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The quality of graduate teachers is a significant concern for teacher educators, policymakers and the public. Initiatives regarding the quality assurance of initial teacher education (ITE) programs require critical examination to ensure that ITE programs develop proficient graduate teachers to meet the demands of modern classrooms. In this paper, we draw on Biesta's (2015, 2019, 2020) theoretical framing of purpose in education (i.e., qualification, socialisation and subjectification) to analyse the policy texts related to graduate teaching performance assessment from institutions involved in the creation and implementation of the Teaching Performance Assessment (TPA) in ITE in Australia. Researchers used document analysis to examine the publicly stated purpose of the TPA. The analysis revealed that the relevant policy texts focused much more on qualification (81%) than socialisation (8%) and subjectification (11%). The findings imply that the TPA policies may contribute to narrowing the ITE curriculum and the subsequent thwarting of teacher subjectification.

Abstract: CD37-directed antibody and cellular-based approaches have shown preclinical and promising early clinical activity. Naratuximab emtansine (Debio 1562; IMGN529) is an antibody-drug conjugate (ADC) incorporating an anti-CD37 monoclonal antibody conjugated to the maytansinoid DM1 as payload, with activity as a single agent and in combination with rituximab in patients with lymphoma. We studied naratuximab emtansine and its free payload in 54 lymphoma models, correlated its activity with CD37 expression, characterized two resistance mechanisms, and identified combination partners providing synergy. The activity, primarily cytotoxic, was more potent in B- than T-cell lymphoma cell lines. After prolonged exposure to the ADC, one diffuse large B-cell lymphoma (DLBCL) cell line developed resistance to the ADC due to the CD37 gene biallelic loss. After CD37 loss, we also observed upregulation of interleukin-6 (IL-6) and related transcripts. Recombinant IL-6 led to resistance. Anti-IL-6 antibody tocilizumab improved the ADC’s cytotoxic activity in CD37+ cells. In a second model, resistance was sustained by a PIK3CD activating mutation, with increased sensitivity to PI3Kδ inhibition and a functional dependence switch from MCL1 to BCL2. Adding idelalisib or venetoclax overcame resistance in the resistant derivative and improved cytotoxic activity in the parental cells. In conclusion, targeting B-cell lymphoma with the naratuximab emtansine showed vigorous antitumor activity as a single agent, which was also observed in models bearing genetic lesions associated with inferior outcomes, such as Myc Proto-Oncogene (MYC) translocations and TP53 inactivation or R-CHOP (rituximab, cyclophosphamide, doxorubicin, Oncovin [vincristine], and prednisone) resistance. Resistant DLBCL models identified active combinations of naratuximab emtansine with drugs targeting IL-6, PI3Kδ, and BCL2.

ABSTRACT: Background: Chronic pain after breast cancer surgery, affecting 25%-60% of patients, significantly impacts the survivors’ quality of life. With improved survival rates, more individuals are experiencing this long-term complication. It is often overlooked that this chronic pain may stem from peripheral nerve injury, resulting in neuropathic pain characterized by burning sensations, electric shocks, and heightened sensitivity. Although neuropathic pain prevalence is reported at 24%-36% post-mastectomy, the data following breast-conserving surgery remain limited. This systematic review aimed to investigate the prevalence of neuropathic pain after breast-conserving surgery and its potential association with axillary procedures. Methods: The electronic databases, Medline, Embase, Web of Science and Cochrane Central, were searched. Inclusion criteria were defined to include studies reporting on the prevalence of neuropathic pain following breast-conserving surgery and exploring associations with axillary procedures. A meta-analysis was performed to compute a pooled prevalence rate. Results: Eight studies, covering 1,469 patients post-breast-conserving surgery, met the inclusion criteria. The meta-analysis revealed a pooled prevalence of 31% (95% confidence intervals [CI] 0.14-0.56) neuropathic pain among patients who underwent breast-conserving surgery. Six studies explored associations with axillary procedures; however, none suggested a correlation between axillary procedures and neuropathic pain after breast-conserving surgery. Conclusion: This systematic review and meta-analysis indicated a pooled prevalence of 31% neuropathic pain following breast-conserving surgery of, with confidence interval ranging from 14% to 56%. The review did not provide conclusive evidence to suggest correlations between axillary procedures and neuropathic pain after breast-conserving surgery.

