Search

Cross sections and corresponding momentum distributions have been measured for the first time at zero degrees for the exotic nuclei obtained from a beam of 18O at 8.5 MeV/A impinging on a 1 mg/cm2 238U target. Sizable cross sections were found for the production of exotic species arising from the neutron transfer and proton removal from the projectile. Comparisons of experimental results with calculations based on deep-inelastic reaction models, taking into account the particle evaporation process, indicate that zero degree is a scattering angle at which the differential reaction cross section for production of exotic nuclei is at its maximum. This result is important in view of the new generation of zero degrees spectrometers under construction, such as the S3 separator at GANIL, for example. Keywords: Nuclear reactions, Deep-inelastic collisions, Exotic nuclei

The strength functions of the πf5/2, πp3/2 and πf7/2 orbitals in neutron-rich 71Cu were obtained in a 72Zn(d,3He)71Cu proton pick-up reaction in inverse kinematics using a radioactive beam of 72Zn at 38 MeV/u. A dedicated set-up was developed to overcome the experimental challenges posed by the low cross section of the reaction and the low energy of the outgoing 3He particles. The excitation-energy spectrum was reconstructed and spectroscopic factors were obtained after analysis of the angular distributions with the finite-range Distorted-Wave Born Approximation (DWBA). The results show that unlike for the πf5/2 orbital and contrary to earlier interpretation, the πf7/2 single-particle strength distribution is not appreciably affected by the addition of neutrons beyond N=40.

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Thrombosis is a common clinical feature associated with morbidity and mortality in coronavirus disease-2019 (COVID-19) patients. Cytokine storm in COVID-19 increases patients' systemic inflammation, which can cause multiple health consequences. In this work, we aimed to indicate the effect of Pfizer-BioNTech vaccination on the modulation of monocyte chemoattractant protein-3 (MCP-3), matrix metalloproteinase 1 (MMP-1), and tumor necrosis factor-alpha (TNF-α) levels, and other systemic inflammatory biomarkers that associates with COVID-19 severity in patients who suffers from thrombosis consequences. For this purpose, ninety people were collected from Ibn Al-Nafees Hospital and divided into three groups each of which contained 30 people, 15 of them were venous thromboembolism (VTE) positive and the other were VTE negative. The three groups were non-vaccinated COVID-19, vaccinated COVID-19, and control. The levels of MCP-3 and TNF-α were significantly (p < 0.05) increased in vaccinated and non-vaccinated COVID-19 patients regardless of their thrombosis condition, while MMP-1 level was non-significantly (p > 0.05) higher in vaccinated patients compared to control. MCP-3 and TNF-α were correlated positively with D-dimer (r = 0.544 and r = 0.513, respectively) in non-vaccinated patients, while MMP-1 and TNF-α were correlated positively with D-dimer (r = 0.624 and r = 0.575, respectively) in vaccinated patients. The odds ratio of MCP-3 (2.252), MMP-1 (1.062), and TNF-α (1.360) were reduced in vaccinated patients (2.093, 1.022, and 1.301 for MCP-3, MMP-1, and TNF-α respectively). Thus, MCP-3 plays a vital role in COVID-19 pathophysiology, and vaccination can reduce the risk of developing VTE in COVID-19 patients, and improve the inflammatory condition of patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Diabetes mellitus (DM) is a prevalent metabolic illness that arises as a result of a complex interplay between genetic predisposition, environmental influences, and lifestyle choices. The precise mechanisms elucidating the association between smoking and the onset of DM remain incompletely understood, despite the proposal of several ideas. The objective of this study ‎was to conduct a comparative analysis of blood glucose levels, hemoglobin A1c (HbA1c) levels, insulin hormone levels, and homeostasis model assessment of insulin resistance (HOMA-IR) ‎levels in diabetic patients who smoked and those who did not., Methods: The study included a total of 320 volunteers divided into four groups, with each group consisting of 80 volunteers. The first group served as the control group and consisted of ‎healthy individuals. The remaining three groups consisted of type 2 diabetes mellitus (T2DM) patients, categorized based on their smoking habits. The second ‎group comprised T2DM patients who did not smoke, the third group consisted of T2‎DM patients who smoked cigarettes, and the fourth group included T2DM patients ‎who smoked e-cigarettes.‎ At recruitment, data on age, fat %, waist circumference (cm), and body mass index (kg/m 2 ) was collected. Biochemical markers measured were fasting blood glucose (FBG), HbA1c, insulin, and HOMA-IR‎ levels., Results: The findings demonstrated a statistically significant increase (P<0.001) in the levels of each parameter, particularly among patients with T2DM who engaged in e-cigarette smoking, compared to the control group.‎ It was found that engaging in dual smoking, which involves the use of both traditional cigarettes and e-cigarettes, was associated with a higher likelihood of elevated HbA1c levels and other negative health effects., Conclusion: When it comes to the management of diabetic patients, abstaining from smoking and participating in smoking cessation programs, for patients who smoke, should be the essential approaches. It was found that dual smoking led to a higher likelihood of elevated HbA1c levels and this association was most pronounced among male individuals, those who were physically inactive, and those classified as obese. Further studies should be conducted on the detrimental health consequences associated with e-cigarettes, with a particular focus on enhancing the awareness of healthcare professionals and their patients of the potential risks. This is particularly significant due to the prevailing perception that e-cigarettes are inherently "safe"., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Baghdad General Hospital, Baghdad issued approval 2/2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khaleel Almusawi et al.)

Background Myocardial infarction (MI) remains a critical emergency with an increasing incidence among young women exposed to various risk factors. Despite extensive data on MI, there is limited information on premature coronary artery disease in women under the age of 50 years. This study describes the clinical, paraclinical, and angiographic characteristics of MI in young women compared to older women and determines the prognosis. Methods This is a single-center retrospective study including women hospitalized between July 2019 and December 2021 in the cardiology department for the evaluation of MI. The population was divided into two groups based on age: women under 50 years, classified as young women, and those aged 50 years and above. A comparison was made between these two groups. Results A total of 197 women were included in our study. Forty-four women under 50 and 153 over 50 years were included. The mean age of young women was 44 ± 6 years. The main cardiovascular (CV) risk factors in young women were smoking (46%), hypertension (53%), diabetes (44%), and family history of coronary artery disease (21%). Autoimmune disease was present in 11%. Of the young women, 34% were admitted for ST-elevation myocardial infarction (STEMI), with 47% consulting late (>12 hours). The majority (91%) presented with typical chest pain. Monovessel disease was observed in 57% of young women. The left anterior descending artery was the most affected at 55%. Atherosclerosis was the most noted etiology (66%), followed by spontaneous coronary artery dissection (SCAD) (16%). The comparative study showed that young women had fewer overall CV risk factors but a higher prevalence of smoking, familial history of coronary artery disease, and autoimmune disease. Young women presented more frequently with non-ST elevation myocardial infarction (NSTEMI). Monovessel disease was more common, and they required less myocardial revascularization by percutaneous intervention. Young women presented more with SCAD and less with atherosclerotic MI. The in-hospital follow-up showed that young women experienced fewer major cardiac and cerebrovascular events (MACCE) compared to older women, with no in-hospital deaths recorded among young women. Long-term follow-up revealed a lower incidence of MACCE among young women (11% vs. 32.7% in older women) and a similar low mortality rate. Survival analysis showed that young women had a longer event-free survival time for MACCE (91.3 months) compared to older women (65.5 months). Conclusions The incidence of MI in young women is increasing. Smoking and hypertension are major risk factors. Hospital complications are rare, and prognosis is generally good, with low mortality rates., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Azaiez et al.)

