningfully, except for subgroup analysis in Grade II cholecystitis, where 24/7 surgery resulted in lower inpatient mortality and morbidity. Color-coded tables of demographic distributions, bar graphs comparing complication rates, or pie charts clarifying the distribution of cholecystitis grades are graphical representations. Conclusion: Laparoscopic cholecystectomy can be safely implemented both selectively or as full implementation, around the clock, with no grade of acute cholecystitis excluding it. It also has been associated with decreased hospital stay and decreased complications without increasing conversion to open surgery. These findings indicate the benefits of around-the-clock laparoscopic services to improve acute cholecystitis patient outcomes.

Impact of Surgical Timing on Ventriculoperitoneal Shunt Failure Rates: A Population-Based Cohort Study.

Hydrocephalus is a common neurosurgical condition treated primarily through ventriculoperitoneal (VP) shunt placement. This study aims to investigate the relationship between the timing of VP shunt surgery (on-call vs. regular hours) and shunt failure rates. In this single-center, population-based observational cohort study, all adult patients who underwent VP shunt surgery were included. The main outcome was reoperation due to shunt failure within 12months of the index surgery, comparing rates between procedures performed during regular hours and on-call periods. Adjustments for confounders were made using multivariable logistic regression. Out of 810 cases included, 25% underwent surgery during on-call hours. Shunt failure occurred in 10% of cases, most often due to infection. Patients operated on during on-call hours had a significantly higher rate of shunt failure compared to those operated on during regular hours (17% vs. 7.9%, P < 0.001). However, after adjusting for confounders in a multivariable logistic regression, this relationship was no longer statistically significant (OR: 1.60, P= 0.073). The rate of shunt failure was significantly greater in surgeries conducted during on-call hours as opposed to regular hours, but this was not statistically significant after adjusting for confounders. Therefore, the timing of VP shunt surgery may not be an independent risk factor for shunt failure. High-risk scenarios still deserve added caution, and further research is needed to identify factors influencing shunt outcomes and develop strategies to minimize failure rates.

Clinical validation and evaluation of the EasyNAT Malaria assay and the Alethia Malaria assay in a non-endemic setting: rapid and sensitive assays for detecting Plasmodium spp. in returning travellers.

Clinical validation and evaluation of the EasyNAT Malaria assay and the Alethia Malaria assay in a non-endemic setting: rapid and sensitive assays for detecting Plasmodium spp. in returning travellers.

The gender gap in academic surgery: the electronic health record

BackgroundThe electronic health record (EHR) contributes to burnout, and excessive EHR work impedes productivity. The scope of potential gender discrepancies in EHR burden among surgeons is unclear. Because clinical operations and workflow vary by institution, EHR research must be conducted at multiple centers. Identifying modifiable factors that influence how surgeons use the EHR would support strategies that mitigate gender discrepancies. We hypothesized that gender differences in EHR use would be related to EHR support from clinical team members, patient message volume, and documentation length.MethodsWe retrospectively evaluated EHR use by surgeons from multiple specialties in eight departments at a large academic center from January to December 2023. Data about clinical and EHR workload were collected using a provider efficiency tracking tool. These data included the amount of time surgeons spent working in the EHR outside of regular work hours overall and on individual tasks such as responding to messages, clinical review, and orders; the number of messages received and their source; proficiency with documenting in the EHR; and receipt of assistance with EHR documentation and orders from clinical team members.ResultsEHR use was analyzed from 323 surgeons (32% women). After adjusting for specialty, women spent more time than men working in the EHR outside of scheduled clinical hours (mean difference: 7.8 min/day; p = 0.001) and 7 AM to 7 PM (3.8 min/day; p = 0.007) despite no difference in clinical workload. Women spent more time on notes (1.8 min/appointment; p < 0.001), messages (0.7 min/appointment; p = 0.004), and clinical review (0.6 min/appointment; p = 0.032) than men. However, there were no surgeon gender differences in clinical support for EHR work, number of patient messages, note length, or proficiency with the EHR.ConclusionWomen surgeons had a greater EHR burden than men at our institution. Assuming 16 clinical days/month, 8 min/day of additional EHR work outside of scheduled clinical hours for women translates to approximately 26 h/year of lost time relative to men. Unequal EHR work may increase the gender gap in career advancement and exacerbate burnout for women. Future research should include prospective multi-center trials to clarify the extent of the surgical EHR gender gap.