Background: The workload of musculoskeletal radiologists has come under pressure. Our objective was to estimate the reading times of common musculoskeletal MRI examinations. Methods: A total of 144 radiologists were asked to estimate reading times (including interpretation and reporting) for MRI of the shoulder, elbow, wrist, hip, knee, and ankle. Multivariate linear regression analyses were performed. Results: Reported median reading times with interquartile range (IQR) for the shoulder, elbow, wrist, hip, knee, and ankle were 10 (IQR 6–14), 10 (IQR 6–14), 11 (IQR 7.5–14.5), 10 (IQR 6.6–13.4), 8 (IQR 4.6–11.4), and 10 (IQR 6.5–13.5) min, respectively. Radiologists aged 35–44 years reported shorter reading times for the shoulder (β coefficient [β] = B-3.412, p = 0.041), hip (β = −3.596, p = 0.023), and knee (β = −3.541, p = 0.013) than radiologists aged 45–54 years. Radiologists not working in an academic/teaching hospital reported shorter reading times for the hip (β = −3.611, p = 0.025) and knee (β = −3.038, p = 0.035). Female radiologists indicated longer reading times for all joints (β of 2.592 to 5.186, p ≤ 0.034). Radiologists without musculoskeletal fellowship training indicated longer reading times for the shoulder (β = 4.604, p = 0.005), elbow (β = 3.989, p = 0.038), wrist (β = 4.543, p = 0.014), and hip (β = 2.380, p = 0.119). Radiologists with p ≤ 0.045), and radiologists with 5–10 years of post-residency experience reported longer reading time for the knee (β = 3.660, p = 0.045) than those with >10 years of post-residency experience. Conclusions: There is substantial variation among radiologists in reported reading times for common musculoskeletal MRI examinations. Several radiologist-related determinants appear to be associated with reading speed, including age, gender, hospital type, training, and experience.

Abstract High‐dose melphalan followed by stem cell rescue is the standard consolidative therapy for transplant‐eligible patients with multiple myeloma (MM) in the United Kingdom. A melphalan dose of 200 mg/m2 (Mel200) is considered the “gold standard” for autologous stem cell transplant (ASCT) conditioning for fit patients ≤70 years old; however, with a peak diagnosis incidence at 80–89 years old in the UK dose adjustments will be inevitable to limit toxicities. In this single‐centre UK‐based retrospective analysis, data was collected from patients with plasma cell dyscrasias who underwent a first reduced‐intensity, Mel140, ASCT from 2006 to 2019, a total of 81 patients. We found that the procedure was overall safe with seven (9%) of patients requiring ITU admission and a single transplant‐related death within the initial autograft admission. The progression‐free survival (PFS) and overall survival were comparable with those previously reported in the literature with median PFS for our cohort of 31 months. Univariate analysis of our data showed an inferior PFS for patients aged ≥70 years. In conclusion, although this is a retrospective analysis, it demonstrates that dose‐reduced melphalan conditioning is safe and effective in patients deemed unfit for standard‐intensity conditioning.

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International students have become one of the main populations in Australian universities. However, due to the COVID-19 pandemic, many international students decided to go to other countries and regions for their higher education due to the border control policies in Australia. Based on the social cognitive career and motivation theory, this study explored the motivations and reasons why Chinese postgraduate international students decided to return to Australia after the Australian government officially re-opened the border for on-campus and face-to-face education and why Chinese postgraduate international students decided to study in Australia instead of other countries, particularly during the COVID-19 pandemic. Based on the general inductive approach with semi-structured interviews, focus group activities, and member-checking interviews, 20 Chinese postgraduate international students' stories were captured. The findings indicated that financial, academic, and personal considerations are significant in the participants’ decision-making processes. The results will fill the research gaps and become a reference in international student mobilities, decisions, and decision-making processes of international students, particularly during the COVID-19 pandemic in the Australian university environment.