Background: Parkinson's disease (PD) substantially contributes to poor functional outcomes, loss in productivity, and poor health-related quality of life (HRQoL). Despite the existence of various scales, there is a notable gap in existing HRQoL reviews with regard to the availability of Arabic validated scales. As a response to this gap, the aim of our scoping review is to identify validated scales, focusing on their psychometric validation procedures, to contribute valuable insights to the understanding of HRQoL among the Arabic-speaking people with PD., Methods: A scoping review was conducted at the end of December 2022, using the Medline and Embase databases. The focus of this review was on examining the psychometric properties and validation procedures of included scales. Articles were included in the full-text screening process if they focused on people with PD of any age, included a scale measuring HRQoL in Arabic, and were written in English, French, or Arabic., Results: After applying inclusion/exclusion criteria, 10 studies were selected to analyze HRQoL scales validated in people with PD. However, the PDQ-39 is the only HRQol PD specific scales validated in the Arabic language. Five studies validated in people with PD were identified in the context of instrument validation (3 generic, 1 specific validated in 2 studies)., Conclusion: There are several HRQoL measurement scales for people with PD. However, only one specific HRQoL instrument has been validated in Arabic for people with PD. For the remaining instruments identified they were just used in people with PD without being validated in this population., (© 2024. The Author(s).)

Introduction: Intermittent fasting (IF) represents a dietary intervention similar to caloric restriction, characterized by the strategic limitation of food consumption. Among the diverse array of practices for IF, Ramadan IF (RIF), a religious observance in Islam, mandates that healthy adult Muslims abstain from both food and drinks during daylight hours. In sports, researchers have extensively studied IF effects on health, including sleep and physical performance, but its impact on cognitive functions during RIF remains understudied. Therefore, this study was conducted to evaluate the influence of RIF on psychomotor and cognitive performance among young female athletes., Methods: To achieve this purpose, a cohort of 23 female handball players, aged 17.2 ± 0.5 years, participated in a series of six testing sessions: one conducted prior to Ramadan (R0), and others during the first (R1), second (R2), third (R3), and fourth (R4) weeks of Ramadan, followed by a session in the week after Ramadan (R5). Each session involved assessments using a Simple Reaction Time Test (SRT), Choice Reaction Time Test (CRT), Vigilance Test (VT), and Mental Rotation Test (MRT). Additionally, dietary intake, body composition, and Pittsburgh Sleep Quality Index (PSQI) scores were evaluated during these periods., Results and Discussion: The obtained data illustrated that there was a decrease in SRT, CRT, VT, and MRT performances during R1 in comparison to R0 (all p  < .001). This reduction was also observed in R2, R3, R4, and R5. Notably, during the fourth week of Ramadan (R4), these cognitive and psychomotor parameters were significantly lower than during the earlier weeks (R1, R2, R3; all p  < .001). Furthermore, a gradual decrease in total PSQI scores, sleep quality, and sleep duration was observed throughout the Ramadan period, reaching the lowest levels during R4. These findings illustrate that RIF has a significantly detrimental impact on neuromuscular and cognitive abilities as well as sleep quality in young female athletes. The study also highlights a fluctuating pattern in cognitive function across the four weeks of Ramadan, with the most pronounced decline observed during the final week of fasting illustrating the importance of conducting similar studies on normal individuals from both genders with larger sample size., Competing Interests: The authors declare that ChatGPT 4.0 was employed to enhance the academic English of certain sections of this manuscript (64, 65). The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Bougrine, Chalghaf, Azaiez, Hammad, Boussayala, Dhahri, Henchiri, Al-Saedi, Al-Hayali, AL-Rubaiawi, Ezzi, AL-Sadoon, Souissi, Azaiez, Dergaa and Al-Asmakh.)

To date, no research has examined the relationship between sexual self-esteem, body self-esteem, psychological distress, marital satisfaction, and engagement in physical activities. Through a study involving 443 adults the aim of this research was to analyze the connections between engaging in physical activities, body self-esteem, sexual self-esteem, marital satisfaction, and psychological distress among adults. The results obtained through Partial Least Squares (PLS) modeling with SmartPLS reveal significant interconnections among these variables. The correlation between body self-esteem and psychological distress, the positive relationship between sexual satisfaction and positive sexual self-esteem, as well as the beneficial influence of engaging in physical activities on marital satisfaction, are key highlights of this study. The robustness of the measures, confirmed by high coefficients, strengthens the credibility of the results. Despite these advancements, the cross-sectional nature of the study emphasizes the need for longitudinal research to gain a deeper understanding of psychological and relational dynamics over time. In conclusion, this study offers significant contributions to promoting balanced marital relationships, highlighting the importance of considering body and sexual self-esteem, psychological distress, and physical activity within the context of human relationships., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Snani, Snani, Tannoubi, Chortane and Azaiez.)

Background: In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics., Objective: The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention., Methods: The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite)., Results: The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation., Conclusions: This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care., Trial Registration: ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759., International Registered Report Identifier (irrid): RR1-10.2196/47525., (©Sonia Chabrak, Abdeddayem Haggui, Emna Allouche, Sana Ouali, Afef Ben Halima, Slim Kacem, Salma Krichen, Sonia Marrakchi, Wafa Fehri, Mohamed Sami Mourali, Zeineb Jabbari, Manel Ben Halima, Elyes Neffati, Aymen  Heraiech, Mehdi Slim, Salem Kachboura, Habib Gamra, Majed Hassine, Sondes Kraiem, Sofien Kammoun, Leila Bezdah, Gouider Jridi, Hatem Bouraoui, Samir Kammoun, Rania Hammami, Rafik Chettaoui, Youssef Ben Ameur, Fares Azaiez, Rami Tlili, Kais Battikh, Hedi Ben Slima, Rim Chrigui, Samia Fazaa, Islem Sanaa, Yassine Ellouz, Mohamed Mosrati, Sami Milouchi, Soumaya Jarmouni, Wacef Ayadi, Malek Akrout, Rabie Razgallah, Wissal Neffati, Meriem Drissa, Selma Charfeddine, Salem Abdessalem, Leila Abid, Lilia Zakhama. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.04.2024.)

Objective: The present study examined the impact of academic engagement, study processes, and grit on the academic achievement of physical education and sport university students., Methods: An internet-based survey recruited 459 university students aged 19-25 years (M = 21 ± 1.3) in physical education and sports (PES) to fill out questionnaires on Physical Education-Study Process Questionnaire (PE-SPQ), Physical Education-Grit (PE-Grit), academic engagement (A-USEI), and Grade Point Average (GPA). A path analysis was carried out to understand variable relationships., Results: Data from each variable exhibited symmetrical and normal distribution, as indicated by the skewness and kurtosis values. The model's fit indices showed sufficient Comparative Fit Index (CFI = 0.92), Tucker-Lewis Index (TLI = 0.90), Goodness of Fit Index (GFI = 0.99) and Normed Fit Index (NFI = 0.90) and showed acceptable levels. The results indicated a statistically significant positive impact of engagement (β = 0.299, p < 0.001) and study processes (β = 0.397, p < 0.001) on academic achievement. However, the effect of grit on achievement was non-significant., Conclusions: Academic engagement as well as study processes are two important factors predicting academic achievement while grit seems to be not a major predictor. Hence, physical education and sport faculty and university administrators should prioritize student engagement as a determinant of academic outcomes by reforming or redesigning physical education and sport curriculum modules that can facilitate engagement., (© 2023. The Author(s).)