Fostering interest in and support for climate change activism among adolescents

Engaging youth in climate change activism is crucial, particularly in countries where such activism is uncommon. Formal environmental education may play a key role in fostering this engagement. This study evaluated the impact of an educational intervention designed to stimulate general discussion on various contributors to climate change and assess its influence on adolescents’ support for climate activism. The intervention was conducted in four high schools across three administrative regions in Lithuania from October to December 2022, involving 245 adolescents (59.6% female; M = 14.84, SD = 1.29). It included a pre-test, four weekly classes held during regular school hours, a post-test, and a follow-up measurement. Results showed that the intervention increased adolescents’ interest in climate change activism and their self-reported willingness to participate in climate change protests. However, while there was a rise in interest in activism, support for specific activist activities and climate change protests did not significantly change. The analysis also indicated modest effects of gender and school on outcomes. Overall, these findings suggest that environmental education focusing on general topics can enhance some aspects of youth interest in climate activism, though the effects are relatively small.

Factors associated with harm in reported patient safety incidents and characteristics during health screenings in Korea: a secondary data analysis.

Various health screenings are conducted in South Korea, including state-supported national health screenings, privately funded comprehensive health screenings, and employment-related or industry-specific screenings. Given the various risks of patient safety incidents during the health-screening process, and the lack of studies of incidents in this environment, this study aimed to analyse the types and characteristics of reported patient safety incidents during health screenings, the distribution of harm, and the impact of the incident types on harm. We analysed patient safety incidents reported to the Korean Institute for Healthcare Accreditation (2017 to 2022) using the World Health Organization's framework for patient safety. We performed frequency analysis, chi-square tests, and binomial logistic regression analysis to identify the types and characteristics of reported patient safety incidents, the differences in the distribution of harm, and the impact of patient safety incident types on harm during health screenings. A total of 213 cases were included in the analysis. Over half of the patient safety incidents during health screenings resulted in harm to the patient, and examination-related incidents were the most frequent type of incident. Furthermore, reported patient safety incidents were more likely to occur during regular working hours, in the examination room, in hospitals with over 500 beds, and amongst patients in their 50s, with no significant differences in sex distribution. Significant differences were observed in the distribution of harm according to incident types (P <0.001) and patient age (P =0.023). Controlling for patient and incident characteristics, the incident type was a determinant of harm. Amongst the incident types, medication/drug administration (adjusted odds ratio [aOR] = 29.730, 95% confidence interval [CI] = 6.081, 145.368), anaesthesia/sedation/treatments and procedures (aOR = 5.121, 95% CI = 1.002, 26.178), falls (aOR = 4.903, 95% CI = 2.022, 11.890), infections/injuries (aOR = 11.898, 95% CI = 1.082, 130.839), and other types of incidents (aOR = 8.719, 95% CI = 2.602, 29.212) increased the probability of harm compared to examination-related incidents. This study underscores the critical need to manage high-risk patient safety incidents and implement systemic harm reduction strategies during health screenings. Encouraging the reporting of incidents, including near misses, alongside developing targeted interventions, is essential for enhancing patient safety. Future research should leverage larger datasets, consistent classification systems, and standardised data collection to generalise findings and advance prevention strategies, thereby improving the quality and safety of health screening services.

Barriers to the performance of timely hemodialysis when recommended by one United States poison center: a retrospective review

Introduction Hemodialysis has an essential role in the treatment of certain poisoned patients, both by enhancing the elimination of select poisons and correcting underlying fluid, electrolyte, and acid-base disturbances. We sought to identify barriers to the performance of hemodialysis when it was recommended by our poison center. Methods Data from a single United States poison center were retrospectively queried for adult patients for whom the poison center recommended intermittent hemodialysis for poison removal. The primary outcome was the performance of intermittent hemodialysis within 12 h of the poison center recommendation, which we defined as timely hemodialysis. Univariable and multivariable logistic regressions were performed to assess the effect of the following variables on this outcome: age group, patient sex, time of day of the recommendation, day of week of the recommendation, year of the recommendation, hospital location, and poison category. Results A total of 535 patient encounters were analyzed. The majority (72%) of patients had intermittent hemodialysis performed within 12 h of when it was recommended. The multivariable analyses showed that the odds of receiving recommended intermittent hemodialysis within 12 h were significantly lower when the recommendation was made during the nighttime (OR: 0.660; 95% CI: 0.442–0.987) compared to daytime and during the weekend (OR: 0.605; 95% CI: 0.398–0.918) compared to weekdays. Discussion Intermittent hemodialysis is resource-intensive and requires specialized equipment and personnel, which is likely less available outside of regular business hours. This study is limited by its retrospective nature and may not be generalizable to other poison centers. Conclusion Patients for whom our poison center recommended intermittent hemodialysis during non-weekday times had lower odds of receiving timely hemodialysis. Hospital administrators and healthcare providers should be aware of this potential treatment obstacle for poisoned patients and identify the specific barriers involved in order to facilitate timely hemodialysis.

