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This classroom-based action research aimed to determine the applicability of implementing Collaborative Learning in online setting to help students develop their interaction with one another and improve their academic performance. Participants of the study consisted of Grade 8 intact pilot section of a public school in an urban community which yielded only 20 valid responses. Student participation during online collaborative learning made use of the first three stages of Siemen's Connectivism taxonomy. Quantitative data were taken from Student Attitude Survey, individual and group learning activity sheets, and achievement test, while qualitative data were taken from focus group discussions. Transcripts of the recorded online collaborative learning were analyzed using content analysis following Garrison's Practical Inquiry Model. Results showed that there is a significant increase in students' scores in the activities done collaboratively than those done individually. However, only 12 out of the 20 students successfully passed the achievement test. Additionally, results of the content analysis of the video recording transcripts show that among the four categories of Garrison's Practical Inquiry Model, students made more extensive use of integration and exploration during online collaborative learning. In terms of students' attitudes toward the intervention, the results indicated a positive response with regard to their experience with online collaborative learning. Analysis of the focus group discussions using interpretative phenomenological analysis revealed similarities and differences in collaborative learning between an online and face-to face learning.

BACKGROUND: Limited English Proficiency (LEP) Latinxs experience a longer duration of untreated depression and anxiety. LEP Latinxs have difficulty accessing mental healthcare due to insufficient Spanish-speaking behavioral/mental health clinicians to meet demand. These under-resourced healthcare systems are less likely to be the site for the implementation of innovations. Digital interventions can provide an effective option for overcoming these barriers; yet, when digital evidence-based treatments are available, uptake and engagement is often low. This manuscript presents the protocol for the SUPERA (SUpport from PEeRs to expand Access) study which will evaluate the implementation of an evidence-based, Spanish language, digital cognitive-behavioral therapy (dCBT) intervention (i.e., SilverCloud) in safety-net primary care clinics for LEP Latinx patients with depression or anxiety. METHODS: We will conduct an effectiveness-implementation hybrid trial (Type 2) design comparing engagement and clinical outcomes in two modalities of dCBT delivery (peer-supported vs. unsupported). We will also compare provider-level outreach (using a clinic patient registry) versus inreach (traditional provider referral) to compare rates of initiation, completion, and cost. Participants will be 426 LEP Latinx adults ≥18 years of age, PHQ-9 ≥ 10 or GAD-7 ≥ 8, with access to the internet via smartphone, and not currently receiving individual psychotherapy. We will collect baseline, post-intervention (8 weeks), and follow up (3 months) data. CONCLUSION: The long-term goal of this research is to aid in the implementation of digital mental health interventions that can be sustainably implemented in low-resourced settings, while reducing the reliance on professionals, overcoming workforce deficits, and increasing relevance for diverse populations.

Abstract We report 14 cases of immune effector cell (IEC)-associated enterocolitis following chimeric antigen receptor T-cell (CAR-T) therapy in multiple myeloma, with a 1.2% incidence overall (0.2% for idecabtagene vicleucel and 2.2% for ciltacabtagene autoleucel). Patients developed acute-onset symptoms (typically non-bloody Grade 3+ diarrhea) with negative infectious workup beginning a median of 92.5 days (range: 22–210 days) after CAR-T therapy and a median of 85 days after cytokine release syndrome resolution. Gut biopsies uniformly demonstrated inflammation, including intra-epithelial lymphocytosis and villous blunting. In one case where CAR-specific immunofluorescence stains were available, CAR T-cell presence was confirmed within the lamina propria. Systemic corticosteroids were initiated in 10 patients (71%) a median of 25.5 days following symptom onset, with symptom improvement in 40%. Subsequent infliximab or vedolizumab led to improvement in 50% and 33% of corticosteroid-refractory patients, respectively. Five patients (36%) have died from bowel perforation or treatment-emergent sepsis. In conclusion, IEC-associated enterocolitis is a distinct but rare complication of CAR-T therapy typically beginning 1–3 months after infusion. Thorough diagnostic workup is essential, including evaluation for potential T-cell malignancies. The early use of infliximab or vedolizumab may potentially hasten symptom resolution and lower reliance on high-dose corticosteroids during the post-CAR-T period.

Abstract Background Atherosclerotic Cardiovascular Disease (ASCVD) is a global public health concern. This study aimed to estimate the healthcare resource utilization (HRU) and costs stratified by cardiovascular disease (CVD) risk categories using real-world evidence, in a regional population in Portugal. Methods This is a retrospective observational study, using data from Electronic Health Records between 2017 and 2021. Patients aged ≥ 40 years, and with at least one general practitioner (GP) appointment in the 3 years before 31st of December 2019, were included. CVD risk categories were determined based on 2021 ESC prevention guidelines. HRU encompassed hospital data (hospitalizations, outpatient and emergency room visits) and GP appointments. Total direct costs per patient were calculated based on the reference cost of the Portuguese legislation for payment methodology on Diagnosis-Related Groups (DRGs). Results Analysis of 3 122 695 episodes, revealed consistent HRU and costs across the five years. Very high-risk patients, showed higher HRU, particularly in hospital admissions. Costs tended to rise with higher CVD risk level. Very high-risk patients with ASCVD had higher costs for hospital admissions, while low-to-moderate risk patients had higher costs for GP visits. Despite a smaller proportion, very high-risk patients with prior ASCVD represent the highest costs per patient across healthcare settings (from 115€ in emergency visits to 2 673€ in hospitalizations), followed by very high-risk patients without prior ASCVD (ASCVD-risk equivalents). Conclusion This study revealed a substantial HRU and costs by patients with very high CVD risk, particularly those with prior ASCVD. Moreover, ASCVD-risk equivalents emerge as notable consumers, emphasizing the importance of risk assessment and preventive measures in cost-effective management of these patients.