Background Spine is the most common location for bone metastases. Microwave ablation (MWA) is a technique for minimally invasive tumor treatment. The aim of the current study was to determine whether MWA is a safe option for treatment in vertebral bodies and to gain data on the amount of cortical insulation in the spine.Method MWA was applied with different settings for power and time in both in- and ex-vivo sheep vertebral bodies. Safety was evaluated by temperature measurements at critical surrounding structures (e.g. spinal cord, nerve root). Furthermore, the distribution of heat through the bone at 5 mm from the ablation needle was measured and compared to the temperature at the posterior wall.Results An effect of cortical insulation in the spine was found, for ablations with 20–30 and 50 W (p

Background During the COVID-19 pandemic, psoriasis care underwent significant changes in consultation methods and treatment management. However, comprehensive data on these changes and patient perceptions are limited.Aims To evaluate the pandemic’s implications on psoriasis patients, focusing on access to information, consultation methods, patient satisfaction, disease control assessment, and treatment management changes.Methods A multicenter cross-sectional survey was performed in psoriasis patients from 4 dutch hospitals during the second wave of the pandemic.Results Among 551 respondents, approximately 55% received information their treatment in relation to COVID-19 from their treating physician, while 16.3% sought information online. Consultation methods were shifted to remote formats for 43.6% of patients, primarily via phone and the shift was often initiated by physicians. Overall patient satisfaction during the pandemic scored high (8.0), with remote consultations scoring between 8.0–9.0. Patients on biological treatment reported better disease control (8.0), compared to those on topical (6.0) or conventional systemic treatments (7.0). However, within the systemic treatment group and biologics group, a notable percentage interrupted (16.3% resp. 12.9%) or discontinued treatment (14.1 resp. 10.6%) during the pandemic. Disease control was moderate-to-good assessed by 75% of patients receiving face-to-face and 68% receiving remote consultations.Conclusion Remote care appears to be a viable alternative to face-to-face consultations, with potential benefits in enhancing access to information provided by treating physicians.

The goal of rehabilitating individuals with chronic pain is to assist them in reclaiming control over their pain management and channeling their focus towards well-being and improving function. By providing rational information that helps patients understand their pain, their distress can be alleviated, resulting in positive changes in both their emotional and behavioral responses. Practitioners can assist patients in comprehending their pain and developing an effective management plan by employing a case formulation model. Within the cognitive behavioral model of chronic pain, event-meaning coupling can be emphasized in case formulation, allowing for a greater focus on the patient’s internal cognitive processes, helping them gaining insight into their pain. This model also considers potential biopsychosocial factors that could afford the patient’s ability to make new meaning from events. By assessing and promoting positive event-meaning couplings, patients can be empowered to interact more effectively with their biopsychosocial arena, which in turn can foster a virtuous cycle for self-expansion for successful rehabilitation.

Viral vectors are agents enabling gene transfer and genome editing and have widespread utility across the healthcare and biotechnology sectors. In January 2023, the International Bureau for Weights and Measures’ Consultative Committee for Amount of Substance (CCQM) held a workshop on Metrology for Viral systems as molecular tools. The workshop brought together international leaders from across regulatory, industry, government science, and metrology sectors to better understand key challenges for the community: Exploring current limitations in the measurement of virus-derived, virus-based, and virus-like systems in terms of quantification and characterisation; surveying the state-of-the-art in analytical methods and reference material provision for these entities; and initiating a dialog for the strategic development and implementation of suitable standardisation approaches for this sector. This article presents the workshop background and rationale, presentation summaries, conclusions, and recommendations.

Summary: Background: In chronic obstructive pulmonary disease (COPD), vascular alterations have been shown to contribute to hypoxia and pulmonary hypertension, but the independent contribution of small vessel abnormalities to mortality remains unclear. Methods: We quantified artery and vein dimensions on computed tomography (CT) down to 0.2 mm. Small vessel volumes (