Background: Heart failure (HF) is a serious and frequent pathology. It represents a major public health problem. We have few data about this pathology in our country. The aim of our study is to determine the epidemiological, clinical, therapeutic, and prognostic characteristics of new-onset HF with reduced left ventricular ejection fraction (HFrEF) and to study the degree of conformity of the management of HF with international recommendations., Results: Our study population includes 210 patients hospitalized for HFrEF newly diagnosed. The average age of our patients was 64 ± 12 years. A male predominance was noted with a sex ratio of 2.8. The main etiology of HF was ischemic heart disease noted in 97 patients (46.2%). The average LVEF is 33 ± 6%. The triple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists) was prescribed in 75 patients (35.7%). The quadruple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists + Sodium-Glucose Co-Transporter 2 inhibitors) was prescribed in 17 patients (8.1%). Myocardial revascularization was indicated in 97 patients (46.6%) and valve surgery was indicated in 49 patients (23.3%). Hospital mortality was 3.8% and at 1 year 18.1%. Among the 192 patients followed during the first year after discharge from hospital, 81 patients had to be re-hospitalized, i.e., a 1-year rehospitalization rate of 42.2%., Conclusions: Our study highlighted the epidemiological and clinical features of HF in a Tunisian care center, revealing our patient management deficiency. This pushes us to have a new Tunisian register to enable a better statistical analysis and lead to more relevant conclusions., (© 2023. The Author(s).)

This study aimed to depict the oxidative status variation in judokas during aerobic-dominant mixed effort (AeDME) and anaerobic-dominant mixed effort (AnDME). It is to be expected that the sporting commitment of Judo is a stimulus of oxidative stress leading to the recruitment of antioxidant responses. Blood samples were collected from 17 athletes at rest, immediately after a training session (AeDME) and after a 5-min bout (AnDME). AeDME and AnDME caused significant increases in malondialdehyde (MDA) (p < 0.01 and p < 0.001 respectively) and glutathione (GSH) (p = 0.018 and p < 0.001 respectively). Blood thiol concentrations decreased following AeDME and AnDME (p < 0.001) whilst catalase decreased significantly after AnDME (p = 0.026) only. Uric acid increased significantly after AnDME than after AeDME (p = 0.047) while, conversely, total bilirubin was higher after AnDME than after AeDME (p = 0.02). We may ultimately summarize that AeDME and AnDME caused oxidative stress, higher in AnDME, and some antioxidant response slightly higher in AnDME compared to AeDME. In sports, monitoring of oxidative stress status is recommended as part of the training regimen., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)

(1) Objective: This is a quasi-experimental study that investigated the effect of four weeks of training sessions using video modeling (VM) on individual and collective technical skills in young novice basketball players. (2) Method: 20 players were equally assigned to either a control group (CG, n = 10; 12 ± 0.7 years) or a video modeling group (VMG, n = 10; 12.5 ± 0.5 years; visualizing videos before each session) were assessed before and after the four-week training period using the Basketball Skill Test of the American Alliance for Health, Physical Education, Recreation and Dance for individual techniques and three vs. three small-sided games for collective aspects. (3) Results: For the passing test, VMG induced higher performance than CG ( p = 0.021; d = 0.87). For offensive balls post-intervention, higher values were recorded for VMG compared to CG ( p = 0.003; d = 1.81). In addition, the number of attack balls index post-intervention was higher for VMG compared to CG ( p = 0.001; d = 0.28). For losing the ball, VMG induced lower values than CG after the training intervention ( p < 0.001; d = -3.23). The efficiency index was higher post-training compared to pre-training for VMG ( p = 0.013; d = 1.24). (4) Conclusion: The study highlighted the importance of using video modeling as an effective strategy to improve technical skills and collective performance in novice young basketball players.

Background: The first wave of COVID-19 pandemic may have significantly impacted antimicrobial consumption in hospitals. The objective of this study was to assess the evolution of carbapenem consumption and describe the implemented measures during the first year of the COVID-19 pandemic., Methods: We calculated carbapenem consumption for all the hospital and for intensive care units (ICU) for three periods: baseline (before COVID-19 cases, January 2019-February 2020), and the period of COVID-19 cases as a pre-intervention (March-August 2020) and a post-intervention phase (September 2020-December 2021)., Results: During the study period, the percentage of admitted COVID-19 patients increased in the months of April-August of 2020 (pre-intervention period) from 5 to 26% of total admitted patients. The consumption of carbapenems (DDD/1000 patient days) increased from a mean of 67.1 at baseline to 142.9 pre-intervention. In ICUS, there was an increase in the mean from 125.7 to 240.8 DDD/1000 patient days. After interventions, the DDD/1000 patient days decreased by 49.5% overall the hospital and by 36% in ICUs. For the post-intervention period, there was a correlation between COVID-19 cases and carbapenem usage in the ICU but not the overall hospital., Conclusion: An increase in the antimicrobial consumption during the first wave of COVID-19 pandemic was noticed, especially in the ICU. Antimicrobial stewardship programs are essential to reduce consumption rate., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Nowadays, digital gaming occupies a central position in the entertainment industry where it has developed into a cherished kind of entertainment in markets all over the world. In addition, it provides other sectors with various social and economic benefits. The Game Experience Questionnaire (GEQ) is a free, quantitative, and comprehensive self-report measure that was developed to assess the player game experience. Despite having been widely used by many research projects in the past, it has not been adapted into Arabic. Furthermore, several components of the scale proved problematic from a psychometric point of view. Therefore, a modified version of the scale is needed to measure the gaming experience of the Arab population., Objective: The aim of this study was to validate and examine the psychometrics of an adapted Arabic version of the GEQ in Tunisia., Methods: A total of 771 volunteer participants completed an online survey, which included an Arabic version of the GEQ, gaming data, and a sociodemographic questionnaire. Subjects were randomized in order to complete two phases of the study: exploratory and confirmatory. The exploratory data were acquired from 360 respondents whose mean age was 23.89 (SD 2.29) years. Out of 360 respondents, 111 (30.8%) were female and 249 (69.2%) were male. Confirmatory data were obtained from the remaining 411 subjects whose mean age was 21.94 (SD 1.80) years. Out of 411 subjects, 169 (41.1%) were female and 242 (58.9%) were male., Results: After the elimination of two items, the exploratory and the confirmatory factor analyses provided an adequate factor structure of the Arabic version of the GEQ. In addition, the internal consistency coefficients suggested the reliability of the instrument. Significant differences were revealed for three subcomponents: flow by age (η 2 =0.013, P=.002), gender (η 2 =0.007, P=.02), and game type (η 2 =0.03, P<.001). For competence (η 2 =0.01, P=.03) and immersion (η 2 =0.02, P=.01), significant differences were highlighted by the type of game. The discriminant and convergent validities of the instrument were supported by calculating the average variance extracted (AVE) and comparing the square roots of the AVE values to the correlation coefficients, respectively., Conclusions: The Arabic adapted version of the GEQ is valid and reliable and can be administered to measure the game experience in Arab countries., (©Mahmoud Rebhi, Mohamed Ben Aissa, Amayra Tannoubi, Mouna Saidane, Noomen Guelmami, Luca Puce, Wen Chen, Nasr Chalghaf, Fairouz Azaiez, Makrem Zghibi, Nicola Luigi Bragazzi. Originally published in JMIR Formative Research (https://formative.jmir.org), 20.03.2023.)

Background: Physical education teachers often experience stress and job disengagement., Objective: This study's aims were as follows: (1) to adapt in the Arabic language and test the reliability and the validity of the work-family conflict (WFC) and family-work conflict (FWC) scales, (2) to develop and assess the psychometric properties of work disengagement among physical education teachers, and (3) to evaluate an explanatory model by presenting the mediating role of perceived stress as a major influencing factor in work disengagement and job satisfaction., Methods: A total of 303 primary and secondary school physical education teachers, comprising 165 (54.5%) men and 138 (45.5%) women participated voluntarily in our study. The measuring instruments are the Work Disengagement Scale, the Perceived Stress Scale, the WFC scale, the FWC scale, and the 9-item Teacher of Physical Education Job Satisfaction Inventory., Results: The Arabic language versions of the WFC and FWC scales had reasonably adequate psychometric properties, which were justified by confirmatory factor analyses and by the measurement of reliability, convergent, and discriminant validity through the measurement model using SmartPLS software. Similarly, the structural model established with SmartPLS confirmed strong links of the concepts of FWC, WFC, the job satisfaction questionnaire, and perceived stress with work disengagement among teachers of physical education., Conclusions: There is a growing interest in helping teachers cope with the daily pressures of work and family. A positive organizational context is a context with clear values regarding work priorities, which constitutes the basis of a feeling of shared responsibility and professional support. Good conditions can act as protective factors reducing work stress and positively influencing personal well-being, work attitudes, work commitment, and professional efficiency. Additional research on teachers is needed to examine the relationship between perceived work stress and the role of families, along with the extent to which this association can have a significant impact on teachers' commitment to work., (©Nasr Chalghaf, Wen Chen, Amayra Tannoubi, Noomen Guelmami, Luca Puce, Noureddine Ben Said, Maher Ben Khalifa, Fairouz Azaiez, Nicola Luigi Bragazzi. Originally published in JMIR Formative Research (https://formative.jmir.org), 01.12.2022.)

