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• Field experiment in mandatory recycling scheme tests effectiveness of door stepping. • Majority of households in mandatory recycling schemes separates waste correctly. • Minority of households is responsible for most miss sorting. • Door stepping does not influence behavior of households in mandatory schemes. • Door stepping can improve recycling behavior in voluntary recycling schemes. Household organic waste has great potential for closing nutrient cycles in agriculture. This requires proper waste separation by households. Personal communication at the doorstep potentially improves household waste separation behaviour but it is expensive and findings from existing research are mixed. Based on results of previous studies and from a quasi-experiment with non-equivalent groups design in two German municipalities, this paper argues that efficiency of personal communication depends on its context. It can positively influence behaviour when recycling is voluntary and participation rates are low. However, it has no significant effects if recycling is mandatory. One explanation could be different perceptions of recycling in mandatory and voluntary schemes. In voluntary schemes door stepping can activate the intrinsic motivation of households. In mandatory schemes, all households need to participate irrespective of intrinsic motivation. This research shows that this creates a situation in which a small share of households is responsible for almost all contamination. This can be overcome by considering extrinsic factors that affect recycling behaviour. The paper recommends further research to understand which combination of incentives, sanctions and information is efficient in affecting behaviour change in mandatory recycling schemes. [ABSTRACT FROM AUTHOR]

• Integrating OMO learning into high school physics enhances problem-solving skills. • Offline and online experiments offer macroscopic and microscopic experimental phenomena. • OMO learning enhances students' reflective capacity and cognitive tool application. • Cognitive tools aid students in understanding problem structures and fostering systematic thinking. • Virtual environment testing enhances students' strategic and decision-making capabilities. Online-merge-offline (OMO) learning in a hybrid learning space is becoming a popular pedagogy to enhance students' blended learning using appropriate technology. This investigation delves into the impact of OMO learning on developing physics problem-solving skills among high school students. A ten-week intervention employing OMO learning is implemented with 34 participants in both the experimental and control groups at a high school in Hangzhou, China. The efficacy of OMO learning is assessed through a quasi-experimental design encompassing pre- and post-assessments. The findings of this inquiry reveal: (1) The experimental group's physics problem-solving abilities are significantly impacted by OMO learning; (2) the use of cognitive tools rationally, the integration of online and offline collaborative learning, rich learning resources, and heuristic teaching all help students become more adept at solving physics problems; and (3) the cognitive load, students' lack of prior knowledge, poor self-regulation, and lack of help-seeking techniques all work against the improvement of students' physics problem-solving abilities. Suggestions are made in line with the research results and aims. [ABSTRACT FROM AUTHOR]

Internationalization at home strategies seek to achieve a more inclusive and equitable higher education. Evidence about the impact of these strategies on students' self-efficacy is still scarce, even though this psychological construct is essential for the performance and well-being of nursing students. The Global Nursing Care program was designed to provide nursing students with an internationalization at home experience, combining a virtual exchange and international clinical simulation. To determine the impact of the Global Nursing Care program on nursing students' self-efficacy. A quasi-experimental, analytic, and longitudinal study was conducted. Settings and participants: The virtual module was carried out online, and the international simulations were developed in the Simulation Centers of the San Juan de Dios School of Nursing and Physiotherapy (Universidad Pontificia Comillas, Spain) and the West Coast University (USA). Seventy students participated in the program and 57 completed the pre-post questionnaire. Data were collected using an online survey that included a sociodemographic questionnaire and the General Self-efficacy Scale. IBM's SPSS (version 28.0.1.1) was used to analyze data. Differences between self-efficacy levels were measured before and after the program, and according to sociodemographic characteristics. General self-efficacy was significantly augmented following program participation (pre-intervention: mean = 32.39, SD = 3.87; post-intervention: mea n = 34.44, SD = 3.86; p < 0.001). No differences based on nationality, previous international academic experience or academic year were found. An internationalization at home program based on virtual exchange and simulation improves nursing students' general self-efficacy. Future research can explore to what extent this effect persists over time. • Virtual exchange and simulation are useful for internationalization in nursing. • A combination of simulation and virtual exchange improves general self-efficacy. • Students in the program show higher self-efficacy after the intervention. • This program impacts nursing students beyond intercultural competence. [ABSTRACT FROM AUTHOR]

• High concentrations of NO 2 prompted the city of Munich to ban older diesel vehicles. • A quasi-experimental approach showed small, uncertain reductions in NO 2 levels. • Selectively banning older vehicles likely reduced the ban's effectiveness. • Exemptions and enforcement uncertainties may have further limited the impact of the ban. • Further research on policy design and monitoring is needed to guide future decisions. The current limit on NO 2 concentrations of 40 μg/m3, set by the European Union, has been regularly exceeded in Munich, Germany. This limit will likely be reduced towards the WHO recommended target of 10 μg/m3. Against this backdrop, the city implemented a selective diesel vehicle ban within the existing low-emission zone in February 2023, targeting Euro 4 and older diesel vehicles. Our study investigated the effect of Munich's selective diesel vehicle ban on NO 2 concentrations, focusing on the half-year period following its implementation. Our study utilized a synthetic control approach (primary analysis) and a controlled interrupted time series approach (secondary analysis). These quasi-experimental methodologies create a 'counterfactual' no-intervention scenario, enabling comparison between observed and counterfactual scenarios to estimate an intervention effect. We employed historical controls, using routine data from multiple monitoring stations located within and outside the low-emission zone for 2014 to 2022, and considered possible confounders. NO 2 concentrations within Munich's low-emission zone showed overall declining trends from August 2014 to July 2023. Effects of the selective diesel vehicle ban were small and wide confidence intervals indicate large uncertainty in the magnitude and direction of the effect. At Landshuter Allee, the average intervention effect was −2.67 μg/m3 (95 %-CI = [-12.72; 7.38]), at Stachus it was −2.74 μg/m3 (95 %-CI = [-9.91; 4.42]), and at Lothstrasse it was −1.03 μg/m3 (95 %-CI = [-7.75; 5.69]). The secondary analysis confirmed these findings, reinforcing uncertainty about the effect of the intervention. Our study suggests that Munich's selective diesel vehicle ban had a limited effect on lowering NO 2 concentrations. Possible explanations include the ban's focus on Euro 4 and older diesel vehicles, many exemptions to the selective ban, and unclear enforcement. This highlights that comprehensive approaches and ongoing, well-designed monitoring and evaluation are crucial for addressing urban air pollution and protecting public health. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effect of enhanced reality simulation on nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Breast cancer is a common disease with increasing incidence and mastectomy is the treatment of choice. Postmastectomy patient care is a multidimensional and complex process. For various reasons, nursing students today graduate with inadequate clinical skills and do not have experience with many cases. This quasi-experimental study was conducted using a pretest–posttest design with a nonequivalent control group. This study was conducted with fourth-year nursing students (78 students). Students were allocated to each group through a simple random allocation using IBM SPSS Statistics version 24. Research data were collected at the Clinical Simulation Training Center of the university in 2020–2021 academic year. The study group (n=39) learned using a scenario-based learning approach with moulage in a real clinical setting using enhanced reality simulation, while the control group (n=39) learned using the same scenario-based approach with the routine practice adult standard patient care model. The data were collected through the "Student Sociodemographic and Descriptive Characteristics Data Collection Form", the "Student Satisfaction and Self-Confidence in Learning Scale", the "Postmastectomy Patient Care Skills Checklist" and the "Pre–Post Knowledge Test on Postmastectomy Patient Care Management". All 78 participants completed the training course. The training significantly increased the Student Satisfaction and Self-Confidence in Learning Scale subdimension scores of both groups (p<0.05). The Postmastectomy Patient Care Management scores of the study group students who received enhanced reality simulation training significantly increased (p<0.05), while there was no significant effect on the scores of the control group students (p>0.05). While most the students in the study group increased their rates of correct answers to Postmastectomy Patient Care Management questions significantly (p<0.05) after the enhanced reality simulation training, the students in the control group showed no significant improvement (p>0.05). The training significantly (p<0.001) increased the mean postmastectomy patient care skills control scores. This increase had a high effect size on the study group. Enhanced reality simulation is a learning method that increases nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Learning with enhanced reality simulation is an effective approach for nursing education that improves nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. • ERS can enhance nursing students' satisfaction and self-confidence while learning post-mastectomy patient care management. • ERS significantly improves nursing students' knowledge and skills on postmastectomy patient care management. • Using ERS for postmastectomy patient care management practice in nursing education is an effective approach. [ABSTRACT FROM AUTHOR]