Background: Delayed post-hypoxic leukoencephalopathy (DPHL) is characterized by a biphasic clinical course, with complete recovery from coma to a fully conscious state lasting one to four weeks (lucid interval), followed by abrupt neurological deterioration as an indirect consequence of hypoxic events like carbon monoxide poisoning and narcotic drug overdose. To our best knowledge, there are no documented cases in literature of choreoathetosis and dementia following poppy-induced DPHL with 14-3-3 protein in cerebrospinal fluid (CSF). Case presentation: We report the case of a 70-year-old female who underwent cardiopulmonary resuscitation (CPR) due to overdose of homemade refined opium poppy paste two weeks prior to presentation. She presented a progressive cognitive decline, along with the development of apraxia and choreic movement affecting her tongue and bilateral upper and lower extremities. During the symptomatic phase, brain magnetic resonance imaging (MRI) showed bilateral symmetrical hyperintense signals mostly in central frontal, temporal, and parieto-occipital lobes in the diffusion weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences which are the characteristic findings of DPHL. CSF routine analysis, as well as toxicology screening, autoimmune and paraneoplastic encephalitis panels were negative, but the presence of 14-3-3 protein in the CSF was detected. With steroid therapy, hyperbaric oxygen therapy and symptomatic treatment, she experienced gradual improvement in cognition, motivation, and psychomotor function. Conclusion: DPHL represents a distinct form of encephalopathy characterized by unique clinical course and imaging features. It is the first report of DPHL with positive 14-3-3 protein in CSF. The potential of 14-3-3 protein as a biomarker for diagnosing DPHL and its ability to predict disease severity and prognosis warrants further research.

A new era of banking in Indonesia has arrived with digital transformation in the banking sector. Digital banks are the main choice of young people, especially millennials and Generation Z. How to choose the ideal digital bank? This research tries to answer the question by understanding the role of customer engagement on repurchase intention. The author connects digital bank applications with customer satisfaction and customers will be committed to attaching themselves to the selected digital bank application. The author uses structural equation modeling (SEM) to test the research model with a sample of millennial and Generation Z customers (n = 200). The study results show a significant positive influence of customer satisfaction on customer engagement and repurchase intention of this generation of customers. These findings can provide input for application development and marketing strategies that suit customers, especially millennials and Z generations. Other digital application companies in Indonesia can conclude what the expectations of millennial and Generation Z customers are. To the author's knowledge, there have not been many articles discussing digital banks, the relationship between application use which is an antecedent effect on customer satisfaction, and the effect of customer engagement on repurchase intention in Indonesia.

Abstract Background Increasing patient loads, healthcare inflation and ageing population have put pressure on the healthcare system. Artificial intelligence and machine learning innovations can aid in task shifting to help healthcare systems remain efficient and cost effective. To gain an understanding of patients’ acceptance toward such task shifting with the aid of AI, this study adapted the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), looking at performance and effort expectancy, facilitating conditions, social influence, hedonic motivation and behavioural intention. Methods This was a cross-sectional study which took place between September 2021 to June 2022 at the National Heart Centre, Singapore. One hundred patients, aged ≥ 21 years with at least one heart failure symptom (pedal oedema, New York Heart Association II-III effort limitation, orthopnoea, breathlessness), who presented to the cardiac imaging laboratory for physician-ordered clinical echocardiogram, underwent both echocardiogram by skilled sonographers and the experience of echocardiogram by a novice guided by AI technologies. They were then given a survey which looked at the above-mentioned constructs using the UTAUT2 framework. Results Significant, direct, and positive effects of all constructs on the behavioral intention of accepting the AI-novice combination were found. Facilitating conditions, hedonic motivation and performance expectancy were the top 3 constructs. The analysis of the moderating variables, age, gender and education levels, found no impact on behavioral intention. Conclusions These results are important for stakeholders and changemakers such as policymakers, governments, physicians, and insurance companies, as they design adoption strategies to ensure successful patient engagement by focusing on factors affecting the facilitating conditions, hedonic motivation and performance expectancy for AI technologies used in healthcare task shifting.

Utilizing digital advancements, an integrated Flask-based platform has been engineered to centralize personal health records and facilitate informed healthcare decisions. The platform utilizes a Random Forest model-based symptom checker and an OpenAI API-powered chatbot for preliminary disease diagnosis and integrates Google Maps API to recommend proximal hospitals based on user location. Additionally, it contains a comprehensive user profile encompassing general information, medical history, and allergies. The system includes a medicine reminder feature for medication adherence. This innovative amalgamation of technology and healthcare fosters a user-centric approach to personal health management.