Background: This study was designed to evaluate the care of hypertensive patients in daily clinical practice in public and private centers in all Tunisian regions., Objective: This study will provide us an overview of hypertension (HTN) management in Tunisia and the degree of adherence of practitioners to international recommendations., Methods: This is a national observational cross-sectional multicenter study that will include patients older than 18 years with HTN for a duration of 4 weeks, managed in the public sector from primary and secondary care centers as well as patients managed in the private sector. Every participating patient signed a consent form. The study will exclude patients undergoing dialysis. The parameters that will be evaluated are demographic and anthropometric data, lifestyle habits, blood pressure levels, lipid profiles, treatment, and adherence to treatment. The data are collected via the web interface in the Dacima Clinical Suite., Results: The study began on April 15, 2019 and ended on May 15, 2019. During this period, we included 25,890 patients with HTN. Data collection involved 321 investigators from 24 Tunisian districts. The investigators were doctors working in the private and public sectors., Conclusions: Observational studies are extremely useful in improving the management of HTN in developing countries., Trial Registration: ClinicalTrials.gov NCT04013503; https://clinicaltrials.gov/ct2/show/NCT04013503., International Registered Report Identifier (irrid): DERR1-10.2196/21878., (©Leila Abid, Rania Hammami, Salem Abdesselem, Selim Boudiche, Ben Slima Hédi, Khaled Sayahi, Amine Bahloul, Ikram Chamtouri, Salma Charfeddine, Lamia Rais, Meriem Drissa, Badreddine Ben Kaab, Hassen Ibn hadj amor, Lilia Ben Fatma, Riadh Garbaa, Sabrine Boukhris, Allouche Emna, Manel Ben Halima, Nesrine Amdouni, Shayma Ghorbel, Sabrine Soudani, Imen Khaled, Syrine Triki, Feten Bouazizi, Imen Jemai, Ouday Abdeljalil, Yemna Ammar, Amani Farah, Adnen Neji, Zeineb Oumaya, Sana Seghaier, Samir Mokrani, Hamza Thawaba, Hela Sarray, Khalil Ouaghlani, Houssem Thabet, Zeineb Mnif, Boujelben Masmoudi Fatma, Mohamed Sghaier, Roueida Khalifa, Sami Fourati, Yassmine Kammoun, Syrine Abid, Chiheb Hamza, Syrine Ben Jeddou, Lassaad Sabbah, Rim Lakhdhar, Najla Dammak, Tarak Sellami, Basma Herbegue, Alia Koubaa, Faten Triki, Tarek Ellouze, Aicha Hmoudi, Ikhlas Ben Ameur, Mohamed Mongi Boukhchina, Neila Abid, Wejdene Ouechtati, Nizar Nasrallah, Yousra Houidi, Fathia Mghaieth Zghal, Ghodhbane Elhem, Mounira Chayeb, Chenik Sarra, Samira Kaabachi, Nizar Saadaoui, Ines Ben Ameur, Moufida Affes, Sana Ouali, Mouna Chaker, Hela Naana, Dghim Meriem, Mourad Jarrar, Jihen Mnif, Ahmed Turki, Ihsen Zairi, Jamel Langar, Safa Dardouri, Imen Hachaichi, Rafik Chettaoui, Wajih Smat, Amel Chakroun, Khadija Mzoughi, Rachid Mechmeche, Afef Ben Halima, Sahar Ben Kahla Koubaa, Slim Chtourou, Maalej Mohamed abdelkader, Mohsen Ayari, Moufid Hadrich, Tlili Rami, Fares Azaiez, Imen Bouhlel, Samir Sahnoun, Habib Jerbi, Ben Mrad Imtinene, Leila Riahi, Mohamed Sahnoun, Abdelhamid Ben Jemaa, Amal Ben Salem, Bassem Rekik, Maroua Ben Doudou, Mohamed Rachid Boujnah, Anissa Joulak, Abid Omar, Rabie Razgallah, Milouchi Sami, Elyes Neffati, Habib Gamra, Soraya Ben Youssef, Wissem Sdiri, Nejeh Ben Halima, Youssef Ben Ameur, Salem Kachboura, Sondes Kraiem, Wafa Fehri, Lilia Zakhama, leila Bezdah, Mourali Mohamed Sami, Habiba Drissa, Mohamed Faouzi Maatouk, Samir Kammoun, Faouzi Addad. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 02.09.2022.)

Background: Coronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries., Objective: The aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia., Methods: We will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis., Results: In this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022., Conclusions: This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region., Trial Registration: Clinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761., International Registered Report Identifier (irrid): RR1-10.2196/24595., (©Rania Hammami, Selim Boudiche, Tlili Rami, Nejeh Ben Halima, Ahmed Jamel, Bassem Rekik, Rym Gribaa, Ben Mrad Imtinene, Salma Charfeddine, Tarek Ellouze, Amine Bahloul, Ben Slima Hédi, Jamel Langar, Habib Ben Ahmed, Zied Ibn Elhadj, Mohamed Hmam, Mohamed Aymen Ben Abdessalem, Sabri Maaoui, Sana Fennira, Laroussi Lobna, Majed Hassine, Sami Ouanes, Drissi Mohamed Faouzi, Souad Mallek, Abdallah Mahdhaoui, Dghim Meriem, Walid Jomaa, Sofien Zayed, Tawfik Kateb, Nidhal Bouchahda, Fares Azaiez, Helmi Ben Salem, Morched Marouen, Aymen Noamen, Salem Abdesselem, Denguir Hichem, Hassen Ibn Hadj Amor, Farhati Abdeljelil, Amine Amara, Karim Bejar, Ben Hamda Khaldoun, Chiheb Hamza, Mohsen Ben Jamaa, Sami Fourati, Faycal Elleuch, Zeineb Grati, Slim Chtourou, Sami Marouene, Mohamed Sahnoun, Morched Hadrich, Maalej Mohamed Abdelkader, Hatem Bouraoui, Kamel Kamoun, Moufid Hadrich, Tarek Ben Chedli, Mohamed Akrem Drissa, Hanene Charfeddine, Nizar Saadaoui, Gargouri Achraf, Siala Ahmed, Mokdad Ayari, Marsit Nabil, Sabeur Mnif, Maher Sahnoun, Helmi Kammoun, Khaled Ben Jemaa, Gharbi Mostari, Nebil Hamrouni, Maazoun Yamen, Yassine Ellouz, Zahreddine Smiri, Amine Hdiji, Jerbi Bassem, Wacef Ayadi, Amir Zouari, Chedly Abbassi, Boujelben Masmoudi Fatma, Kais Battikh, Elyes Kharrat, Imen Gtif, Milouchi Sami, Leila Bezdah, Salem Kachboura, Mohamed Faouzi Maatouk, Sondes Kraiem, Gouider Jeridi, Elyes Neffati, Samir Kammoun, Youssef Ben Ameur, Wafa Fehri, Habib Gamra, Lilia Zakhama, Faouzi Addad, Mourali Mohamed Sami, Leila Abid. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.08.2022.)