This paper empirically demonstrates the value of quasi-experimental study designs to evaluate the direct impacts of new public transit services on ridership within its corridor. Using a new bus rapid transit (BRT) service, CMAX, in Columbus, Ohio, USA, as an example, we compare its impact on ridership based on a pre-post and quasi-experimental analysis framework. We conduct the pre-post analysis using a ridership space-time cube exploring a massive Automatic Passenger Counter (APC) database. Differences in total passenger counts before and after the BRT intervention indicate a 36% increase in ridership within its corridor. However, this patronage increase may not be attributable solely to the new public transit service. Potential confounding effects include systemwide ridership trends and a new unlimited transit pass program for downtown workers. To address these issues, we adopt a quasiexperimental study design with a difference-in-differences (DiD) identification strategy. We use propensity score matching (PSM) to match a counterfactual control group with the treatment group when implementing DiD model. After accounting for confounding effects, we find a less than 5% increase but not statistically significant impacts of CMAX on ridership. Our results support the argument that a simple pre-post analysis ignoring confounding effects can lead to a misleading evaluation of a new public transit service's direct impact on ridership. [ABSTRACT FROM AUTHOR]

This study aims to provide practice-oriented evidence regarding the implementation of healthcare data analytics and its impact on the use of new data analytics tools and relevant analytical skills improvement. A quasi-experimental pre-test/post-test controlled study was conducted in a large medical system in the eastern United States. Healthcare data analytics training program participants (N = 21) and a comparison group comprising trainee-identified peers completing comparable work (N = 27) were compared at the start of training and one year later. Results showed that both trainees and peers demonstrated improved healthcare data analytics skills over time, related to concomitant increases in their healthcare data analytics-related learning and performance goals. This study suggests that healthcare organizations aiming at successfully implementing a new data analytics infrastructure should provide well-designed training that enables trainees to develop specific learning and performance goals as well as improve relevant skills and ability to use new tools. [ABSTRACT FROM AUTHOR]

Chinese elders are under high threats of seasonal influenza, while showing low influenza vaccination coverage comparing with other countries. The study explored the impacts of free vaccination policy and associated factors on influenza vaccination behavior of the elderly in Zhejiang Province, China, offering a guidance of interventions for protecting elders from seasonal influenza. 1210 elders ≥60 years were conveniently recruited between July and September of 2019. 607 of them were sampled from 6 counties with free vaccination policy, while the other 603 elderly people were sampled from another 6 comparable counties without the policy. A self-reported questionnaire, involving socio-democratic information, physical status and behavior, influenza knowledge, vaccination awareness, relatives of healthcare workers, and vaccination behavior, was completed by elders under supports of research assistants. Chi-square tests and logistic regression analyses were performed to explore the impacts of research factors. A total of 464 (38.3%, 95%CI: 36.9–39.7%) elders claimed that they got vaccinated, and the vaccination coverages of elders in the counties with and without free vaccination policy were 68.4% (95%CI: 64.7–72.1%) and 8.1% (95%CI: 5.9–10.3%), respectively. Protective and risk factors of vaccination behavior were identified, including free vaccination policy (OR step = 27.29, 95%CI: 18.69–39.82), positive vaccination awareness (OR step = 7.93, 95%CI: 5.50–11.43), catching cold frequently (OR step = 2.00, 95%CI: 1.32–3.05), and having relatives of healthcare workers (OR step = 0.56, 95%CI: 0.34–0.93). Age, education level, monthly income, family structure, physical status, and influenza knowledge were significantly associated with vaccination behavior. Having relatives of healthcare workers may indirectly affect vaccination behavior through vaccination awareness. Free vaccination policy plays the most fundamental role of improving vaccination coverage among studied factors. To protect elders from seasonal influenza, effective measurements, such as issuing free vaccination policy, enriching influenza knowledge, and guiding positive vaccination awareness for both elders and healthcare professionals are recommended to be included into influenza immunization strategies. [ABSTRACT FROM AUTHOR]

There is a need for globally competent nurses; however, some cannot train abroad. Internationalization at home strategies seek to teach intercultural and international competencies to all students, regardless of location. This study evaluated the impact of a virtual exchange and clinical simulation program on nursing students' cultural intelligence. The Global Nursing Care (GNC) program was designed to improve nursing students' global competencies, particularly cultural intelligence. It was implemented in two universities in Spain and the USA. A quasi-experimental, analytic, and longitudinal study involved 261 nursing students, 57 from the GNC program and 204 in the control group. Sociodemographic data were collected, and the Cultural Intelligence Scale was used to measure cultural intelligence. All cultural intelligence dimensions were augmented following program participation. Moreover, students who participated in the program presented higher cultural intelligence than the control group. The results suggest that program participation was associated with a statistically significant gain in nursing students' cultural intelligence. • An internationalization at home program (simulation + virtual exchange) was created. • Every cultural intelligence (CQ) dimension is higher after completion of the program. • The level of improvement is similar in Spanish and U.S. nursing students. • Program students show higher CQ than the control group. • Our combination of simulation and virtual exchange improves CQ. [ABSTRACT FROM AUTHOR]