The Impact of Earnings Announcements Before and After Regular Market Hours on Asset Price Dynamics in the Fintech Era

With the recent increase in retail investor participation led by commission-less fintech trading applications and new features like fractional trading, we now have higher volatility and significantly quicker price changes. This makes it hard to make informed trading decisions. Moreover, these effects are exacerbated even further around earnings announcements days. In this paper, we use Nasdaq data feed at a minute frequency and show that there is a significant increase in the slope of the price–volume structure during extended hours (after-hours, or pre-market hours) as compared with the ones observed during regular market times. Our analysis shows that the liquidity is much less during the extended market hours. As such, earnings announcements of stocks during these times have a significantly larger price impact than those stocks that have their earnings announced during regular trading hours. This significant difference can be explained by observing the limit order book structures during these different trading periods. We suggest that the earnings announcements should not be made during extended hours given the significantly lower liquidity and thus, the significantly larger price impact that not only determines the prices for the next trading session but also sets the new “fundamental” price signals for the stocks.

Recommendations From Arizona Budtenders to Mystery Callers Regarding Morning Sickness.

Recommendations From Arizona Budtenders to Mystery Callers Regarding Morning Sickness.

Oral Antibacterial Drug Prescribing in Primary Care Out-of-Hours Services: A Scoping Review.

The rapid spread of antimicrobial resistance (AMR) presents a critical threat to global health. Primary care plays a significant role in this crisis, with oral antibacterial drugs among the most prescribed medications. Antibacterial prescribing rates are often high and complicated in out-of-hours (OOH) services, including weekdays outside regular hours, weekends, and holidays, potentially exacerbating AMR. This review aims to identify the existing literature on oral antibacterial drug prescribing within primary care OOH services. This review followed established frameworks, adhered to PRISMA-ScR guidelines, and the protocol was registered on Open Science Framework. Seven databases were searched from 2017 to May 2022. Data were summarised, tabulated, and presented narratively to explore themes and patterns that aligned with the review objectives. The search identified 28 studies from nine high-income countries, mainly the UK (n = 6) and Belgium (n = 5). Most were quantitative studies (n = 23). Key areas identified included common oral antibacterial prescriptions, prescribing trends, presentations and conditions managed in OOH services, factors and predictors associated with prescribing, prescribing appropriateness, the impact of interventions on prescribing, prescribing in the context of COVID-19, patient satisfaction and expectations, and the challenges encountered, such as factors influencing prescribing behaviour and decision making, safety netting, and communication. This review highlights key areas around oral antibacterial prescribing in primary care OOH services. Despite the numerous articles identified covering various areas within OOH services, the variability in OOH services approaches across countries and studies complicates the comparison of practice. Further research is needed to better understand practices in these settings.

Association between health literacy and behaviors among shift workers: an observational cross-sectional study with mediation analysis.

Previous research has indicated that shift workers exhibit fewer healthy behaviors than those working regular daytime hours. Although health literacy influences health behaviors, studies comparing health literacy levels between shift and fixed-day workers and investigating whether differences in health behaviors between these 2 groups are mediated by health literacy are lacking. This cross-sectional study used a self-administered questionnaire in a large-scale manufacturing company. Overall, 2152 manual workers aged 18-64years were enrolled in this study (961 and 1191 fixed-day and shift workers, respectively). Logistic regression structural equation models were used for analyzing the mediating role of health literacy in the relationship between shift work and health behaviors. Shift and fixed-day workers did not show differences in age-adjusted health literacy. Compared with fixed-day workers, the odds ratios of shift workers for leisure time exercise, not currently smoking, having breakfast, brushing their teeth, and eating green and yellow vegetables were 0.85 (95% CI, 0.70-1.02), 0.68 (95% CI, 0.56-0.80), 0.63 (95% CI, 0.52-0.76), 0.79 (95% CI, 0.65-0.95), and 0.58 (95% CI, 0.48-0.70), respectively. Mediation analysis showed that the odds ratios of the direct effects of shift work on favorable habits were almost the same as the total effect. This study observed that health literacy did not mediate health behavior and shift work. Further research is needed to clarify the causes of these differences.

