Supplemental Intervention Research Articles

Retinal Oxygen Delivery and Metabolism Response to Hyperoxia During Bilateral Common Carotid Artery Occlusion in Rats.

PurposeThe purpose of the current study was to test the hypothesis that responses of total retinal blood flow (TRBF), inner retinal oxygen delivery (DO2), metabolism (MO2), and extraction fraction (OEF) to hyperoxia are higher after minutes of bilateral common carotid artery occlusion (BCCAO) as compared to days of BCCAO.MethodsTwenty-eight rats were subjected to BCCAO for 30 minutes (n = 12), 1 day (n = 8), or 3 days (n = 8). Eight of the 12 rats were also evaluated at baseline, prior to BCCAO. During room air breathing (RA) and 100% O2 inspiration (hyperoxia), blood flow and phosphorescence lifetime imaging were performed to measure TRBF and vascular O2 contents, respectively. DO2, MO2, and OEF were calculated from these measurements.ResultsAfter 30 minutes or 3 days of BCCAO, TRBF did not differ between RA and hyperoxia conditions (P ≥ 0.14) but decreased under hyperoxia after 1 day (P = 0.01). Compared to RA, DO2 and MO2 were increased under hyperoxia after 30 minutes of BCCAO (P ≤ 0.02). Additionally, MO2 was decreased under hyperoxia after 1 day of BCCAO (P = 0.04). OEF was decreased under hyperoxia compared to RA (P < 0.001). Under hyperoxia, TRBF and DO2 were reduced after all BCCAO durations compared to baseline (P ≤ 0.04), whereas MO2 did not differ from baseline after 30 minutes of BCCAO (P = 1.00).ConclusionsThe findings indicate that hyperoxia introduced minutes after ischemia can reduce DO2 impairments and potentially return MO2 to approximately normal values. This information contributes to the knowledge of the effect of supplemental oxygen intervention on TRBF, DO2, MO2, and OEF outcomes after variable durations of ischemia.

Issues of Confidentiality and Potential Disability Discrimination in Behavior Intervention Team Responses to College Student Suicidality

In response to concerns about liability and safety, many colleges and universities have instituted Behavior Intervention Teams (BITs) to help assess and intervene with students who may pose a risk of harm to self or others. Students, lawyers, and advocates have raised concerns about some aspects of the implementation of BITs and related institutional policies, particularly with regard to students who are suicidal and those who engage in self-injurious behavior. Specifically, BITs are on complicated legal ground regarding confidentiality, disability civil rights law, and potential discriminatory or disparate treatment of students with psychiatric disabilities. In addition to reviewing the nature and background of BITs, this article reviews the professional, ethical, and legal issues surrounding confidentiality in the context of university intervention with students who are at risk for harm to self and the potentially applicable of disability civil rights law to BIT intervention with students who are suicidal. Suggestions for alternative and supplemental interventions, especially widespread use of suicide gatekeeping, are provided. Finally, the need for advocates who are knowledgeable in disability civil rights law is highlighted.

Infants With Congenital Muscular Torticollis Requiring Supplemental Physical Therapy Interventions.

To describe supplemental intervention (SI) frequency in infants with congenital muscular torticollis (CMT) and compare groups of infants who received first-choice intervention only to infants who received SI. Data were retrospectively extracted from a registry. Baseline and treatment variables were collected and analyzed. The cohort included 907 infants with 85 receiving SI. Order of SI frequency was kinesiological tape, manual techniques, tubular orthosis for torticollis (TOT) collar, and the Benik system. Statistically significant differences were found in baseline age, passive cervical range of motion (ROM), muscle function, and treatment time between groups. A positive association was found for CMT presentation, classification grade, plagiocephaly type, and external referrals between groups. Nine percent of infants received SI, most frequently kinesiological tape. Infants who received SI had larger baseline passive ROM and muscle function differences and more visits over a longer duration but had similar CMT resolution. Education is needed when using SI.