• Simulation-based learning positively influences nursing students' perception of their competencies in evidence-based practice (EBP). • Simulation supports critical thinking and encourages the rational use of evidence-based care. • Simulation training significantly improves nursing students' EBP skills and knowledge. • Simulation improves students' perception of EBP and creates a motivating connection to scientific evidence for practical purposes. Clinical simulation provides a safe learning environment and enhances the clinical and non-technical skills of students in Nursing. Meanwhile, evidence-based practice is crucial as it involves utilizing the best available research to deliver high-quality care. This study aimed to evaluate the impact of high-fidelity simulation (HFS) on nursing students' acquisition of evidence-based practice (EBP) competencies. A quasi-experimental study was conducted with third-year undergraduate nursing students using a non-randomized intervention group. Questionnaires were used to collect socio-demographic and academic data and assess students' EBP competence. EBP competence was compared before and after implementing an HFS training program. The results showed a significant improvement in EBP competence after HFS training. Students showed a statistically significant increase in EBP-related knowledge and skills after the HFS training program. HFS enables the improvement of evidence-based practice competency in nursing students. Clinical simulation-based training improves the evidence-based practice of student nurses as it can promote evidence-based practice and thus improve the quality of patient care. [ABSTRACT FROM AUTHOR]

The nursing education system has changed with the increased emphasis on patient safety in healthcare settings. Early education in patient safety is crucial to preparing nurses to be competent in patient care. Therefore, providing undergraduate patient safety education courses using an innovative approach is essential to enhancing patient safety and quality in nursing care. This study aimed to examine the effects of a patient safety course using a flipped classroom approach on patient safety competency among undergraduate nursing students in South Korea. A pre- and post-test quasi-experimental design with a non-equivalent control group was adopted. This study was conducted in the college of nursing at a university in Seoul, South Korea. A total of 75 undergraduate nursing students participated. All students enrolled in the patient safety course comprised the experimental group (n = 32); those with similar characteristics to the experimental group (age, gender, and year) but did not take the course comprised the control group (n = 43). A total of 14 sessions (28 h) addressing the topics from the World Health Organization patient safety curriculum guide were delivered using a flipped classroom approach. The teaching methods included online learning and quizzes, case studies, small and large discussions, incident report tasks, and group projects including the development of strategies for patient safety. A survey including a demographic questionnaire and the Patient Safety Competency Self-Evaluation tool was administered at the beginning and end of the fall semester. Pre- and post-test results demonstrated a significant increase in students' patient safety competency including attitude, skills, and knowledge. Mean scores of patient safety competency in the experimental group were significantly higher than in the control group. The flipped-classroom patient safety course was shown to be effective in improving patient safety competency in terms of attitude, skills, and knowledge among undergraduate nursing students. [ABSTRACT FROM AUTHOR]

This quasi-experimental study investigates the impact of enhancing metacognition in learning inferential reading skills in English as a second language. Six Grade 4 classes were randomly assigned to two groups. The "Control group" received an instructional unit on inferential reading skills. The "Metacognition group" received the same unit, including metacognitive activities. Students were assessed in metacognitive and inferential reading skills before (pre-test), immediately after (post-test) and four weeks after the intervention (deferred test). Metacognitive strategy instruction enhanced student learning of inferential reading skills and its sustainability in time. The Metacognition group attained a significantly higher average score in deploying metacognitive skills both in the post and deferred tests, indicating that the intervention was effective, as intended, to this end. While both groups significantly improved their proficiency in inferential reading skills after working with the provided instructional unit, there was a significant difference in the Metacognition group, which outperformed the Control one, even more strongly in the deferred test. Findings support the importance of deliberately promoting metacognition as it positively impacts learning outcomes and sustainability. [ABSTRACT FROM AUTHOR]

Abstract Background The air quality management policy was introduced in Seoul and Incheon metropolitan cities in the Republic of Korea, from 2005 to 2014. Despite particulate matter concentrations decreasing after policy implementation, the consequent health benefits have not been evaluated. Therefore, we evaluated the effects of the air quality management policy on cause-specific mortality rates in Seoul and Incheon. Methods Using interrupted time series analysis with a generalized Poisson regression model, we compared daily average mortality rates before (baseline, 2004–2005) and after (2006–2007, 2008–2009, 2010–2011, 2012–2013) the policy implementation. To account for the long term mortality trends, we weighted daily mortality rate of Seoul and Incheon with daily mortality rate of Daejeon (another metropolitan city with no air quality management policy implemented during the same period). Results Decline in the particulate matter concentration was greater in Seoul and Incheon than in Daejeon. After adjusting for potential confounders, there were 8% decrease in cardiovascular disease mortality rates and 10% decrease in cerebrovascular disease mortality rates in Seoul in 2012–2013 compared to the baseline period. In Incheon, an 8% reduction in cerebrovascular disease mortality rates in 2012–2013 was calculated. There was no change in mortality rates due to external causes or respiratory disease after policy implementation. Conclusions Our study suggests that the air quality management policy was effective in reducing cardiovascular and cerebrovascular mortality rates in Seoul and cerebrovascular mortality rates in Incheon. Highlights • The air quality management policy was introduced in Seoul and Incheon cities in the Republic of Korea. • We used interrupted time series analysis to evaluate the health effects of the policy. • There were decrease in cardiovascular and cerebrovascular disease mortality after the policy implementation. • The policy was associated with improvements of both air quality and health. [ABSTRACT FROM AUTHOR]

While there's a growing body of research studying the health effects of minimum wage increases, evidence of its impact on smoking is inconsistent. Using nationally representative statistics, our quasi-experimental study examines the impacts of South Korea's 2018 minimum wage increase on smoking patterns, offering a distinctive context due to the significant wage growth and the country's permissive smoking culture. Using the Korean Welfare Panel Study (KOWEPS), we conducted a difference-in-differences analysis using two-way fixed effect (TWFE) and Callaway and Sant'Anna Difference-in-differences (CSDID) methods. The study sample (n = 3494) included individuals aged 19–64 at baseline in 2016, and employed in the entire study period (2016–2019). The model results suggest a roughly 2% increase in the probability of current smoking with an insignificant impact on average daily cigarette consumption following the 2018 minimum wage increase in Korea. These effects were most pronounced among men and age groups (45–64). We also found policy effects on those earning up to 150% of the minimum wage. In a culture with widespread acceptance of smoking, an exogenous increase in disposable income due to elevated minimum wage might enhance vulnerability to societal pressure to smoke. Although TWFE and CSDID both suggest the same overall trend, the latter approach allows a more detailed examination by acknowledging heterogeneous treatment effects. These results could guide policymakers to contemplate the potential for increased smoking resulting from minimum wage hikes in societies where tobacco use is common, and accordingly strategize anti-smoking public health initiatives. • High smoking prevalence in men is linked to ingrained cultural norms of Korea. • Korea had a large (16.4%) increase in minimum wage in 2018. • We conducted a quasi-experimental study using difference-in-differences. • The minimum wage hike led to a 2% increase in the probability of smoking. • Men and those aged 45-64 were most affected. [ABSTRACT FROM AUTHOR]