Hepatic de novo lipogenesis is influenced by the branched-chain α-keto acid dehydrogenase (BCKDH) kinase (BCKDK). Here, we aimed to determine whether circulating levels of the immediate substrates of BCKDH, the branched-chain α-keto acids (BCKAs), and hepatic BCKDK expression are associated with the presence and severity of nonalcoholic fatty liver disease (NAFLD). Eighty metabolites (3 BCKAs, 14 amino acids, 43 acylcarnitines, 20 ceramides) were quantified in plasma from 288 patients with bariatric surgery with severe obesity and scored liver biopsy samples. Metabolite principal component analysis factors, BCKAs, branched-chain amino acids (BCAAs), and the BCKA/BCAA ratio were tested for associations with steatosis grade and presence of nonalcoholic steatohepatitis (NASH). Of all analytes tested, only the Val-derived BCKA, α-keto-isovalerate, and the BCKA/BCAA ratio were associated with both steatosis grade and NASH. Gene expression analysis in liver samples from 2 independent bariatric surgery cohorts showed that hepatic BCKDK mRNA expression correlates with steatosis, ballooning, and levels of the lipogenic transcription factor SREBP1. Experiments in AML12 hepatocytes showed that SREBP1 inhibition lowered BCKDK mRNA expression. These findings demonstrate that higher plasma levels of BCKA and hepatic expression of BCKDK are features of human NAFLD/NASH and identify SREBP1 as a transcriptional regulator of BCKDK.

The rising incidence of injuries and neurological disorders has highlighted the critical need for accessible and affordable rehabilitation solutions. In response to this demand, robotic exoskeletons have become a popular option for rehabilitation. However, current rehabilitation exoskeletons are generally expensive due to the high force of the actuators used, i.e., electric motors. Therefore, the availability is limited to patients who can afford to pay for physiotherapy using these robotic exoskeletons. Because of the demand for high force, the exoskeleton is heavy, impacting patient safety. In response to these challenges, the main contribution of this study is to develop a lightweight lower-body rehabilitation exoskeleton with sufficient force while maintaining a fast response time and precise motion control for rehabilitation purposes. In this research, a lower body knee joint rehabilitation exoskeleton prototype implementing a slider-crank mechanism was meticulously designed and optimized using Finite Element Analysis (FEA) via SolidWorks software. After optimising the design, the lower body exoskeleton (LBE) was fabricated and assembled. Next, the LBE system was characterized to understand its non-linear behaviour, as the LBE uses a double-acting pneumatic cylinder that is known to exhibit non-linear behaviour. To further analyse the effectiveness of LBE for rehabilitation, a Proportional-Integral-Derivative (PID) controller was adopted for its simplicity in controlling the exoskeleton's angular motions. Excellent results were obtained using a PID controller at the angular displacement of 75?, with a 96.5% reduction in overshoot (OS%), a 92.9% decrease in steady-state error (Ess), a 3.2% reduction of rise time (Tr), and a minimal 0.006% reduction in settling time (Ts). These findings indicate that the LBE with the slider-crank mechanism is a promising device, particularly for knee joint rehabilitation, and that it can be applied to other rehabilitation applications that require a lightweight design and high force application. ABSTRAK: Peningkatan kecederaan dan gangguan neurologi menyebabkan keperluan kritikal terhadap pemulihan yang senang diakses dan berpatutan. Sebagai solusi kepada keperluan ini, robot eksoskleton telah menjadi pilihan popular bagi sesi pemulihan. Namun, eksoskleton pemulihan sedia ada adalah secara amnya mahal kerana memerlukan daya penggerak yang tinggi, contohnya motor elektrik. Maka, ketersediaan menggunakan eksoskleton pemulihan ini terhad kepada pesakit yang mampu membayar fisioterapi mahal menggunakan robot eksoskleton. Selain itu, disebabkan permintaan pada daya penggerak tinggi, robot eksoskleton secara tidak langsung adalah berat dan ini akan memberi kesan kepada keselamatan pesakit. Sebagai solusi kepada permasalahan ini, sumbangan utama kajian ini adalah bagi membangunkan eksoskleton pemulihan bahagian bawah badan yang ringan dan mempunyai daya penggerak yang mencukupi, di samping mengekalkan masa tindak balas yang cepat dan kawalan pergerakan yang tepat bagi tujuan pemulihan. Penyelidikan ini membangunkan prototaip eksoskleton pemulihan sendi lutut bawah badan (LBE) yang menggunakan mekanisme engkol gelangsar dan dioptimumkan dengan teliti menggunakan Analisis Unsur Terhingga (FEA), menggunakan perisian SolidWorks. Selepas reka bentuk dioptimumkan, eksoskleton LBE telah difabrikasi dan dipasang. Seterusnya sistem LBE telah direka bagi memahami ciri-ciri tidak linear, kerana sistem LBE ini menggunakan silinder pneumatik dwitindakan, dimana pneumatik terkenal sebagai sistem tidak linear. Bagi menganalisa lebih lanjut keberkesanan LBE sebagai sistem pemulihan, kawalan Berkadaran-Kamiran-Pembeza (PID) telah digunakan bagi memudahkan kawalan sudut gerakan eksoskleton. Dapatan kajian menunjukkan, kawalan PID adalah sangat baik pada gerakan sudut maksimum, anjakan sudut 75?, di mana pengurangan 96.5% yang ketara dalam lajakan (OS%), penurunan 92.9% dalam ralat keadaan mantap (Ess), 3.2% pengurangan masa naik (Tr), dan pengurangan minimum 0.006% dalam masa penetapan (Ts). Penemuan ini menunjukkan bahawa sistem LBE dengan menggunakan mekanisme engkol gelangsar adalah peralatan yang berkesan, terutama bagi pemulihan sendi lutut, dan ia juga boleh digunakan bagi aplikasi pemulihan lain yang memerlukan reka bentuk ringan dan aplikasi daya yang tinggi.