0178 Examining Rates and Change in Insomnia Severity among Veterans Enrolled in an Outpatient Exercise Program

Abstract Introduction Exercise moderately improves middle insomnia and sleep quality in older adults. GeroFit is a national structured exercise program for Veterans over age 60 that offers 14 virtual classes per month. Each 60-minute class has a combination of cardiovascular, resistance, flexibility, and balance training and is modified to accommodate the range of functional abilities. The purpose of this analysis was to characterize insomnia symptoms (using the Insomnia Severity Index [ISI]) among GeroFit participants across different time points and examine the impact of attendance on change in insomnia symptoms over time. Methods Veterans in the VA Boston GeroFit program (n=69; 60-93years; Meanage=74.3±8.3; 80.6%male; 80.6%White) were administered the ISI at baseline (n=32), 3-months (n=38), 6-months (n=23), and 12-months (n=21) after enrollment. Participants were categorized by ISI scores: no clinically significant insomnia (ISI=0-7), subthreshold insomnia (ISI=8-14), moderate clinical insomnia (ISI=15-21), and severe clinical insomnia (ISI=22-28). A repeated measures ANOVA was performed to assess for ISI score change over time by attendance rate. Results Veterans attended 64% of the 14 classes per month and exhibited a range of functional ability (Physical Function Subscale [SF-36] scores ranged from 11-29 at baseline). The rates of subthreshold and moderate insomnia were: baseline (15.6%;6.3%), 3-months (26.3%;13.2%), 6-months (30.4%;8.7%), and 12-months (38.1%;9.5%), respectively. Overall, ISI scores remained consistent over time as there were no significant score changes over the first 6 months (p=.121); however, participants with &amp;lt;50% attendance demonstrated a significant increase in ISI scores from baseline to 3months (p=.002). Conclusion Of Veterans participating in the VA Boston GeroFit program, about 1 in 10 reported moderate insomnia and 1 in 4 had subthreshold insomnia. Increasing attendance rates is important for improving sleep quality and more research is needed to clarify the “dose” of exercise required to reap meaningful gains in insomnia symptoms, particularly among Veterans with more severe symptoms. Given that 1/3 of participants reported at least subthreshold insomnia, future studies are needed to better understand whether supplemental interventions (e.g., sleep psychoeducation, stimulus control) might be offered to GeroFit participants with clinically significant insomnia symptoms, to dually target sleep and physical functioning. Support (If Any)

Deliberate practice of consultation communication skills: A randomized controlled trial.

Consultation is a key competency area for school psychologists, though much is unknown about how school psychologists develop the competency to consult. Deliberate practice (DP) is a promising approach to enhance use of communication skills, thereby supporting consultation competence. DP training included multiple opportunities for video-recorded consultation practice in response to a consultee's request for assistance, self-reflection on skill application, and corrective supervisory feedback. In this randomized controlled trial, 109 school psychology graduate students across 45 training programs received either consultation training as usual delivered through their first consultation course (control group; n = 61) or a supplemental DP training intervention in addition to their first consultation course (treatment group; n = 48). Students who completed the DP training significantly increased their use of communication skills during a simulated practice opportunity, while the control group participants did not. Students in the DP condition also reported significantly greater self-efficacy than students in the control group, although students in both groups reported significantly greater self-efficacy over time. DP participants also reported high levels of training satisfaction. Implications of these findings for the design and delivery of consultation training and supervision are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Benefit of Supplemental Cough Suppression Therapy for Chronic Refractory Cough

Background and Objectives Cough suppression therapy (CST) is a physiotherapy that can be used for patients with chronic refractory cough (CRC). We aimed to investigate the efficacy of CST for CRC.Materials and Method A prospective randomized controlled trial was conducted in 27 patients with CRC. Participants were randomized to receive either standard mucolytic medications for CRC combined with supplemental CST (CST group) or standard medications alone (control group). CST consists of laryngeal hygiene management, humidification, cough suppression technique, breathing method, and counseling. We assessed the symptoms change at baseline and week 4 with the Leicester Cough Questionnaire (LCQ). Secondary efficacy outcomes included the degree of cough Visual Analog Scale (VAS) score (0 to 100 scale).Results From 2019 to 2021, 14 CST group patients and 13 control group patients were included. The improvement was significantly greater in the CST group than in the control group for cough VAS score (36.67 to 13.33 vs. 74.29 to 16.43, p&lt;0.001). Patients in the CST group had a significant improvement in total (70.14 to 107.71, p=0.005), physical (31.42 to 43.86, p= 0.015), psychological (23.57 to 40.14, p=0.003), and social (15.14 to 23.71, p=0.005) LCQ scores. However, there was not a significant pre- to post-treatment LCQ score improvement in control group.Conclusion CST might be an effective supplemental intervention for CRC.