The educational underachievement of foster children has long been known and interventions aiming to improve school achievements in this population are highly warranted. The Skolfam model is a Swedish preventive approach with the primary goal to improve school performance among foster children. This quasi-experimental study aimed to explore the effects of Skolfam in comparison with the effects of ordinary support from the local community among foster children in Sweden. The study comprised one baseline assessment and one follow-up assessment, including both psychological and pedagogical outcome measures. In total, 91 foster children were included, of which 54 participated in the intervention group (Skolfam) and 37 participated in the comparison group. Children who had been given support in accordance with Skolfam showed minor improvements with weak effects on perceptual reasoning, general cognitive ability and literacy skills relative to the comparison group. These improvements were found regardless of gender, native language, signs of intellectual deficiency or having been replaced in a new foster home and/or in other societal care. For foster children in Sweden, the Skolfam model could be considered promising in improving school performance and may serve as a protective factor against adverse outcomes. Given the limited sample size, further research on this topic should be conducted before firm conclusions are drawn. [ABSTRACT FROM AUTHOR]

Parents and children experiencing an episode of homelessness face a variety of adverse factors that can increase their risk of difficult relationships and even child maltreatment. Parent support programs have been suggested as one way to strengthen parent-child relationships and decrease risk of child maltreatment for this vulnerable population, but such programs have not been rigorously evaluated. This study was designed to investigate if Circle of Parents, a self-help support group developed to decrease child maltreatment, was a feasible, acceptable, and effective intervention for parents residing in shelters ( N = 80). The investigation utilized a quasi-experimental design using propensity score analysis with a services-as-usual comparison group. The Protective Factors Survey (PFS) and a client satisfaction questionnaire served as the primary outcome measures and group facilitators provided information about feasibility of the intervention within shelters. Promising evidence was found for the acceptability and feasibility of Circle of Parents. However, analyses of PFS data showed little difference between the intervention and services-as-usual comparison groups. Overall, findings pointed to emerging positive findings but underscored the need for continued controlled examination of the effectiveness of Circle of Parents implemented in shelters and transitional housing. [ABSTRACT FROM AUTHOR]

To examine the effects of Chinese culture-adapted dignity therapy on dignity-related and psychological, spiritual distress and family function for advanced cancer patients receiving chemotherapy in the day oncology unit. This is a quasi-experimental study. Patients were recruited from a day oncology unit at a tertiary cancer hospital in Northern China. A total of 39 patients agreeing to participate were assigned to receive Chinese culture-adapted dignity therapy (intervention group, n = 21) or supportive interview (control group, n = 18) according to their admission time. Patients' dignity-related, psychological, spiritual distress, and family function were assessed at baseline (T0) and after completing the intervention (T1) and the scores were compared between and within the groups. Besides, the interviews were conducted with patients at T1 to obtain their feedback, which were analyzed and integrated with the quantitative results. There was no statistical significance in all outcomes at T1 between the two groups, as well as in most outcomes between T0 and T1 in the intervention groups except for the relieved dignity-related distress (P = 0.017), especially the physical distress (P = 0.026), and the improved family function (P = 0.005), especially the family adaptability (P = 0.006). The synthesized quantitative and qualitative results showed that the intervention could relieve physical and psychological distress, enhance the sense of dignity, and improve the spiritual well-being and family function of patients. The Chinese culture-adapted dignity therapy showed positive effects on the life experiences of patients receiving chemotherapy in the day oncology unit and their family, and it might be a suitable, indirect communication prompt for Chinese families. • Early receiving psychological support is recommended for advanced cancer patients receiving chemotherapy in outpatient settings. • The quantitative and qualitative methods were used for effect evaluation of Chinese culture-adapted dignity therapy. • C-DT could promisingly relieve sufferings of patients receiving chemotherapy in a day oncology unit. • C-DT could promisingly improve family functions in the family-cultural context in China. • C-DT could be viewed as an indirect communication prompt in Chinese families. [ABSTRACT FROM AUTHOR]

• Little is known about real-world effects of initiating insulin pump therapy (IPT). • IPT, on average, reduces HbA 1c and HbA 1c variability, compared with injections. • IPT, on average, increases the risk of hospitalised diabetic ketoacidosis. • IPT, on average, does not affect the risk of hospitalised severe hypoglycaemia. • Women, older individuals, and the higher educated benefit most from initiating IPT. We aimed to estimate effects of insulin pump therapy (IPT) on HbA 1c level, HbA 1c variability, and risk of hospitalised diabetic ketoacidosis (DKA) and severe hypoglycaemia (SH), compared with multiple daily insulin injections (MDI). We identified a cohort of all adults with type 1 diabetes in Denmark using national registry data and assigned each individual to either IPT (treatment) or MDI (control) from 2010 to 2020. We estimated average treatment effects on the treated (ATT) and treatment effects among population subgroups using treatment-staggered difference-in-differences. The cohort consisted of 26,687 individuals with a collective 243,601 person-years of observation; 38,823 (16 %) were IPT person-years. We identified an ATT for HbA 1c of −0.33 % (95 % CI −0.39 to −0.27; −3.6 mmol/mol [95 % CI −4.2 to −2.9]). ATTs were larger among women and individuals who were older, had highest baseline HbA 1c , and used continuous glucose monitoring. ATT for HbA 1c variability (−0.016 % [−0.028 to −0.0041); −0.17 mmol/mol [95 % CI −0.30 to −0.045]) corresponded to a 6.5 % decrease in the standard deviation of HbA 1c. ATTs for DKA and SH corresponded to 0.52 additional and 0.11 fewer hospitalisations per 1,000 person-years, respectively. IPT significantly reduced HbA 1c level and variability, compared with MDI. However, it also marginally increased the risk of hospitalised DKA. [ABSTRACT FROM AUTHOR]