IMPACT OF OFF-HOURS PRESENTATION ON DOOR-TO-BALLOON TIME AND CLINICAL OUTCOMES IN PATIENTS REFERRED FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Timely intervention is crucial in managing ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Due to staffing and logistical constraints, off-hours presentations may impact door-to-balloon (D2B) time and clinical outcomes. Objectives: To assess the impact of off-hours presentation on door-to-balloon time and clinical outcomes in patients referred for primary percutaneous coronary intervention. Methods: After receiving approval from the Ethical Committee of the Department of Cardiology, Armed Forces Institute of Cardiology, and NIHD, 92 patients meeting inclusion criteria were enrolled, with written informed consent obtained. Participants underwent a detailed history review and physical examination. The study divided participants into off-hours and regular-hours groups based on their hospital arrival times. The main focus was on the timing of presentation, linked to outcomes like door-to-balloon (D2B) time, mortality, and complications such as cardiogenic shock and heart failure. Data on demographics, clinical characteristics, and PCI details were carefully collected using standardized forms by trained personnel. Results: The off-hours group had a mean age of 58.8 years, with 76.1% male, while the regular hour’s group had a mean age of 54.7 years and 69.6% male. Hypertension was present in 37% of the off-hours group and 41.3% of the regular-hour group. Smokers comprised 67.4% of the off-hours group and 45.7% of the regular-hours group. The off-hours group had a mean door-to-balloon time of 89.96 minutes, compared to 83.46 minutes for the regular hour group. Mortality was 4.3% in the off-hours group and 8.7% in the regular-hour group. The Cardiogenic shock occurred in 6.5% of the off-hours group versus 10.9% in the regular-hour group. Multivariable regression showed that off-hours presentation increased D2B time by 12.6 minutes. Logistic regression revealed no significant differences in mortality, shock, or heart failure between the two groups. Both groups had similar angiography findings, with most lesions in the LAD. Conclusion: Off-hours presentations result in longer D2B times for STEMI patients, mainly due to staffing and logistical challenges. However, the off-hours group had lower mortality and cardiogenic shock rates, likely influenced by disease severity and post-procedural care. Although no significant outcome differences were observed, there was a trend toward more adverse events. These findings highlight the importance of improving off-hours care, optimizing pre-hospital processes, and promoting public health initiatives.

First Impressions on Supporting Students with a Course-Aligned, AI-powered Virtual Teaching Assistant (TA), Oliver

We show in this paper that an LLM-based tutor with a simple, web-based interface is readily used by students to answer natural language queries without specific training. Through analysis of the log data of nearly 3000 separate interactions, we find that students tend to use the tutor to clarify concepts and explain sticking points in laboratory assignments. Results indicate that the chatbot was used throughout the course at times outside of regular help-seeking hours, indicating that the tutor provides personalized support to students who are in need of help even when it is not available. Finally, through analysis of the log data, we can generate useful insights into student learning throughout the course.

After-hours, Severity, and Distance are Associated with Non-VHA Emergency Department Use for Older Veterans: Insights from a Regional Health Information Exchange.

Older adults treated in emergency departments (EDs) are at higher risk for adverse outcomes. Using multiple facilities can worsen this issue through service duplication and poor care transitions. Veterans with dual insurance coverage can access both Veterans Health Administration (VHA) and non-VHA EDs. This study aimed to identify factors associated with non-VHA ED use among veterans. We conducted a retrospective observational study of patients aged ≥ 65 who had primary care at the James J Peters VA Medical Center and at least one VHA or non-VHA ED visit between October 2017 and February 2020. Data were collected from the Veterans Affairs Corporate Data Warehouse and the Bronx Regional Health Information Exchange Organization. Generalized linear mixed models were used to examine factors influencing non-VHA ED use. The study sample consisted of 3,897 veterans and a total of 13,312 ED visits. Compared to VHA-exclusive ED users, non-VHA ED users were more likely to live farther away (OR 1.04, CI 1.02 - 1.06) and seek care outside regular hours, including mornings (OR 1.61, CI 1.39 - 1.87), nights (OR 1.49, CI 1.33 - 1.66), weekends (OR 1.28, CI 1.16 - 1.42), and holidays (OR 1.32, CI 1.04 - 1.68). They were also more likely to present with emergency care sensitive conditions (OR 2.13, CI 1.90 - 2.37) and recent inpatient hospitalizations (OR 1.22, CI 1.05 - 1.41). These findings suggested that distance and acuity are important predictors of non-VHA ED use in urban areas such as the Bronx, NY. Identifying veterans with key risk factors could improve care coordination and potentially reduce non-VHA ED use.