Human gut microbiome in human immunodeficiency virus and acquired immunodeficiency syndrome‐related diseases: Clinically relevant observations

AbstractThe implications of recent discoveries pertaining to immune‐mediated disease and the human gut microbiome are vast. In a symbiotic relationship, the immune system modulates the maintenance of host‐microbe normobiosis, and the gut microbiome plays a critical role in developing and maintaining the host's innate and adaptive immune systems. The cutting edge of microbiome research and personalized medicine targets the clinical application and exploitation of gut microbiota modulation in the setting of specific diseases. For example, prebiotic/probiotic supplementation, microbiome enhancing diets, and fecal microbiota transplant have been studied as potential ameliorative supplemental interventions to combined antiretroviral therapy (cART) in human immunodeficiency virus‐positive (HIV+) individuals. Furthermore, recent evidence shows a positive correlation between improved CD4+ cell counts in HIV+ individuals and improved gut microbiota profile after cART. We supplement this finding with data and supporting evidence from recent studies to aid in the clinical application of these findings in this commentary. Preliminary data support the consideration of the gut microbiota in the proactive management of HIV‐associated comorbidities.

Novel Non-invasive Transcranial Electrical Stimulation for Parkinson's Disease.

Conventional transcranial electrical stimulation (tES) is a non-invasive method to modulate brain activity and has been extensively used in the treatment of Parkinson’s disease (PD). Despite promising prospects, the efficacy of conventional tES in PD treatment is highly variable across different studies. Therefore, many have tried to optimize tES for an improved therapeutic efficacy by developing novel tES intervention strategies. Until now, these novel clinical interventions have not been discussed or reviewed in the context of PD therapy. In this review, we focused on the efficacy of these novel strategies in PD mitigation, classified them into three categories based on their distinct technical approach to circumvent conventional tES problems. The first category has novel stimulation modes to target different modulating mechanisms, expanding the rang of stimulation choices hence enabling the ability to modulate complex brain circuit or functional networks. The second category applies tES as a supplementary intervention for PD hence amplifies neurological or behavioral improvements. Lastly, the closed loop tES stimulation can provide self-adaptive individualized stimulation, which enables a more specialized intervention. In summary, these novel tES have validated potential in both alleviating PD symptoms and improving understanding of the pathophysiological mechanisms of PD. However, to assure wide clinical used of tES therapy for PD patients, further large-scale trials are required.

Care Management of Comorbid Medical and Psychiatric Illness: A Conceptual Framework for Improving Equity of Care.

Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address the needs of individuals with comorbid conditions. Although there is substantial evidence supporting the use of care management for improving health outcomes for patients with chronic diseases, the majority of interventions described in the literature are condition-specific. Given the prevalence of comorbidities, the authors of this article reviewed the literature and drew on their clinical expertise to guide the development of future multimorbidity care management programs. Their review yielded one study of multimorbidity care management and two studies of multimorbidity collaborative care. The authors supplemented their findings by describing three key pillars of effective care management, as well as specific interventions to offer patients based on their psychiatric diagnoses and illness severity. The authors proposed short-, medium-, and long-term indicators to measure and track the impact of care management programs on disparities in care. Future studies are needed to identify which elements of existing multimorbidity collaborative care models are active ingredients, as well as which of the suggested supplemental interventions offer the greatest value.

Infants With Torticollis Who Changed Head Presentation During A Physical Therapy Episode.

The purpose of this study is to describe infants with congenital muscular torticollis (CMT) who changed head presentation during an episode of physical therapy. Data were extracted from electronic medical records between January 2015 and December 2018 to describe infants with CMT who changed presentation. Eighty-nine infants met criteria (predominantly male, non-Hispanic, White, with private insurance). Torticollis symptoms were noticed by 3 months in 90% of infants with a physical therapy examination before 6 months in 100% of infants. Most infants had early mild CMT with abnormal head shape and greater limitation in active cervical range of motion (ROM) than passive cervical ROM. Clinicians frequently recommended weekly physical therapy that included first- choice and supplemental interventions. Episodes of care averaged 7 visits over 64 days with 73% of infants meeting goals. Physical therapists should recognize that infants with CMT may change presentation but benefit from physical therapy to resolve symptoms.Digital Abstract available at: http://links.lww.com/PPT/A366.

Physical Exercise, a Potential Non-Pharmacological Intervention for Attenuating Neuroinflammation and Cognitive Decline in Alzheimer's Disease Patients.