Developing second language (L2) listening skills is one of the goals in L2 teaching and learning. Despite its importance, there are insufficient empirical studies experimenting with teaching methodologies for L2 listening in actual classroom settings. Even less information can be found regarding the effects of a widely supported teaching approach, task-based or task-supported language teaching, on L2 listening proficiency. Adopting a quasi-experimental (pre-post-test) design, this study investigated the effects of task-supported language teaching (TSLT) and a post-task self-reflection technique on the listening proficiency development of 60 English-as-a-foreign-language (EFL) learners in a semester-long course at a university in China. Besides the statistical analyses of the pre-test and post-test scores, the learners' input in the self-reflection worksheets with open-ended questions was qualitatively analysed. Their perceptions, captured by an open-ended survey, together with the instructor's interview data, were also analysed to triangulate and supplement the other data sources. The findings revealed the positive influence of TSLT on L2 listening proficiency development and the positive viewpoints of the stakeholders. Self-reflection, however, was not so effective in enhancing L2 listening proficiency. The findings contribute to teaching and learning L2 listening with suggestions revolving around issues related to task design, implementation, and teaching procedures. [ABSTRACT FROM AUTHOR]

• Explanatory mixed-method design. • Quasi-experimental approach for two critical thinking courses' effectiveness: one independent, one embedded. • The objective test tool for critical thinking skills was created and validated in the study context for cultural sensitivity. • Opportunities to apply critical thinking skills in problem-solving influence course effectiveness. • Taking a critical thinking course increases the students' awareness of critical thinking skills and motivation to practice deliberately. Collegiate critical thinking skills are taught via independent courses or embedded modules, but effectiveness of instruction methods needs further study. Our study adopted a pre- and post-test quasi-experimental design with intervention and control groups to explore effectiveness of independent and embedded critical thinking modules at two Chinese universities. Embedded critical thinking modules had a significant, positive effect on development of collegiate critical thinking skills, but the independent critical thinking course did not have a statistically significant effect. This study incorporated a qualitative component to provide critical reflection on why independent critical thinking courses may be less effective, including aspects of course logistics, characteristics, and teaching methods, to provide guidance for future research and practical considerations for teaching critical thinking courses. [ABSTRACT FROM AUTHOR]

An unhealthy diet is among the leading global causes of death and disability. Globally, a range of policies are being implemented to support healthy food choices at a population level, including novel polices in the areas of food marketing, nutrition labeling, and taxation of less healthy foods. There is a need to evaluate and inform the implementation of these policies, including their impacts on marginalized population subgroups. The International Food Policy Study (IFPS) consists of repeated cross-sectional surveys conducted in 5 high- and upper-middle-income countries: Australia, Canada, Mexico, the United Kingdom, and the United States. In each country, approximately 4000 adults and 1200 children and youth (aged 10-17) were recruited from a global commercial panel to complete an online survey using consistent measures and methodologies across countries. The first annual IFPS surveys were conducted in 2017 with adults; annual surveys for young people aged 10-17 were launched in 2019 in the same countries, as well as in Chile. The design of the IFPS surveys creates a framework for evaluating "natural experiments" in food policies, including comparisons over time within countries implementing the policy and comparisons with countries in which the policy was not implemented. IFPS surveys have 3 primary areas of focus: 1) knowledge, attitudes, and beliefs associated with specific policies; 2) diet-related behaviors; and 3) dietary intake, including 24-hour dietary recalls for adults in 4 of the 5 countries. Surveys also assess food insecurity, income adequacy, sex and gender, race/ethnicity, and a range of other measures to assess trends among priority subgroups. Overall, the IFPS project has the potential to address important gaps in national monitoring surveys for dietary patterns, and to evaluate the impacts of novel food policies implemented in any of the 5 countries over the study period. [ABSTRACT FROM AUTHOR]

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Abstract: Objective: To examine the effects of learning-centered assessment on students'' attitudes toward and knowledge of statistics. Methods: This nonequivalent control group study examined second-year (P2) and third-year (P3) year PharmD students enrolled in a required course on statistics. P2 students received a learning-centered assessment approach; P3 students received an instruction-centered approach. Course topics, sequencing, and examinations were identical between the courses. Students'' statistical self-efficacy, attitudes toward statistics, statistical knowledge, and course perceptions were measured at the beginning and end of the course. Results: Statistical self-efficacy increased over time but was not statistically different between classes. Statistical knowledge increased significantly (p < 0.001) over the semester, with greater increases for P2 students than P3s. A significant improvement in statistics attitudes was noted in the SATS-36 difficulty domain (p = 0.026) over the semester, but this was not different between classes. Compared with P3s (instruction-centered), the P2 students (learning-centered) had significantly better perceptions regarding the course with respect to having multiple opportunities to demonstrate learning (p < 0.001), control in the determination of the course grade (p < 0.001), focusing on learning rather than course grade (p = 0.033), and receiving adequate feedback (p = 0.006). Conclusions: There were changes in statistical self-efficacy and attitudes toward statistics among the students, but these appeared to be the effect of time rather than the assessment approach. Students in the learning-centered course had greater increases in statistical knowledge and more positive perceptions of the learning environment. More research comparing learning-centered teaching with traditional approaches is needed. [Copyright &y& Elsevier]

Background: The highly transmissible and virulent carbapenem-resistant Klebsiella pneumoniae (CRKP) KPC-3 strain has been spreading in our medical center and in other centers in Israel since 2006. An intervention that aimed to diminish its prevalence was constructed and applied in our institute. Methods: We analyzed the efficacy of the intervention during the years 2006-2010 using quasi-experimental methodology. The intervention included guidelines for patient isolation, cohorting, and environment cleaning; education of staff; and a computerized notification system that flags CRKP carriers and provides instructions. The efficacy of the program was evaluated through 3 quantifiable parameters: incidence of CRKP isolates from clinical samples, rate of cross-infections, and rate of screening for CRKP carriage in patients at risk identified by rectal samples. Results: The incidence of CRKP decreased by 16-fold (P < .001), and this decrease was sustained for 30 months. The rate of cross-infection decreased from 6% during 2007-2008 to 2.7% in 2009-2010 (P < .05). This period saw an increased rate of active surveillance for carriers, from 20% to 89%. Conclusions: A comprehensive infection control program can contain an outbreak of the CRKP KPC-3 strain in acute care hospitals during a nationwide outbreak of this strain. [Copyright &y& Elsevier]

The aim of the experimental study was to evaluate the effectiveness of a parent training intervention for young children with varied difficulties and to examine the differential effects of the intervention for children with and without a developmental difficulty. A quasi-experimental waitlist design was employed and participants were parents of 81 children aged three-to six-years (M= 53.30 months; SD = 10.80 months) with behavioural and/or developmental difficulties, who received parent training (n = 46) or 'treatment as usual' services (n = 35) over a 12-week period. Assessment took place before and immediately following the 12-week intervention for both groups and five-months later for the parent-training group. Significant changes were found, including improvements in parent reports of behaviour problems, parental stress and independently rated observations. Changes in behavioural difficulties were greater for the parent-training group compared with the treatment as usual group and no differential effects emerged for children with and children without a developmental difficulty. The findings suggest that parent training is equally effective for young children with exclusively behavioural problems and those with associated behavioural and developmental difficulties. This highlights the clinical utility of parent training as a broad tool of intervention for young children referred to frontline mental health settings. [ABSTRACT FROM AUTHOR]