Abstract Background Neurofibromatosis type 1 (NF1), an autosomal dominant disorder, characterized by a spectrum of diverse neurocutaneous manifestations, is caused by heterozygous pathogenic variants in NF1 gene. While patients with NF1 often exhibit characteristic features, atypical phenotypes can arise, necessitating consideration of differential diagnoses or concurrent pathologies. Case presentation A seven-year-old boy with suspected NF1 underwent clinical evaluation. He presented hallmark café-au-lait spots, axillary freckling, and neurofibromas. Neuroimaging revealed a cranial plexiform neurofibroma. Additionally, he exhibited attention-deficit hyperactivity disorder and developmental delay. Genetic testing identified an Alu insertion variant within the NF1 gene, and subsequent array comparative genomic hybridization detected a 16p13.11 duplication. Conclusions This case underscores the intricate molecular bases of NF1 by identifying a rare Alu insertion variant. The patient's neurocognitive challenges and dysmorphic features prompted exploration of a potential overlapping genetic condition. Coexisting genetic disorders have been documented in NF1 patients, emphasizing the necessity of discerning atypical manifestations. The observed 16p13.11 duplication likely contributes to the patient's phenotype, enhancing the precision of diagnosis, prognosis, and genetic counseling.

Background: Nearly half of patients diagnosed with cancer are in the middle of their traditional working age. The return to work after cancer entails challenges because of the cancer or treatments and associated with the workplace. The study aimed at providing more insight into the occupational outcomes encountered by workers with cancer and to provide interventions, programs, and practices to support their return to work. Methods: A scoping review was conducted using the Arksey and O’Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review guidelines. Relevant studies were systematically searched in PubMed/MEDLINE, SCOPUS and Grey literature from 01 January 2000 to 22 February 2024. Results: The literature search generated 3,017 articles; 53 studies were considered eligible for this review. Most of the studies were longitudinal and conducted in Europe. Three macroarea were identified: studies on the impact of cancer on workers in terms of sick leave, employment, return to work, etc.; studies reporting wider issues that may affect workers, such as the compatibility of treatment and work and employment; studies reporting interventions or policies aiming to promote the return to work. Conclusion: There is a lack in the literature in defining multidisciplinary interventions combining physical, psycho-behavioural, educational, and vocational components that could increase the return-to-work rates. Future studies should focus on interdisciplinary return to work efforts with multiple stakeholders with the involvement of an interdisciplinary teamwork (healthcare workers and employers) to combine these multidisciplinary interventions at the beginning of sick leave period.

Education is a primary childhood occupation. Dysfunction in sensory processing can make it challenging for children to succeed in school. School-based occupational therapy (SBOT) services address these differences through sensory-based interventions. Limited research exists to support the use of sensory-based interventions in school-based settings. The purpose of this study is to summarize existing research supporting the use of sensory-based interventions in SBOT and to identify gaps in the literature. A scoping review methodological framework was used to search seven databases. Descriptive numerical summary and qualitative thematic analysis were used to summarize and report the results. Nineteen articles met the inclusion criteria for this study. Quantitative results describe variations in diagnoses, outcomes, and intervention types. Major qualitative themes include the impact of sensory-based interventions on classroom participation and engagement, and the efficacy of treatment methods used in SBOT. Gaps in the literature include the long-term effects and specificity of sensory-based interventions. There are many factors that may influence the effectiveness of interventions. Individualized OT services are needed to consider the intricacies of the child-environment interaction. Additional research is needed to support the efficacy of sensory-based interventions in SBOT.