This narrative review summarises the evidence for considering physical exercise (PE) as a non-pharmacological intervention for delaying cognitive decline in patients with Alzheimer’s disease (AD) not only by improving cardiovascular fitness but also by attenuating neuroinflammation. Ageing is the most important risk factor for AD. A hallmark of the ageing process is a systemic low-grade chronic inflammation that also contributes to neuroinflammation. Neuroinflammation is associated with AD, Parkinson’s disease, late-onset epilepsy, amyotrophic lateral sclerosis and anxiety disorders. Pharmacological treatment of AD is currently limited to mitigating the symptoms and attenuating progression of the disease. AD animal model studies and human studies on patients with a clinical diagnosis of different stages of AD have concluded that PE attenuates cognitive decline not only by improving cardiovascular fitness but possibly also by attenuating neuroinflammation. Therefore, low-grade chronic inflammation and neuroinflammation should be considered potential modifiable risk factors for AD that can be attenuated by PE. This opens the possibility for personalised attenuation of neuroinflammation that could also have important health benefits for patients with other inflammation associated brain disorders (i.e., Parkinson’s disease, late-onset epilepsy, amyotrophic lateral sclerosis and anxiety disorders). In summary, life-long, regular, structured PE should be considered as a supplemental intervention for attenuating the progression of AD in human. Further studies in human are necessary to develop optimal, personalised protocols, adapted to the progression of AD and the individual’s mental and physical limitations, to take full advantage of the beneficial effects of PE that include improved cardiovascular fitness, attenuated systemic inflammation and neuroinflammation, stimulated brain Aβ peptides brain catabolism and brain clearance.

Promoting Larval Source Management in Urban and Arid Communities as a Vital Supplementary Intervention, Zambia

Promoting Larval Source Management in Urban and Arid Communities as a Vital Supplementary Intervention, Zambia

Training Culturally Congruent Health Coaches to be Socially-Embedded Support on Physical Activity among Older Asian Americans: Phase One Report

There is a reported heterogeneity in burden with cardiovascular disease (CVD) among Asian Americans subgroups. Physical inactivity is an identified key risk factor for CVD, across age and race/ethnic backgrounds. The latest data showed that 42% of Asian Americans are physically inactive. Health coaching is a rapidly emerging primary or supplemental intervention to address issues related to preventable chronic illness, including physical inactivity. Hence, the purpose of this paper is to describe Phase One of this project - training of culturally congruent Health Coaches as socially embedded social support to promote physical activity to their older Asian communities. A 3-day training curriculum was developed based on the four pillars of Health Coaching and the Transtheoretical Model of Change. Fifteen Asian Americans Health Coaches were trained using this curriculum. Fifteen health coaches completed the 3-day training. Phase Two of this project is ongoing and results may provide information on the long-term effects of health coaching among older Asian Americans.

Acceptance of a Third Dose of COVID-19 Vaccine and Associated Factors in China Based on Health Belief Model: A National Cross-Sectional Study.

COVID-19 infections are returning to many countries because of the emergence of variants or declining antibody levels provided by vaccines. An additional dose of vaccination is recommended to be a considerable supplementary intervention. We aim to explore public acceptance of the third dose of the COVID-19 vaccine and related influencing factors in China. This nationwide cross-sectional study was conducted in the general population among 31 provinces in November, 2021. We collected information on basic characteristics, vaccination knowledge and attitudes, and vaccine-related health beliefs of the participants. Univariable and multivariable logistic regression models were used to assess factors associated with the acceptance of a third COVID-19 vaccine. A total of 93.7% (95% CI: 92.9–94.6%) of 3119 Chinese residents were willing to receive a third dose of the COVID-19 vaccine. Individuals with low level of perceived susceptibility, perceived benefit, cues to action cues, and high level of perceived barriers, old age, low educational level, low monthly household income, and low knowledge score on COVID-19 were less likely to have the acceptance of a third dose of COVID-19 (all p < 0.05). In the multivariable logistic regression model, acceptance of the third dose of COVID-19 vaccine was mainly related to previous vaccination history [Sinopharm BBIP (aOR = 6.55, 95% CI 3.30–12.98), Sinovac (aOR = 5.22, 95% CI:2.72–10.02), Convidecia (aOR = 5.80, 95% CI: 2.04–16.48)], high level of perceived susceptibility (aOR = 2.48, 95% CI: 1.48–4.31) and high level of action cues (aOR = 23.66, 95% CI: 9.97–56.23). Overall, residents in China showed a high willingness to accept the third dose of COVID-19 vaccines, which can help vaccine manufacturers in China to manage the vaccine production and distribution for the huge domestic and international vaccine demand. Relevant institutions could increase people’s willingness to booster shots by increasing initial COVID-19 vaccination rates, public’s perception of COVID-19 susceptibility and cues to action through various strategies and channels. Meanwhile, it also has certain reference significance for other countries to formulate vaccine promotion strategies.