Interventions that involve key aspects of community organizing, such as quantitative community assessments and organizational partnership support for the community, may promote residents' health. We evaluated the effectiveness of this form of intervention on mortality and its variability across individual-level household equivalized income tertiles, comparing 52,858 residents aged 65 and above in 12 intervention municipalities to 39,006 residents in nine control municipalities in Japan. During 1,166 days of follow-up, the adjusted hazard ratio for cumulative mortality among men in the intervention municipalities was 0.92 (95% confidence interval: 0.86, 0.99) compared to those in the control group, with similar results being observed across all income levels. Active utilization of data to evaluate communities and building intersectoral partnerships might lower older male residents' mortality risk, regardless of their income status. [ABSTRACT FROM AUTHOR]

The aim of the present study was to explore the effect of the one session behavioral treatment of specific phobia, proposed by Öst on: a) approach and manipulation behaviors of children diagnosed with specific phobia, and b) their anxiety, according to their parents' perception, one week, three and six months after treatment. The quasi-experimental study used an interrupted time series design. Treatment was individually applied to 10 children, 6 to 12 years of age, diagnosed with specific phobia to spiders. Pre, post, 3 and 6 months after treatment measurements of children's behavioral approximations to spiders, and their depression/anxiety as reported by their parents, were conducted. Clinical and statistically significant improvement was observed at post-test and 3 months later in all children. Improvement was maintained after 6 months for 6 of the 7 children who completed the study Results of previous studies on the efficacy of the one session behavioral treatment were replicated in Latin American children. [ABSTRACT FROM AUTHOR]

The objective of this quasi-experimental study is to examine the scholar fears in a Spanish sample of 95 children between 8 and 12 years whose parents are divorced. They are compared with a group of children with similar ages and gender and non-divorce parents. Results show that children of divorce present slightly higher levels of scholar fears than the children whose parents remain together, except in the fears related to scholar failure and punishment, higher in children with non-divorce parents. The logistic regression analysis revealed that children whose parents are not divorced have a probability of presenting scholar fears related to failure and punishment .42 times higher than the other group of children. The changes in the rearing styles and the lack of supervision after the divorce may explain the found differences. The clinical implications of these findings are discussed, emphasizing the importance of a coherent and common parenting practice. [ABSTRACT FROM AUTHOR]

Abstract: Hospitals in the northeast of Scotland have experienced methicillin-resistant Staphylococcus aureus (MRSA) outbreaks since 1997. Several infection control measures were introduced sequentially to control MRSA, and antibiotic use has been monitored. From January 1997 to December 2004, data on the monthly percentage of non-duplicate MRSA infections (%MRSA) were collated from an intervention hospital (IH) and a control hospital (CH). Both hospitals introduced the use of alcohol hand gel in November 2002. Furthermore, the IH introduced an environmental MRSA swabbing programme in March 2001, chlorine disinfection of the environment in September 2001, discharge screening in December 2001, admission screening in November 2003 and environmental audits in March 2004. Multivariate dynamic regression analysis was used to evaluate the longitudinal effects of these interventions as measured by new clinical cases of MRSA. At the IH, the %MRSA increased between January 1998 and January 2001 and then decreased. At the CH, the %MRSA increased from January 1997 to December 2004. Introduction of alcohol hand gel was associated with an absolute decrease in %MRSA of 21% and 30%, respectively, for the IH and CH. At the IH, introduction of chlorine disinfection and environmental swabbing were, respectively, associated with a decrease in %MRSA of 27% immediately and 32% 3 months later. Discharge screening and environmental audit did not significantly affect %MRSA, whereas admission screening was associated with a 22% decrease in %MRSA 4 months later. Increasing macrolide use was associated with increasing %MRSA in both hospitals, and increasing quinolone use was associated with increasing %MRSA in the CH. Implementation of stepwise infection control measures was associated with a decrease in %MRSA in the IH. Introduction of an alcohol gel for hand hygiene was associated with a decrease in %MRSA in both hospitals. Antibiotic use also affects %MRSA, in particular that of macrolides and quinolones. [Copyright &y& Elsevier]

Abstract: The emergence of Escherichia coli (E. coli) resistance to fluoroquinolones (FQs) increased and spread gradually worldwide since the early 1990s. The selective pressure of FQs is the main mechanism responsible for the emergence of FQ resistance as shown by in vitro studies. Clinical trials are required to prove the causality between exposure to FQs and emergence of resistance. But this would not be ethical in humans. Non experimental studies must answer several principles to establish causality: association, anteriority, and directional change. We described and compared the contribution of observational and quasi-experimental studies implemented to answer several of these principles. Quasi-experimental studies using interventional models (ARIMA models with transfer function), can answer several of these principles, unlike observational studies. Thus, in addition to assessment of the association, they were able to show that the exposure to FQs precedes the emergence of FQ resistance to E. coli. They were also able to estimate the time necessary for the emergence of resistance and the dose effect, and to show if this association was reversible. [Copyright &y& Elsevier]

The purpose of this study is to explore the effects of the "SURVIVAL" intervention program on the nursing competencies, work self-efficacy, occupational stress and retention rate for students who recently graduated from the two-year baccalaureate nursing program. The role transition for students who have recently graduated is a dynamic process, which is associated with stress and challenges. It was also a vital stage for successfully adapting to a nursing career to overcome the reality shock and become competent. A prospective, longitudinal, quasi-experimental design was used to examine the effects of the SURVIVAL intervention on 72 participants in the control group and 38 participants in the experimental group. The SURVIVAL intervention included an internship program, the adjustment of the college curriculum, career mentorship and peer support. The outcomes, including nursing competencies, work self-efficacy, occupational stress and the retention rate, were evaluated prior to the participants started working and one, three, six and 12 months after they started working. Compared with the participants in the control group, those in the experimental group performed significantly better with regard to general clinical nursing skills, basic biomedical science, ethics, overall assessment, work self-efficacy and lower occupational stress. The "SURVIVAL" intervention program for career transition, jointly developed through a partnership between academia and practice, improved some of the nursing competencies and work self-efficacy of the newly graduated nurses and also reduced their occupational stress. [ABSTRACT FROM AUTHOR]