The objective of this study was to explore the effect of COVID-19 and Ramadan on physical activity (PA) and burnout in teachers and the relationship between them. A total of 57 secondary school teachers from public education centers participated in the present study. They were aged between 29 and 52 years. To determine the effect of Ramadan and COVID-19 on PA and burnout, participants completed the online questionnaires before COVID-19, one week before Ramadan and during the second week of Ramadan. The International Physical Activity Questionnaire-BREF and the Maslach Burnout Inventory-Human Services Survey were used to assess PA intensities and burnout, respectively. The data revealed that total PA (p < 0.001, p < 0.05, respectively) vigorous metabolic equivalent of task (MET) (p < 0.001, p < 0.05, respectively), moderate MET (p < 0.001, p < 0.01, respectively) were higher before COVID-19 and before Ramadan than during Ramadan. Regarding burnout subscales, emotional exhaustion (p < 0.001, p < 0.01, respectively) was higher before Ramadan than before COVID-19 and during Ramadan. A lower personal accomplishment was reported before Ramadan than before COVID-19 and during Ramadan (both p < 0.05). In addition, low to high correlations were observed between PA intensities and burnout subscales, except for the correlation between depersonalization and all PA intensities. In conclusion, Ramadan intermittent fasting along with PA was highly recommended for teachers and the general population to improve positive emotions and general health.

Background: Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control., Methods: Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg., Results: Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02-1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01-1.13], diabetes (OR = 1.18, 95% CI [1.11-1.25], Smoking (OR = 1.15, 95% CI [1.05-1.25]), Obesity (OR = 1.14, 95% CI[1.07-1.21]), management in public sector (OR = 1.25, 95% CI [1.16-1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8-0.93]), salt restriction (OR = 0.48, 95% CI [0.45-0.51]), drug compliance (OR = 0.57, 95% CI[0.52-0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control., Conclusion: NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate., (© 2022. The Author(s).)

Aims: Our study aimed to develop a two-factor self-administered orthogonal questionnaire to assess the experience of perceived physical inactivity, to test its psychometric properties, to confirm its relationships with fear of COVID-19, and finally, with perceived stress during the pandemic., Methods: A total of 481 Tunisian subjects collected in several cities, aged from 16 to 67 years with a mean age = 32.48 ± 9.46, and of both sexes participate in our study with (male: 51.8%) and (female: 48.2%), divided according to the level of study into three categories. All subjects voluntarily answered the PIPES questionnaire, the IPAQ scale, the COVID-19 fear scale and the PSS-10 test., Results: The results of the exploratory and confirmatory factor analysis supported the robustness of the tool measure. In addition, examination of configurational, metric, scalar, and strict invariance supported the equivalence of the structure by gender and educational level. Concurrent validity was established by the positive association of a negative perception of physical inactivity with scores measured by the IPAQ scale and a negative association with scores of COVID-19 fear and perceived stress. Whereas, a positive perception of physical inactivity from the COVID-19 scale was negatively associated with the IPAQ and positively associated with fear of COVID-19 and perceived stress., Conclusion: The PIPES-10 scale can be used to measure the perception of physical inactivity in different situations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Guelmami, Chalghaf, Tannoubi, Puce, Azaiez and Bragazzi.)

Background: The Revised Two Factor Study Process Questionnaire (R-SPQ-2F) is used to examine students' study approaches in higher education. The questionnaire is designed to measure two factors: deep and surface approaches. In order to measure these approaches for students in physical education and sport, a new measurement instrument should take into consideration the practical context of this field of education that makes it specific to other fields., Objective: The present study aims (a) to develop and empirical test of a new instrument for measuring the study process in physical education and sports students, and (b) to test psychometric properties of the tool., Methods: Two exploratory and confirmatory samples of physical education students enrolled in a bachelor's degree program in physical education at the High Institute of Physical Education and Sports of Kef-Tunisia, aged 19-26 years, were recruited online among female students ( n = 414) and male students ( n = 393). The participants filled in Google Form survey including Physical Education-Study Process Questionnaire (PE-SPQ) and the Arabic version of the Revised Study Process Questionnaire-2 Factors (R-SPQ-2F)., Results: Exploratory factor analysis showed a suitable four factors solution, which is approved by confirmatory factor analysis indices [χ2 = 466.47, TLI = 0.94, CFI = 0.95; RMSEA = 0.56 IC 90% (0.050-0.062)]. Internal consistency of the PE-SPQ simultaneously checked by McDonald's ω, Cronbach's α and Gutmann's λ6 showed good reliability of the PE-SPQ. Convergent validity examined by Average variance extracted (AVE) was good. The comparison between the AVE root mean square and Pearson correlation coefficients of each factor with his indicators reveals the discriminant validity of the PE-SPQ. Furthermore, Pearson's correlation between the PE-SPQ factors and the R-SPQ-2F establishes the concurrent validity of the new scale., Conclusion: The PE-SPQ scale is valid and reliable and can be used to assess study process factors in physical education students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tannoubi, Guelmami, Bonsaksen, Chalghaf, Azaiez and Bragazzi.)

Background: Grit is a key concept in positive psychology and educational science. The construct measures two related constructs that are interest and effort. Several instruments have been developed to measure this construct in professional and educational contexts, but no tools have been developed considering specific contexts such as physical education and sport., Objectives: The objective of this study is to develop and test a measurement scale to assess Grit in the context of physical education and sport., Methods: Two exploratory (Phase 1) and confirmatory (Phase 2) samples were administered the 16-item PE-Grit scale in Arabic. In addition, the confirmatory sample also was administered the R-SPQ-2F two-factor learning approaches scale. The factor structure was examined first by exploratory factor analysis on the first sample and then by confirmatory factor analysis on the second sample. Reliability testing was performed by checking internal consistency simultaneously by the three indices: McDonald's ω, Cronbach's α and Gutmann's λ6. Concurrent validity was checked by Pearson's correlation between the PE-Grit and the two dimensions of the SPQ-2F., Results: After the exploratory factor analysis, which identified the factors and gave a preliminary validation of the designed instrument, confirmatory factor analysis was performed on three hierarchical models to be able to identify the best fitting model. A third-order hierarchical model with two physical and academic components each formed by interest and effort presented the best fit indices: chi X2 = 192.95 ( p < 0.01), and the X2/DF = 1.36; GFI = 0.99; AGFI = 0.99; CFI and TLI close to 1; RMSEA = 0.025. In addition, McDonald's ω, internal consistency, and Gutmann's λ6 ranged from 0.78 to 0.86 for all four scale dimensions., Conclusion: The PE-Grit scale displays adequate factor structure, good reliability, and acceptable concurrent validity and can be administered to assess Grit in physical education and sport students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Guelmami, Chalghaf, Tannoubi, Puce, Azaiez and Bragazzi.)

Context/Objective: This is a preliminary study of movement finalities prediction in manual wheelchairs (MWCs) from electromyography (EMG) data. MWC users suffer from musculoskeletal disorders and need assistance while moving. The purpose of this work is to predict the direction and speed of movement in MWCs from EMG data prior to movement initiation. This prediction could be used by MWC to assist users in their displacement by doing a smart electrical assistance based on displacement prediction. Design: Experimental study. Setting: Trained Subject LAMIH Laboratory. Participants: Eight healthy subjects trained to move in manual wheelchairs. Interventions: Subjects initiated the movement in three directions (front, right and left) and with two speeds (maximum speed and spontaneous speed) from two hand positions (on the thighs or on the handrim). A total of 96 movements was studied. Activation of 14 muscles was recorded bilaterally at the deltoid anterior, deltoid posterior, biceps brachii, pectoralis major, rectus abdominis, obliquus externus and erector spinae. Outcome Measures: Prior amplitude, prior time and anticipatory postural adjustments were measured. A hierarchical multi-class classification using logistic regression was used to create a cascade of prediction models. We performed a stepwise (forward-backward) selection of variables using the Bayesian information criterion. Percentages of well-classified movements have been measured through the means of a cross-validation. Results: Prediction is possible using the EMG parameters and allows to discriminate the direction / speed combination with 95% correct classification on the 6 possible classes (3 directions * 2 speeds). Conclusion: Action planning in the static position showed significant adaptability to the forthcoming parameters displacement. The percentages of prediction presented in this work make it possible to envision an intuitive assistance to the initiation of the MWC displacement adapted to the user's intentions.