The role of dietitian in the multidisciplinary treatment of PCOS

It is well accepted by the medical literature that polycystic ovary syndrome (PCOS) is an extremely heterogeneous condition and that a multidisciplinary approach, involving gynecologists, endocrinologists, primary healthcare providers, mental health professionals, and nutritional professionals, especially dietitians, is fundamental to provide an immediate care and to counteract long-term risk factors related to the comorbidity of PCOS.Although lifestyle modifications are the first step intervention in the treatment of PCOS, unfortunately, the involvement of dietitian in clinical practice remains sporadic. The goal of this viewpoint is to put a greater emphasis on the role of dietitian in the management of PCOS by highlighting frequently faced difficulties in the clinical settings and the importance of a three-step nutritional care: accurate assessment; lifestyle, nutritional, and supplementary intervention; long-term follow-up. The intention is to raise awareness among dietitians themselves and other health providers as well as to express an exceeding necessity of evidence-based guidelines formulated specifically for nutritional professionals, which would allow a uniform approach with respect to heterogeneity and complexity of PCOS at the international level.

Modeling impact and cost-effectiveness of driving-Y gene drives for malaria elimination in the Democratic Republic of the Congo.

Malaria elimination will be challenging in countries that currently continue to bear high malaria burden. Sex‐ratio‐distorting gene drives, such as driving‐Y, could play a role in an integrated elimination strategy if they can effectively suppress vector populations. Using a spatially explicit, agent‐based model of malaria transmission in eight provinces spanning the range of transmission intensities across the Democratic Republic of the Congo, we predict the impact and cost‐effectiveness of integrating driving‐Y gene drive mosquitoes in malaria elimination strategies that include existing interventions such as insecticide‐treated nets and case management of symptomatic malaria. Gene drive mosquitoes could eliminate malaria and were the most cost‐effective intervention overall if the drive component was highly effective with at least 95% X‐shredder efficiency at relatively low fertility cost, and associated cost of deployment below 7.17 $int per person per year. Suppression gene drive could be a cost‐effective supplemental intervention for malaria elimination, but tight constraints on drive effectiveness and cost ceilings may limit its feasibility.

Effectiveness of Emerging Post Covid Teaching Approaches in Partido State University

Today’s pandemic changed the educational landscape in the Philippines. In Partido State University, covid-19 paved the way for new teaching approaches. The traditional face-to-face teaching suddenly shifted to online teaching. This study determined the emerging post covid teaching approaches, instructional strategies used by teachers, the challenges encountered by teachers and students, and the level of effectiveness of the teaching approaches. The study employed a descriptive research design and it used a survey questionnaire in google form to gather data from 52 teachers and 263 students in the seven campuses. The emerging post covid teaching approaches in Partido State University were the use of online learning approach indicated by 46 respondents, Teacher- Student Consultation by 38 respondents, and the “flipped classroom’’ by 34 respondents. To support the teaching approaches, teachers used instructional strategies. These were sharing learning resources to the students (48 respondents), use of flexible assessment policy (39 respondents), and asking the students more questions during synchronous classes (30 respondents). Despite the efforts to perfect the new teaching approaches, respondents were found to be constrained by some challenges. For both respondents, the common challenge encountered was the slow internet or unstable connection. Effectiveness of these emerging post-covid teaching approaches were measured through the presence of online sources, student engagement, technology, and presence of supplemental interventions. Among these, the use of technology to facilitate the teaching approaches was high among teachers with an average weighted mean of 3.39. On the other hand, for students, the post-covid teaching approaches was high in student engagement with 3.27 average weighted mean. With these findings, the study recommends the following 1.) ensure a more stable and stronger internet connection in the campus, 2.) train the students thoroughly in the new learning management system, and 3.) make online resources available.