Conflict among nurses within the healthcare system negatively impacts them and patient outcomes. Therefore, it is essential to prepare nursing students for conflict resolution in clinical practice. This study aimed to develop a conflict resolution training program based on the situated learning theory (SLT) for nursing students and to verify the impact of the program on abilities of communication, problem-solving, and conflict resolution. This quasi-experimental study was conducted using a non-randomized control group pretest and posttest design. A college of nursing with the main campus in South Korea. The subjects were 48 senior nursing students in the last semester of their nursing program. The program was developed based on the SLT. It was delivered to the experimental group (90 min per session, a total of eight sessions) while the control group received no intervention. Data were analyzed with χ2-test, Fisher's exact test, unpaired t -test, Mann-Whitney U test, repeated-measures ANOVA, and Bonferroni correction using SPSS/WIN 25.0 program. There were significant interactions between group and time in problem-solving ability (p = 0.048) and subjective conflict resolution ability (p = 0.005). Problem-solving ability and subjective conflict resolution ability in the experimental group significantly improved compared to the control group based on post-hoc test. After the program, objective conflict resolution ability was significantly higher in the experimental group than the control group (p < 0.001). For communication ability, there was a significant interaction between group and time (p = 0.046). However, it showed no significant difference between the two groups in a post-hoc test. The conflict resolution training program based on the SLT was found to be effective in improving the abilities of problem-solving and conflict resolution of nursing students. [ABSTRACT FROM AUTHOR]

Medication administration is a main role of nurses, and by mastering this skill, medication errors can be reduced. Simulation provides a safe environment for learning and improving medication administration. Simulation design may influence the students' learning curve and ability to transfer skills into the clinical setting. To examine the influence of simulation-based learning of the medication administration process, on satisfaction, self-perception of preparedness, and clinical performance of students who practice simulation either individually or in a group. A comparative quasi-experimental study. A public university in southern Israel. Third-year nursing students in two consecutive academic years (78 in the individual sample and 50 in the group sample). Nursing students participated in a scenario-based simulation for medication administration either individually or in a group. Self-reported questionnaires evaluated participants' satisfaction with the simulation experience, and perception of preparedness before and after the simulation. Faculty members observed and evaluated participants' medication administration during the simulation and in the clinical setting. Paired t -tests were performed to compare preparedness before and after the simulation experience. Linear regression models were formulated to elicit the predictors of preparedness after simulation and evaluations for medication administration in the clinical setting. The simulation experience increased participants' preparedness both when designed for an individual student and for a group of students. Simulation performance was the main contributor to the participant preparedness among the individual sample (β = 0.51, p < 0.01), whereas previous preparedness was the main contributor among the group sample (β = 0.42, p < 0.01). The association between simulation performance and clinical performance was mediated by preparedness after simulation in the individual sample, but not in the group sample. Simulation improves students' preparedness for medication administration. Individual simulation also impacts clinical performance, via preparedness. Further research is needed to identify other factors that facilitate skills transfer into the clinical setting. • Improving students' competency in medication management may reduce medication errors. • Simulation is an effective teaching method for enhancement of students' competencies. • Simulation for medication management is a valuable teaching method. • Simulation enhances students' perception of preparedness for medication administration. • Individual simulation enables the transfer of learning into the clinical setting. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, the Bavarian State government announced several COVID-19 mitigation measures beginning on March 16, 2020, which likely led to a reduction in traffic and a subsequent improvement in air quality. In this study, we evaluated the short-term effect of COVID-19 mitigation measures on NO 2 concentrations in Munich, Germany. We applied two quasi-experimental approaches, a controlled interrupted time-series (c-ITS) approach and a synthetic control (SC) approach. Each approach compared changes occurring in 2020 to changes occurring in 2014–2019, and accounted for weather-related and other potential confounders. We hypothesized that the largest reductions in NO 2 concentrations would be observed at traffic sites, with smaller reductions at urban background sites, and even small reductions, if any, at background sites. All hypotheses, as well as the main and additional analyses were defined a priori. We also conducted post-hoc analyses to ensure that observed effects were not due to factors other than the intervention. Main analyses largely supported our hypotheses. Specifically, at the two traffic sites, using the c-ITS approach we observed reductions of 9.34 μg/m3 (95% confidence interval: −23.58; 4.90) and 10.02 μg/m3 (−19.25; −0.79). Using the SC approach we observed reductions of 15.65 μg/m3 (−27.58; −4.09) and 15.1 μg/m3 (−24.82; −9.83) at these same sites. We observed effects ranging from smaller in magnitude to no effect at urban background and background sites. Additional analyses showed that the effect was largest in the first two weeks following introduction of measures, and that a 3-day lagged intervention time also showed a larger effect. Post-hoc analyses suggested that at least some of the observed effects may have been attributable to changes in air quality occurring before the intervention, as well as unusually high concentrations in January 2020. We applied two quasi-experimental approaches in assessing the impact of the COVID-19 mitigation measures on NO 2 concentrations in Munich. Taking the 2020 pre-intervention average concentrations as a reference, we observed reductions in NO 2 concentrations of approximately 15–25% and 24–36% at traffic sites, suggesting that reducing traffic may be an effective measure to reduce NO 2 concentrations in heavily trafficked areas by margins which could translate to public health benefits. • The effect of COVID-19 mitigation measures on NO 2 in Munich was unclear. • We applied two robust quasi-experimental approaches. • All hypotheses, as well as main and additional analyses were defined a priori. • As hypothesized, we observed largest reductiotns in NO 2 at traffic sites. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the level of knowledge of registered nurses about palliative care and to determine the effect of educational intervention on this level of knowledge in Turkey. The study was a quasi-experimental study and consists of 136 nurses. The study was conducted between April and June 2019 in a university hospital in Malatya, Turkey. Nurse are educated on the definition, history, and philosophy of palliative care, the responsibilities of palliative care nurses, symptom management, and end of life care. The education was applied in five sessions. Each session took approximately 40 min and sessions were conducted once a week. Data were collected before and after the education via nurse identification form developed by the research team and the Palliative Care Knowledge Test. It was determined that the nurses received 8.9 ± 1.1 out of 20 points before and 17.5 ± 1.9 points after the education. There was a statistically significant difference between the mean scores of nurses before and after training (p < 0.001). It was found that educational intervention has a large effect (Cohen's d = 5.540) on nurses' knowledge about palliative care. It was determined that educational intervention was an effective way to improve nurses' knowledge about palliative care. • Nurses' knowledge about palliative care was at moderate-low level. • Educational intervention is an effective way to improve the nurses' knowledge about palliative care. • Nurses know pain management better than other symptoms in palliative care. [ABSTRACT FROM AUTHOR]