Background: Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are "virtual pathways" facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals., Objective: The aim of this study is to characterize suicide-related webpages in the Italian language., Methods: The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term "suicidio" (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument., Results: A total of 65 webpages were included: 12.5% (8/64) were antisuicide and 6.3% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2%) and had informative content and purpose (39/64, 60.9%). Most webpages targeted adolescents as an age group (38/64, 59.4%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6%), included medical/professional supervision or guidance (45/64, 70.3%), lacked figures or pictures related to suicide (41/64, 64.1%), and did not contain any access restraint (62/64, 96.9%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword "suicide.", Conclusions: Specialized mental health professionals should try to improve their presence online by providing high-quality material., (©Wen Chen, Andrea Boggero, Giovanni Del Puente, Martina Olcese, Davide Prestia, Haitham Jahrami, Nasr Chalghaf, Noomen Guelmami, Fairouz Azaiez, Nicola Luigi Bragazzi. Originally published in JMIR Formative Research (https://formative.jmir.org), 11.11.2021.)

Background: The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa)., Objective: The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial., Methods: A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface., Results: At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study., Conclusions: The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia., Trial Registration: ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675., International Registered Report Identifier (irrid): DERR1-10.2196/12262., (©Leila Abid, Ikram Kammoun, Manel Ben Halima, Salma Charfeddine, Hedi Ben Slima, Meriem Drissa, Khadija Mzoughi, Dorra Mbarek, Leila Riahi, Saoussen Antit, Afef Ben Halima, Wejdene Ouechtati, Emna Allouche, Mehdi Mechri, Chedi Yousfi, Ali Khorchani, Omar Abid, Kais Sammoud, Khaled Ezzaouia, Imen Gtif, Sana Ouali, Feten Triki, Sonia Hamdi, Selim Boudiche, Marwa Chebbi, Mouna Hentati, Amani Farah, Habib Triki, Houda Ghardallou, Haythem Raddaoui, Sofien Zayed, Fares Azaiez, Fadwa Omri, Akram Zouari, Zine Ben Ali, Aymen Najjar, Houssem Thabet, Mouna Chaker, Samar Mohamed, Marwa Chouaieb, Abdelhamid Ben Jemaa, Haythem Tangour, Yassmine Kammoun, Mahmoud Bouhlel, Seifeddine Azaiez, Rim Letaief, Salah Maskhi, Aymen Amri, Hela Naanaa, Raoudha Othmani, Iheb Chahbani, Houcine Zargouni, Syrine Abid, Mokdad Ayari, Ines ben Ameur, Ali Gasmi, Nejeh ben Halima, Habib Haouala, Essia Boughzela, Lilia Zakhama, Soraya ben Youssef, Wided Nasraoui, Mohamed Rachid Boujnah, Nadia Barakett, Sondes Kraiem, Habiba Drissa, Ali Ben Khalfallah, Habib Gamra, Salem Kachboura, Leila Bezdah, Hedi Baccar, Sami Milouchi, Wissem Sdiri, Skander Ben Omrane, Salem Abdesselem, Alifa Kanoun, Karima Hezbri, Faiez Zannad, Alexandre Mebazaa, Samir Kammoun, Mohamed Sami Mourali, Faouzi Addad. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 27.10.2021.)

Background: In recent years, online disinformation has increased. Fake news has been spreading about the COVID-19 pandemic. Since January 2020, the culprits and antidotes to disinformation have been digital media and social media., Objective: Our study aimed to develop and test the psychometric properties of the 12-item Social Media Disinformation Scale (SMDS-12), which assesses the consumption, confidence, and sharing of information related to COVID-19 by social media users., Methods: A total of 874 subjects were recruited over two phases: the exploratory phase group had a mean age of 28.39 years (SD 9.32) and the confirmatory phase group had a mean age of 32.84 years (SD 12.72). Participants completed the SMDS-12, the Internet Addiction Test, the COVID-19 Fear Scale, and the 10-item Perceived Stress Scale. The SMDS-12 was initially tested by exploratory factor analysis and was subsequently tested by confirmatory factor analysis., Results: The test supported the three-factor structure. In addition, no items were removed from the measurement scale, with three factors explaining up to 73.72% of the total variance, and the items had a lambda factor loading ranging from 0.73 to 0.85. Subsequently, confirmatory factor analysis confirmed the robustness of the measure by referring to a wide range of goodness-of-fit indices that met the recommended standards. The construct validity of the scale was supported by its convergent and discriminant validity. The reliability of the instrument examined by means of three internal consistency indices, and the corrected item-total correlation, demonstrated that the three dimensions of the instrument were reliable: Cronbach α values were .89, .88, and .88 for the consumption, confidence, and sharing subscales, respectively. The corrected item-total correlation ranged from 0.70 to 0.78. The correlation of the instrument's dimensions with internet addiction and mental health factors showed positive associations., Conclusions: The SMDS-12 can be reliably utilized to measure the credibility of social media disinformation and can be adapted to measure the credibility of disinformation in other contexts., (©Noomen Guelmami, Maher Ben Khalifa, Nasr Chalghaf, Jude Dzevela Kong, Tannoubi Amayra, Jianhong Wu, Fairouz Azaiez, Nicola Luigi Bragazzi. Originally published in JMIR Formative Research (https://formative.jmir.org), 09.06.2021.)

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems., Competing Interests: The authors have declared that no competing interests exist.

Background: Pseudoaneurysm of inferior wall of the left ventricle is an uncommon complication of myocardial infarction with high mortality., Case Presentation: We report the case of a 63-year-old Tunisian man, diagnosed with a thrombosed left ventricular pseudoaneurysm and a pericardial effusion after 1 week of angina., Conclusions: Left ventricular pseudoaneurysm is a serious complication of myocardial infarction that has atypical presentations. Diagnosis is generally established by transthoracic echocardiography but confirmed by magnetic resonance imaging. Urgent surgery is the treatment choice given the risk of embolization and rupture.

Biomedical applications at high-energy particle accelerators have always been an important section of the applied nuclear physics research. Several new facilities are now under constructions or undergoing major upgrades. While the main goal of these facilities is often basic research in nuclear physics, they acknowledge the importance of including biomedical research programs and of interacting with other medical accelerator facilities providing patient treatments. To harmonize the programs, avoid duplications, and foster collaboration and synergism, the International Biophysics Collaboration is providing a platform to several accelerator centers with interest in biomedical research. In this paper, we summarize the programs of various facilities in the running, upgrade, or construction phase., Competing Interests: Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Aims: This study aimed to investigate the effects of the fear of COVID-19, level of physical activity, and gender on negative stress (distress) in an Arab population by means of structural equations based on partial least squares., Materials and Methods: The sample population comprised of 459 participants from four Arab countries (age M = 33.02, SD = 8.46; n = 237 women and n = 222 men). The level of education was basic (<9 years of study; n = 144), secondary/vocational (between 9 and 12; n = 178), and university ( n = 137). The "Fear of COVID-19" Scale, the short form of the "International Physical Activity Questionnaire," and the "Perceived Stress Scale" questionnaires were disseminated by emails and social networks via Google Forms. SMARTPLS software version 3.2.9 was used to model the relationships between the variables under study., Results: Results confirmed the links between level of physical activity, fear of COVID-19, and gender, showing a significant mediating effect of the fear of COVID-19 on the relationship between gender and general distress. The level of physical activity was also found to influence the fear of COVID-19, varying depending on gender. In addition, the model highlighted the presence of a moderation effect of the level of physical activity., Conclusion: Based on the model presented in the present study, we can conclude that the COVID-19 pandemic has a profound impact on psychological distress in the target populations. The impact of the level of physical activity on psychological distress is shown to be very important during the pandemic phase., (Copyright © 2020 Alsalhe, Aljaloud, Chalghaf, Guelmami, Alhazza, Azaiez and Bragazzi.)