Interest of Supplementary Intervention in Civil Procedure

보조참가 제도는 제3자에게 소송에 참가할 기회를 줌으로써 피참가인에게는 소송수행에 있어서 조력을 받을 기회를 제공하고 제3자(참가인)에게는 자신의 권리나 법적 지위에 유리한 판단을 얻음으로써 관련자들과의 사이에서의 분쟁을 예방하거나 합리적으로 해결할 수 있는 기회를 제공할 수 있는 제도이지만, 제3자의 부당한 소송개입의 통로로 이용될 수 있는 우려도 있다. 따라서 보조참가를 어느 범위 내에서 허용할 것인지는 법규정의 형식적 해석에 의존하기 보다는 위와 같은 장단점과 법조환경의 실태(변화), 일반인의 제도에 대한 기대와 수요 등을 두루 검토하여 정할 문제이다. 보조참가의 허용범위를 결정하게 되는 [보조참가의 이익]에 관하여 종래 통설은 “소송물인 권리관계에 관한 판단에 직접 영향을 받는 관계(또는 판결주문에서 판단될 사항과의 논리적 의존관계)”로 그 기준을 매우 엄격하게 제시해 왔는데, 이와 같이 제한적으로 볼 문리적, 법리적 근거는 찾을 수 없고, 오히려 우리 법의 규정취지, 소송실무의 현실, 대법원의 해석기준 등은 [보조참가의 이익]을 개방적으로 해석함으로써 보조참가 제도를 좀 더 유용하게 활용할 수 있는 여지를 두고 있다고 생각된다. 이에 따라 필자는 [보조참가의 이익]을 제3자가 ‘판결주문에서 판단될 사항’ 외에도 ‘판결이유에서 판단될 법률요건 충족 여부에 관한 판단(주요사실에 대한 판단)’과의 관계에서 직접 영향을 받는 권리 또는 법적 지위를 가지고 있는 경우에도 인정하는 것이 타당하다는 점을 대표적 모델과 관련 판례의 분석을 통해 논증하려고 노력하였고, 나아가 법원이 그 요건을 심리, 판단함에 있어서는 기본적 관계에만 의존하여서는 안되고, 관련 사실관계를 종합적, 구체적으로 고려하여 심리, 판단할 필요가 있다는 점을 관련 사례를 들어 강조하였다.

Effectiveness of Game-Based Self-Management Interventions for Individuals with Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Objective: Self-management is essential for individuals with diabetes. However, traditional self-management interventions may be hard to follow for other patients. Although games can stimulate extrinsic motivations, its application on self-management remains unclear. This review aims to evaluate the effects of game-based self-management interventions on health outcomes. Materials and Methods: We utilize PubMed, CINAHL, Cochrane Central, EMBASE, ProQuest Dissertation and Theses, PsycINFO, and Scopus from their inception until January 20, 2020. Meta-analyses are performed using Comprehensive Meta-analysis 3.0 software. The overall effect is measured using Hedges' g and determined using Z-statistics at significance level of P < 0.05. Heterogeneity is assessed using χ2 and I2 statistics. The risk of bias tool and the grades of recommendation, assessment, development, and evaluation system are used to assess individual and overall quality of evidence, respectively. Results: A total of 2150 records are identified, and 13 randomized controlled trials are selected. Meta-analyses revealed that game-based self-management interventions significantly improved patients' change in glycated hemoglobin (HbA1c) level (g = 0.18, P = 0.02), adherence to physical activities (g = 0.59, P < 0.001), balance (g = 0.94-1.14, P < 0.001), and fall efficacy (g = 1.01, P < 0.001). Significant results were only found for the three-trial meta-analysis for HbA1c changes, but not for the two other HbA1c meta-analyses that included more trials. Furthermore, negligible improvements were observed in glycated hemoglobin at postintervention and follow-up assessments, diabetes knowledge, and self-efficacy. Conclusion: Game-based self-management can consider a supplementary intervention. Overall evidence is ranging from very low to low. Future studies can consider a large sample size with high-quality design according to the Consolidated Standards of Reporting Trials statement criteria.

Enhancing Classroom Management Skills: Efficacy of a Supplemental Multi-Platform Intervention for Preservice Teachers

Many teachers are ill-prepared to apply practices that can both preempt and address challenging behaviors that interfere with academic instruction. We evaluated the efficacy of a supplemental multi-platform (direct instruction, guided practice, and mixed reality simulations) intervention designed for preservice teachers who do not have opportunities to participate in formal classroom management courses. Efficacy of the intervention was assessed through the quality of classroom management plans, the presentation and implementation of the plan in the virtual classroom, and classroom management self-efficacy. Results indicated that preservice teachers successfully developed quality proactive classroom management plans but struggled to present and implement their plans. However, self-efficacy increased indicating that participants believed they were better able to manage classroom behavior than they did prior to the intervention. Implications of these outcomes are discussed with an emphasis on how adequate opportunities to practice acquired classroom management skills are included in budget-challenged teacher preparation programs.