Aim/Purpose: This study explores the subject structure, social networks, research trends, and issues in the domain that have the potential to derive an overview of the development of virtual reality-based learning media in vocational education. Background: Notwithstanding the increasingly growing interest in the application of virtual reality in vocational learning, the existing research literature may still leave out some issues necessary for a comprehensive understanding. This study will point out such areas that need more exploration and a more comprehensive synthesis of the literature by conducting a bibliometric analysis. It will be interesting to keep track of the changing concepts and methodologies applied in the development of VR-based learning media in vocational education research. Methodology: This review was carried out using bibliometric methodology, which can highlight patterns of publication and research activity in this hitherto little studied area. The results of the study have the potential to lead to evidence-based priority in VR development, which will tailor work for vocational contexts and set the compass against the growing worldwide interest in this area. The study provides a descriptive analysis of publications, citations, and keyword data for 100 documents published between the years 2013 and 2022 from the Scopus database, which is conducted to illustrate the trends in the field. Contribution: This study also counts as a contribution to understanding the research hotspots of VR-based learning media in vocational education. Through bibliometric analysis, this study thoroughly summarized the relevant research and literature laying a knowledge foundation for researchers and policy makers. Additionally, this analysis identified knowledge gaps, recent trends, and directions for future research. Findings: The bibliometric analysis revealed the following key findings: 1. A growing publication trajectory, with output increasing from 7 articles in 2013 to 25 articles in 2022. 2. The United States led the contributions, followed by China, and Germany. 3. The most prominent authors are affiliated with American medical institutions. 4. Lecture proceedings include familiar sources that reflect this nascent domain. 5. Citation analysis identified highly influential work and researchers. 6. Keyword analysis exposed technology-oriented topics rather than learning-oriented terms. These findings present an emerging landscape with opportunities to address geographic and pedagogical research gaps. Recommendations for Practitioners: This study will be beneficial for designers and developers of VR-based learning programs because it aligns with the most discussed and influential VR technologies within the literature. Such an alignment of an approach with relevant research trends and focus can indeed be very useful for the effective application and use of VR-based learning media for quality improvements in vocational students' learning. Recommendation for Researchers: In fact, in this bibliometric review of VR integration within vocational classrooms, a future call for focused research is presented, especially on teaching methods, course design, and learning impact. This is a framework that seeks to establish its full potential with effective and integrated use of VR in the various vocational curricula and settings of learners. Impact on Society: From the findings of the bibliometric analysis, it is evident that virtual reality technologies (VR) have significantly led to transformation within educational media. There is no denying that the growing interest and investment in the integration of virtual reality into vocational education has been well manifested in the substantive increase in publications in the last decade. This shows what the innovation driving factor is in the United States. At the same time the rapid contributions from China signal worldwide recognition of the potential of VR to improve technical skills training. This study points the way for more research to bridge critical gaps, specifically how VR tools can be used in vocational high school classrooms. Furthermore, research should be aligned to meet specific needs of vocational learners and even promote international cross-border partnerships, pointing out the potential of virtual reality to be a universally beneficial tool in vocational education. The examination of highly cited articles provides evidence of the potential of VR to be an impactful pedagogical tool in vocational education. The findings suggest that researchers need to move forward looking at the trajectory of VR in vocational education and how promising it is in defining the future for innovative and effective learning methodologies. Future Research: This study is an exceptionally valuable contribution, a true landmark in the field of dynamic development, and one that denotes very meaningful implications for the future course of research in the dynamically developing field of bibliometric analysis of VR-based learning media for vocational education. The increase in the number of publications emanates from growing interests in the application of virtual reality (VR) technologies in vocational education. The high concentration of authorship from the USA, along with the ever increasing contributions from China, spotlights the increasing worldwide recognition of the impact of immersive technologies in the enhancement of training in technical skills. These are emerging trends that call for research to exemplify the diverse views and global teamwork opportunities presented by VR technologies. The study also highlights critical areas that need focused attention in future research endeavors. The fact that the embedding of VR tools into classrooms in vocational high schools has been poorly researched points to the major gap in pedagogical research within authentic educational settings. Therefore, further investigations should evaluate teaching methods in VR, lesson designs, and the impacts of VR in specific vocational trades. This supports the need for learner-centered frameworks that are tailor-made to the needs of vocational learners. This calls for more direct and focused investigations into identified research gaps noting a growing dominance in the field of health-related research with the most cited articles in this field, to integrate virtual reality into additional vocational education contexts. In this way, the gaps present an opportunity for researchers to make significant contributions to the development of interventions responsive to the unique needs of vocational learners; this will contribute to strengthening the evidence base for the worldwide implementation of VR within vocational education systems. This was recommended as the intention of such a bibliometric analysis: supporting the potential of VR as a pedagogical tool in vocational contexts and providing grounding for a strong and focused future research agenda within this burgeoning area of educational technology.

The proteasome plays key roles in synaptic plasticity and memory by regulating protein turnover, quality control, and elimination of oxidized/misfolded proteins. Here, we investigate proteasome function and localization at synapses in Alzheimers disease (AD) post-mortem brain tissue and in experimental models. We found a marked increase in ubiquitinylated proteins in post-mortem AD hippocampi compared to controls. Using several experimental models, we show that amyloid-β oligomers (AβOs) inhibit synaptic proteasome activity and trigger a reduction in synaptic proteasome content. We further show proteasome inhibition specifically in hippocampal synaptic fractions derived from APPswePS1ΔE9 mice. Reduced synaptic proteasome activity instigated by AβOs is corrected by treatment with rolipram, a phosphodiesterase-4 inhibitor, in mice. Results further show that dynein inhibition blocks AβO-induced reduction in dendritic proteasome content in hippocampal neurons. Finally, proteasome inhibition induces AD-like pathological features, including reactive oxygen species and dendritic spine loss in hippocampal neurons, inhibition of hippocampal mRNA translation, and memory impairment in mice. Results suggest that proteasome inhibition may contribute to synaptic and memory deficits in AD.