The use of doping substances and methods is prevalent not only among elite athletes, but also among amateur athletes and other athletes. However, the abuse of substances and methods of doping has been associated with the occurrence of numerous adverse health effects. Cardiovascular effects are the most deleterious. The objective of this manuscript is to study through a review the literature, adverse cardiovascular effects after the abuse of substances and doping methods in athletes. Three major classes of products have more cardiovascular side effects; they are anabolic, stimulants and narcotics. It is possible to predict their use according to the desired objectives. Anabolic doping is used by sportsmen who practice strength sports, stimulants are used by those who practice speed sports, while endurance sportsmen prefer products that improve the transport of oxygen. Cases of myocardial infarction, hyperlipidemia, hypertension, venous thrombosis, arrhythmogenesis, heart failure and sudden cardiac death have been observed. The doping substances of varied nature seem to have adverse cardiovascular effects whose physiopathology remains a research and investigation track. Further randomized trials are needed to better understand the interaction of these doping substances taken in a combined way in athletes.

Background: Smoking cessation should be a priority for smokers, especially coronary patients., Aim: To study the place and effectiveness of acupuncture in smoking cessation in coronary patients., Methods: We conducted a prospective open-label study of 25 coronary smokers treated by acupuncture over a 10-month period, from June 2017 to March 2018. A 2-session protocol acupuncture weekly for three to five weeks, with a positive response. In order to evaluate the effectiveness of acupuncture, a questionnaire was completed by the doctor during the treatment, at three and six months after the end of the sessions. Positive response was defined by total cessation of smoking., Results: The average age of our patients was 55.5 years (33 to 77 years). The sex ratio of our population was 1.5 with a male predominance. All our patients had a coronary history. The average cigarette consumption was 22.7 pack-years on average. The results of our study showed that acupuncture allows the withdrawal of 5 smokers (20%) from the first session. After the fifth session, 60% of our patients stopped smoking. At the end of the treatment, 17 smokers (70%) stopped smoking completely. At 3 and 6 months of treatment, we observed a stabilization of smoking cessation and decrease rates., Conclusion: Smoking cessation is difficult to obtain whatever the therapeutic method used, which encourages us to strengthen preventive measures.

Background: Job satisfaction is largely associated with organizational aspects, including improved working environments, worker's well-being and more effective performance. There are many definitions regarding job satisfaction in the existing scholarly literature: it can be expressed as a positive emotional state, a positive impact of job-related experiences on individuals, and employees' perceptions regarding their jobs. Aims: No reliable scales in Arabic language to assess job satisfaction in the sports and physical education field exist.This study aimed to trans-culturally adapt and validate the Pepe's "Teacher Job Satisfaction Scale" 9 items (TJSS-9), creating the "Teacher of Physical Education Job Satisfaction Inventory" (TPEJSI) in Arabic language. This scale was administered to a Tunisian population of sports and physical education teachers and analyzed according to the Pepe's theoretical model. More in detail, this investigation systematically tested its factor structure, in terms of internal consistency/reliability, predictive validity, sensitivity and convergent validity. Methods: A total of 417 Tunisian teachers of sports and physical education participated voluntarily in this study. The sample comprised of 258 males and of 159 females. More in detail, 189 were teachers teaching in primary schools of physical education, 105 teaching in secondary schools, and 123 were university teachers. Both exploratory (EFA) and confirmatory (CFA) factor analyses were performed on random-split halves of the sample. Results: The three-dimensional alpha coefficients of the TPEJSI were all >0.80: for satisfaction with colleagues, alpha was 0.865; for satisfaction with parents, alpha was 0.856 and for satisfaction with students alpha was 0.860. The CFA fit indices were satisfactory. Conclusions: Given the good EFA factor loadings, the CFA fit indices, the correlation matrix, the sensitivity analysis, the convergent validity and the excellent internal consistency, it can be concluded that the TPEJSI is a good psychometric tool that can be used to quantitatively assess the job satisfaction level among teachers of sports and physical education in the Arabic-speaking world., (Copyright © 2019 Chalghaf, Guelmami, Re, Maldonado Briegas, Garbarino, Azaiez and Bragazzi.)

Background: As an optimal psychological state, flow represents those moments when everything comes together for the performer. Flow is often associated with high levels of performance and is a positive psychological experience. Aim: Our study aimed to validate the "Academic Flow Scale" (Flow 4D 16) in Arabic language across Tunisian population, and to test its factor structure, in terms of internal consistency/reliability, predictive validity, and sensitivity. Methods: The population is composed of 320 students (139 men and 181 women) belonging to the University of Sfax, with a mean age of 22.26 years. The students voluntarily responded to the scale of academic flow (Flow 4D 16). Both exploratory (EFA) and confirmatory (CFA) factor analyses were performed. Results: The four-dimensional alpha coefficients of the Flow 4D 16 indicate an excellent internal consistency, respectively, of 0.902 (Cognitive), 0.959 (Time), 0.974 (Ego) and 0.960 (Well-being). The CFA fit indices were satisfactory. Conclusion: In summary, the 16-items model (original version) showed for all the indices an excellent fit to the theoretical model, confirming the four-dimensional factor structure among Tunisian student population., (Copyright © 2019 Chalghaf, Azaiez, Krakdiya, Guelmami, Re, Maldonado Briegas, Zerbetto, Del Puente, Garbarino, Bragazzi and Azaiez.)

Introduction: Right ventricular (RV) dysfunction is one of the leading predictors of mortality and heart failure in chronic hemodialysis (HD) patients., Aim: To describe the different echocardiographic abnormalities of the RV in subjects with HD., Methods: We performed a descriptive cross-sectional study covering the period from July to October 2018; involving 42 patients treated with chronic HD. Patients underwent a conventional transthoracic echocardiographic (TTE) study supplemented with tissue Doppler between two hemodialysis sessions., Results: We included 42 patients. The sex ratio of our population was 1.6 with a male predominance, the average age of patients was 62.7 ± 12.4 years. The most important cardiovascular risk factor was arterial hypertension (78.6%). The most important causative nephropathy was nephroangisclerosis (31% of cases). The average age of dialysis was 34.5±30 months. Forty-two percent of our patients had RV dilation, 38% had right atrium dilatation, 7% had Right ventricular outflow tract dilatation, and 59.5% had RV hypertrophy. We noted RV systolic dysfunction in 66.7% of cases, a predominant normalized tricuspid profile with an average E / A ratio of 1.11 ± 0.5., Conclusion: Our study is consistent with the various echocardiographic data already raised in the literature, showing a high prevalence of RV dilatation and systolic dysfunction. It is one of the leading predictors of mortality and heart failure in chronic hemodialysis patients.