• Vitamin D may be a central biological determinant of COVID-19 outcomes. • Bolus vitamin D3 supplementation during or just before COVID-19 was associated with less severe COVID-19 in frail elderly. • Bolus vitamin D3 supplementation during or just before COVID-19 was associated with better survival rate in frail elderly. • Randomized controlled trials are expected to firmly conclude the effect of vitamin D supplementation on COVID-19 prognosis. Vitamin D may be a central biological determinant of COVID-19 outcomes. The objective of this quasi-experimental study was to determine whether bolus vitamin D3 supplementation taken during or just before COVID-19 was effective in improving survival among frail elderly nursing-home residents with COVID-19. Sixty-six residents with COVID-19 from a French nursing-home were included in this quasi-experimental study. The "Intervention group" was defined as those having received bolus vitamin D3 supplementation during COVID-19 or in the preceding month, and the "Comparator group" corresponded to all other participants. The primary and secondary outcomes were COVID-19 mortality and Ordinal Scale for Clinical Improvement (OSCI) score in acute phase, respectively. Age, gender, number of drugs daily taken, functional abilities, albuminemia, use of corticosteroids and/or hydroxychloroquine and/or antibiotics (i.e., azithromycin or rovamycin), and hospitalization for COVID-19 were used as potential confounders. The Intervention (n = 57; mean ± SD, 87.7 ± 9.3years; 79 %women) and Comparator (n = 9; mean, 87.4 ± 7.2years; 67 %women) groups were comparable at baseline, as were the COVID-19 severity and the use of dedicated COVID-19 drugs. The mean follow-up time was 36 ± 17 days. 82.5 % of participants in the Intervention group survived COVID-19, compared to only 44.4 % in the Comparator group (P = 0.023). The full-adjusted hazard ratio for mortality according to vitamin D3 supplementation was HR = 0.11 [95 %CI:0.03;0.48], P = 0.003. Kaplan-Meier distributions showed that Intervention group had longer survival time than Comparator group (log-rank P = 0.002). Finally, vitamin D3 supplementation was inversely associated with OSCI score for COVID-19 (β=-3.84 [95 %CI:-6.07;-1.62], P = 0.001). In conclusion, bolus vitamin D3 supplementation during or just before COVID-19 was associated in frail elderly with less severe COVID-19 and better survival rate. [ABSTRACT FROM AUTHOR]

Social activities in the community help older adults maintain functional ability. Community organizing, based on the assessment of health risks, community assets, and fostering intersectoral organizational partnerships, could increase participation opportunities. Supporting municipality staff members in building their capacity to take those actions might benefit them. Nevertheless, the effectiveness of such support remains unclear. This real-world-setting study evaluated the effectiveness of providing support for municipality health sectors in relation to older residents' social activities. Based on the Japan Gerontological Evaluation Study (JAGES), a nationwide study of community-dwelling older adults, from 2013 to 2016 researchers collaborated with health sector staff members in 13 participating municipalities (intervention group) in utilizing the JAGES-based community assessment data and building organizational partnerships. The remaining 12 municipalities (control) obtained the data only. We analyzed the longitudinal data of 47,106 older residents, performing a difference-in-differences (DID) analysis, weighted by the inverse of propensity to be selected for the intervention group, allowing for a multilevel (municipality/individual) data structure. In the intervention group, the estimated group participation prevalence in men increased by 10.4 percentage points from 47.5% to 57.9%, while in the control group, participation increased by 7.9 percentage points from 47.2% to 55.0% (DID estimated = 0.025, P = 0.011). No statistically significant difference between the two groups was observed among women (P = 0.131). Support for community organizing may improve group participation among older male residents. The community-attributable impact could be large, given that the intervention has the potential to work for all older residents in the municipality. • Older men participated more where researchers and health sector collaborated well. • The effects were specifically strong for participation in leisure activity groups. • Community organizing might encourage older men to engage in social activities. [ABSTRACT FROM AUTHOR]

Purpose Young men who have sex with men (YMSM) in Myanmar are disproportionately affected by HIV, with prevalence five times that of the general population. The Link Up project implemented an intervention using peer education and outreach providing education and counseling on health seeking around sexually transmitted infections and reproductive health, combined with focused clinic capacity building to improve the sexual and reproductive health of YMSM. This study aimed to evaluate the effectiveness and acceptability of the intervention. Methods Using a mixed-methods approach, and employing a quasi-experimental design, we conducted two quantitative repeat cross-sectional surveys in purposively selected control (no intervention) and intervention townships, before and after implementation of the Link Up intervention. Respondent-driven sampling was used to recruit YMSM aged 15–24 years, and study participants were administered a structured questionnaire assessing intervention exposure, health service access, knowledge of HIV, and sexual risk behavior. Focus group discussions were held to elicit perspectives on the use and acceptability of the health services and peer outreach. Results At baseline, 314 YMSM were recruited in the intervention townships and 309 YMSM in the control townships. At end line, 267 (intervention) and 318 (control) YMSM were recruited. Coverage of the program was relatively low, with one-third of participants in the intervention townships having heard of the Link Up program by the end line. Comparing changes between baseline and end line, a greater proportion of HIV-negative or unknown status YMSM accessed HIV testing in the past 3 months in intervention townships (from 45.0% to 57.1%) compared with those in control townships (remained at 29.0%); however, this difference in the effect over time was not statistically significant in multivariate modeling (adjusted odds ratio: 1.45; 95% confidence interval: .66–3.17). Qualitative findings showed that the intervention was acceptable to YMSM. Conclusions Overall, the intervention was perceived as acceptable. Although not statistically significant, results showed some trends toward improvements among YMSM in accessing HIV testing services and HIV-related knowledge. The modest coverage and short time frame of the evaluation likely limits the ability for any significant behavioral improvements. [ABSTRACT FROM AUTHOR]

Abstract: Background: Registered nurses are the frontline of defense against unrecognized changes in patients' condition to prevent failure-to-rescue events, reducing mortality and morbidity in hospitalized patients. This study explores the impact of two types of evidence-based training methodologies, in situ simulation-based training (SBT) versus case study review, both incorporating TeamSTEPPS® training, on practicing nurse early warning sign knowledge, confidence, teamwork, and clinical skill performance. Methods: A quasi-experimental, two-group comparison, pre/post intervention study. Results: Increased knowledge and teamwork skills after education were seen in both groups (p < .05). The SBT group showed greater improvement in all areas except knowledge, with greatest significance found in teamwork skills (p < .05). Conclusions: High-quality, in situ, simulation-based team training may have its greatest impact on improvement in nurse confidence in and performance of teamwork skills. However, the study indicates that, regardless of the method, well-designed educational programs are effective in improving nursing knowledge of care of complex patients. [Copyright &y& Elsevier]