When work never ends: How after-hours electronic communication expectations affect job satisfaction through work interference with family and emotional exhaustion

In today’s interconnected and fast-paced work environment, technological advancements have blurred the boundaries between work and personal life. Consequently, employees often find themselves expected to remain available for electronic communication outside regular work hours. While some studies suggest that this aids employees in transitioning between work and home life, it may also hinder their ability to maintain a balance between work and personal life. Thus, drawing on boundary theory and conservation of resources theory, this study examines the impact of after-hours electronic communication expectations (AECE) on job satisfaction through work interference with family and emotional exhaustion. The results of data collected from 300 participants in the textile industry of Pakistan reveal a direct negative impact of AECE on job satisfaction. The results also indicate an indirect effect, wherein AECE influences job satisfaction through a sequential mediation process involving work interference with family, emotional exhaustion, and ultimately, negatively impacts job satisfaction, indicating a cascading effect. The study’s implications for theory and practice, as well as its limitations, are also addressed and discussed.

Challenges of modern work environments and means of overcoming them in the context of psychosocial risk assessments

BackgroundModern work environments constitute an underrepresented part of psychosocial risk assessments at work. Little is known about whether there is an increased stress load at all and what possible improvements could be made in such a case.MethodsModern work environments were assessed in an online questionnaire in 33 companies across a period of more than 4 years. A total of 3431 employees participated in the study. Both quantitative and qualitative data was applied to obtain a differentiated picture.ResultsIncreased stress caused by modern work environments was an issue for around a third of the sample. 31.6% of the participants at least sometimes struggled to balance work and private life. Quite a few of the participants (36.3%) worked sometimes or more outside regular working hours. For 32.4% of participants, the workload has increased due to new technologies, but for 30.4% it has not. The majority (81.4%) feel they can work productively in home offices. The data from 178 completed free text fields on improving modern work environments from the employees’ perspective was analysed. Many named suggestions relate to improvements in time management.ConclusionThis study provides both detailed insights into various aspects of modern work environments and offers solutions to counteract possible negative consequences. Assessing modern work environments in psychosocial risk assessments would be a valuable addition to its completeness.

Illuminating the shadows: the role of private supplementary tutoring on student math performance in PISA 2022

Recent decades have witnessed a global expansion of private supplementary tutoring, known as shadow education—additional support in academic subjects that takes place outside of regular school hours. Using the data of 55 countries from the Programme for International Student Assessment (PISA) 2022, this study examines the association between students’ participation in shadow education and their academic achievement in mathematics and how these relationships change for developed, developing, and East Asian regions. This study also sheds light on the moderating effect that socio-economic status has on the relationship between engagement in shadow education and math performance. Multilevel regression analyses revealed that, at the between-school level, only one of the five forms of shadow education, namely the degree to which students received asynchronous video-recorded instruction, was associated with improved math performance. Similarly, at the within-school level, only the degree to which students received video-recorded instruction was statistically significantly associated with improved mathematical outcomes. Incidentally, we find that institutional-related school-level factors such as the overall quality of student–teacher relationships, provision of math-related extra-curricular activities, and support in terms of peer-to-peer tutoring appear to be associated with improved school math performance, while the quality of student–teacher relationships and level of math teacher support also feature positively for students within-schools. Regarding differential effects by region, at the between-school level, only the degree to which students received large-group study or practice was associated with math performance in East Asian countries. With regards to the moderating effect of SES on the positive relationship between asynchronous shadow education and math performance, we find the effects to be negative, suggesting that asynchronous engagement might be more beneficial for students from lower SES backgrounds. Finally, while the overall negative relationships between synchronous forms of shadow education and math performance appear counter-intuitive, we speculate that this may reflect the use of such tutoring for remedial purposes. We suggest that further research into these “remedial reverse effects” in post-COVID AI-bot-capable educational contexts may provide a more definitive understanding of the role that student engagement in shadow education has on their academic performance.

The association between surgical start time and spine surgery outcomes

The association between surgical start time and spine surgery outcomes