Background: Burnout is an inappropriate response to chronic work stress, leading to emotional exhaustion (EE), depersonalization (D), and low personal accomplishment (PA). Burnout can affect workers in the helping professions. To quantitatively assess the burnout level among teachers, Maslach has adapted the "Maslach Burnout Inventory" (MBI) to the educational environment (the so-called MBI Educators Survey version or MBI-ES). Among teachers, sports and physical education teachers may suffer from burnout due to high workload. Aims: No reliable psychometric tool in Arabic language exists that can be used to measure the burnout level among sports and physical education teachers. The objective of the present study was to develop a burnout measurement scale according to the Maslach's three-dimensional theoretical model for physical education teachers in Tunisia and to test its factor structure, in terms of internal consistency/reliability, predictive validity, and sensitivity. Methods: A total of 525 Tunisian teachers teaching in secondary schools from different Tunisian governorates volunteered to participate in this study. The sample comprised of 285 males (54.3%) and of 240 females (45.7%). More in detail, 327 were teachers of primary school of physical education (62.3%) and 198 teachers of secondary school (37.7%). Teachers were administered both the ad hoc developed "Teacher of Physical Education Burnout Inventory" (TPEBI) and the MBI-ES. Both exploratory [principal component analysis (PCA)] and confirmatory factor analyses (CFAs) were performed. Results: The Cronbach's alpha coefficients were excellent (0.93, 0.94, and 0.91 for EE, D, and PA, respectively). The correlation matrix indicated significant correlations between the TPEBI and MBI-ED dimensions. However, CFA fit indices were not completely satisfactory. Conclusion: Given the good PCA factor loadings, the correlation matrix, the sensitivity analysis, and the excellent internal consistency, it can be concluded that the TPEBI is a reliable psychometric tool that can be used to quantitatively assess the burnout level among teachers of physical education in the Arabic-speaking world. However, considering the CFA fit indices, further modifications to fully support the model are warranted.

Background: Unprotected left main (LM) coronary artery disease (CAD) represents a challenging lesion with a major prognostic impact., Aim: Evaluate the clinical outcome and major adverse cardiac events (MACE) predictors of unprotected LM percutaneous coronary intervention (PCI) in an "all-comers" population., Methods: We performed a prospective observational study of patients with unprotected LM stenosis treated by PCI. MACE were defined as the composite endpoint of all-cause death, myocardial infarction and target lesion revascularization., Results: From January 2012 to December 2017, 150 consecutive patients who underwent unprotected LM PCI were included. The mean age was 64±12 years and 75.3% were males. Diabetes was noted in 50.7%. Emergent revascularization was performed in 20.7% of cases, including 3.3% patients with cardiogenic shock. Distal LM was involved in 76.7% of cases. A majority of patients (94.0%) had low or intermediate SYNTAX Score I (≤32). The median SYNTAX score II was 31.1. Drug-eluting stents were used in 78.7% and bare metal stents in 21.3% of patients, mainly in emergent setting where the former were unavailable. In distal LM PCI, provisional approach was mostly used (81.7%). The median follow-up was 13.4 months. MACE occurred in 23.3% with an estimate of 37.9% at 5 years. Significant predictors of MACE were cardiogenic shock, bare metal stents use, previous PCI, and SYNTAX score II ≥30., Conclusion: Unprotected LM PCI presents encouraging short and long term outcomes. SYNTAX score II might represent a predictor for long-term outcome in this particular lesion subset.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuro-developmental/behavioral disorders among adolescents. Sport and physical activity seem to play a major role in the development of cognition, memory, selective attention and motor reaction time, especially among adolescents with ADHD. In this context, the objective of this study was to investigate the effects of a one-and-a-half-year-long Taekwondo (TKD) intervention on cognitive function in adolescents with ADHD. Two cognitive instruments, namely the Stroop and the Ruff 2 and 7 tests, were administered to assess attentional inhibitory control and sustained and selective visual attention, respectively. Comparisons between the TKD and control groups at baseline did not reveal significant differences. For post-test scores, there were statistically significant differences on the Stroop color block test (large effect size or ES = 1.26 [95% confidence interval or CI 0.30⁻2.22]), the color-word interference test (large ES = 2.16 [95% CI 1.10⁻3.26]), the interference test (large ES = 1.63 [95% CI 0.62⁻2.64]) and error (large ES = -2.20 [95% CI -3.31 to -1.10]). Similar trends were reported for the Ruff 2 and 7 automated detection trials (large ES = 2.78 [95% CI 1.55⁻4.01]), controlled search trials (large ES = 2.56 [95% CI 1.38⁻3.75]) and total speed (large ES = -2.90 [95% CI -4.15 to -1.64]). In conclusion, TKD practice increased selective attention in adolescents with ADHD. Practitioners should implement martial art programs in their general plans to favorably influence attention and health in adolescents with ADHD.

Objectives: To examine (a) the relationships between the psychosocial risk factors and injury rates and (b) the effects of psychological-based prevention interventions on the injury risk of soccer players., Design: Scholarly electronic databases (PubMed/MEDLINE, Google Scholar, Scopus) were searched on 1 January 2017, complemented by manual searches of bibliographies., Setting: Systematic review and meta-analysis., Participants: We identified 13 eligible studies, including a total of 1149 injured soccer players aged between 14 and 36 years., Main Outcome Measures: Psychosocial risk factors, psychological-based prevention interventions and injury risk in soccer players., Results: Personality traits, such as trait anxiety and perceived mastery climate, along with a history of stressors, like negative-life-event stress or high level of life stress, daily hassle, and previous injury, are the main predictors of injury rates among soccer players. Also, from injury prevention studies, it has been shown that psychological-based interventions reduce injury rates (effect size = 0.96; 95% CI 0.34-1.58; p = 0.002) in senior soccer players., Conclusions: Practitioners need to ensure injured soccer players are psychologically and socially ready to play. They should also employ psychological-based interventions (i.e., mindfulness, imagery, self-talk, stress management, relaxation, goal setting) when designing injury prevention programs., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Arm-trunk coordination during the initiation of displacement in manual wheelchair is a complex task. The objective of this work is to study the arm-trunk coordination by measuring anticipatory and compensatory postural adjustments. Nine healthy subjects participated in the study after being trained in manual wheelchair. They were asked to initiate a displacement in manual wheelchair in three directions (forward vs. left vs. right), with two speeds (spontaneous vs. maximum) and with two initial hand's positions (hands on thighs vs. hands on handrails). Muscular activities in the trunk (postural component) and the arms (focal component) were recorded bilaterally. The results show two strategies for trunk control: An anticipatory adjustment strategy and a compensatory adjustment strategy with a dominance of compensation. These two strategies are influenced by the finalities of displacement in terms of speed and direction depending on the hands positions. Arm-trunk coordination is characterized by an adaptability of anticipatory and compensatory postural adjustments. The study of this type of coordination for subjects with different levels of spinal cord injury could be used to predict the forthcoming displacement and thus assist the user in a complex task., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Shape parameters of a weakly deformed ground-state band and highly deformed slightly triaxial sideband in ^{42}Ca were determined from E2 matrix elements measured in the first low-energy Coulomb excitation experiment performed with AGATA. The picture of two coexisting structures is well reproduced by new state-of-the-art large-scale shell model and beyond-mean-field calculations. Experimental evidence for superdeformation of the band built on 0&#95;{2}^{+} has been obtained and the role of triaxiality in the A∼40 mass region is discussed. Furthermore, the potential of Coulomb excitation as a tool to study superdeformation has been demonstrated for the first time.

Giant resonances are collective excitation modes for many-body systems of fermions governed by a mean field, such as the atomic nuclei. The microscopic origin of such modes is the coherence among elementary particle-hole excitations, where a particle is promoted from an occupied state below the Fermi level (hole) to an empty one above the Fermi level (particle). The same coherence is also predicted for the particle-particle and the hole-hole excitations, because of the basic quantum symmetry between particles and holes. In nuclear physics, the giant modes have been widely reported for the particle-hole sector but, despite several attempts, there is no precedent in the particle-particle and hole-hole ones, thus making questionable the aforementioned symmetry assumption. Here we provide experimental indications of the Giant Pairing Vibration, which is the leading particle-particle giant mode. An immediate implication of it is the validation of the particle-hole symmetry.