Introduction Reducing neonatal deaths in premature infants in low- and middle-income countries is key to reducing global neonatal mortality. International neonatal networks, along with patient registries of premature infants, have contributed to improving the quality of neonatal care; however, the involvement of low-to-middle-income countries was limited. This project aims to form an international collaboration among neonatal networks in Asia (AsianNeo), including low-, middle- and high-income countries (or regions). Specifically, it aims to determine outcomes in sick newborn infants, especially very low birth weight (VLBW) infants or very preterm infants, with a view to improving the quality of care for such infants.Methods and analysis Currently, AsianNeo comprises nine neonatal networks from Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan and Thailand. AsianNeo will undertake the following four studies: (1) institutional questionnaire surveys investigating neonatal intensive care unit resources and the clinical management of sick newborn infants, with a focus on VLBW infants (nine countries/regions); (2) a retrospective cohort study to describe and compare the outcomes of VLBW infants among Asian countries and regions (four countries/regions); (3) a prospective cohort study to develop the AsianNeo registry of VLBW infants (six countries/regions); and (4) implementation and evaluation of educational and quality improvement projects in AsianNeo countries and regions (nine countries/regions).Ethics and dissemination The study protocol was approved by the Research Ethics Board of the National Center for Child Health and Development, Tokyo, Japan (reference number 2020–244, 2022–156). The study findings will be disseminated through educational programmes, quality improvement activities, conference presentations and medical journal publications.

BackgroundThe clinical management of type 2 diabetes mellitus (T2DM) presents a significant challenge due to the constantly evolving clinical practice guidelines and growing array of drug classes available. Evidence suggests that artificial intelligence (AI)–enabled clinical decision support systems (CDSSs) have proven to be effective in assisting clinicians with informed decision-making. Despite the merits of AI-driven CDSSs, a significant research gap exists concerning the early-stage implementation and adoption of AI-enabled CDSSs in T2DM management. ObjectiveThis study aimed to explore the perspectives of clinicians on the use and impact of the AI-enabled Prescription Advisory (APA) tool, developed using a multi-institution diabetes registry and implemented in specialist endocrinology clinics, and the challenges to its adoption and application. MethodsWe conducted focus group discussions using a semistructured interview guide with purposively selected endocrinologists from a tertiary hospital. The focus group discussions were audio-recorded and transcribed verbatim. Data were thematically analyzed. ResultsA total of 13 clinicians participated in 4 focus group discussions. Our findings suggest that the APA tool offered several useful features to assist clinicians in effectively managing T2DM. Specifically, clinicians viewed the AI-generated medication alterations as a good knowledge resource in supporting the clinician’s decision-making on drug modifications at the point of care, particularly for patients with comorbidities. The complication risk prediction was seen as positively impacting patient care by facilitating early doctor-patient communication and initiating prompt clinical responses. However, the interpretability of the risk scores, concerns about overreliance and automation bias, and issues surrounding accountability and liability hindered the adoption of the APA tool in clinical practice. ConclusionsAlthough the APA tool holds great potential as a valuable resource for improving patient care, further efforts are required to address clinicians’ concerns and improve the tool’s acceptance and applicability in relevant contexts.