The mediating effect of dispositional mindfulness on the association between UPPS-P impulsivity traits and gaming disorder among Asia-Pacific young adults.

BACKGROUND: Little evidence is available to verify the mediating effect of dispositional mindfulness on the association between gaming disorder and various impulsivity traits. The present study aimed to investigate the mediating effect of dispositional mindfulness on the association between the five UPPS-P impulsivity traits and the risk of gaming disorder among young adults. METHODS: It was an inter-regional cross-sectional study using online survey in Australia, Japan, The Philippines and China. Impulsivity measured by the UPPS-P Impulsive Behavior Scale-Short version; dispositional mindfulness measured by the Mindfulness Attention Awareness Scale; and the risk of gaming disorder measured by the Internet Gaming Disorder Scale were collected in the focal regions. Structural equation modeling was performed by SPSS AMOS version 26 to verify the study hypotheses. Bootstrapped 95% confidence interval was reported. Statistical significance was indicated by the p-value below 0.05. RESULTS: Among the 1,134 returned questionnaires, about 40% of them aged 18-20 years and 21-23 years, respectively. 53.8% were male. 40.7% had been playing digital and video games for over 10 years. The prevalence of gaming disorder was 4.32%. The model fitness indices reflected that the constructed model had an acceptable model fit (χ2(118) = 558.994, p < 0.001; χ2/df = 4.737; CFI = 0.924; TLI = 0.890; GFI = 0.948; RMSEA = 0.058; SRMR = 0.0487). Dispositional mindfulness fully mediated the effect of positive urgency and negative urgency on the risk of gaming disorder. The effect of lack of premeditation on the risk of gaming disorder was partially mediated by dispositional mindfulness. However, dispositional mindfulness did not mediate the effect of sensation seeking on the risk of gaming disorder. CONCLUSIONS: The varied associations between dispositional mindfulness and the five impulsivity traits hints that improving some impulsive traits may increase dispositional mindfulness and so lower the risk of gaming disorder. Despite further studies are needed to verify the present findings, it sheds light on the need to apply interventions on gamers based on their impulsivity profile. Interventions targeting at emotion regulation and self-control such as mindfulness-based interventions seem to be effective to help gamers with dominant features of urgency and lack of premeditation only. Other interventions shall be considered for gamers with high sensation seeking tendency to enhance the effectiveness of gaming disorder prevention.

Discontinuing Nasal Continuous Positive Airway Pressure in Infants ≤32 Weeks of Gestational Age: A Randomized Control Trial.

OBJECTIVES: To compare immediate cessation of nasal continuous positive airway pressure (NCPAP) vs a stepwise decrease in pressure on the duration of NCPAP therapy in infants born prematurely. STUDY DESIGN: A single center study in infants 230-326 weeks of gestational age. NCPAP was stopped either at 5 cm H2O (control) or 3 cm H2O after a stepwise pressure wean (wean) using defined stability and failure criteria. Primary outcome is total NCPAP days. RESULTS: We enrolled 226 infants; 116 were randomly assigned to control and 110 to the wean group. There was no difference in the total NCPAP days between groups (median [25th, 75th percentiles] 16 [5, 36] vs 14 [7, 33] respectively). There were no differences between groups in secondary outcomes, including duration of hospital stay, critical care days, and oxygen supplementation. A higher proportion of control infants failed the initial attempt to discontinue NCPAP (43% vs 27%, respectively; P < .01) and required ≥2 attempts (20% vs 5%, respectively; P < .01). In addition, infants 23-27 weeks of gestational age in the wean group were 2.4-times more likely to successfully stop NCPAP at the first attempt (P = .02) vs controls. CONCLUSIONS: Discontinuation of NCPAP after a gradual pressure wean to 3 cm H2O did not decrease the duration of NCPAP therapy compared with stopping from 5 cm H2O in infants ≤32 weeks of gestational age. However, weaning decreased failed initial attempts to stop NCPAP, particularly among infants <28 weeks of gestational age. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02064712.

Associations between demographic characteristics, perceived threat, perceived stress, coping responses and adherence to COVID-19 prevention measures among Chinese healthcare students.

AIM: To investigate the associations between demographic characteristics, perceived threat, perceived stress, coping responses and adherence to COVID-19 prevention measures in Chinese Healthcare students. DESIGN: A cross-sectional survey collecting data in Hong Kong and Fujian Province of China in April 2020. METHODS: A convenience and snowball sample of 2706 students aged 18 years or older and studying a healthcare programme were recruited in tertiary education institutions/universities in Hong Kong and Putian. The participants completed the questionnaire with six scales: Social Distancing Scale; Personal Hygiene Scale; Empathic Responding Scale; Wishful Thinking Scale; Perceived Stress Scale and Perceived Threat Scale. Path analysis was performed to identify factors associated with the preventive measures outcomes. p value < .05 was considered as statistical significance. RESULTS: The participants reported high compliances to both social distancing (SoD) and personal hygiene measures (PHM). Confidence to manage the current situation, wishful thinking and empathetic responding directly predicted compliance with SoD and PHM. The final model constructed demonstrated a very good fit to the data. CONCLUSION: The findings suggest that students who are male, habituate in Hong Kong, have more clinical experience and weak confidence to manage the threat tend to have lower compliance with the COVID-19 preventive measures. IMPACT: The predictive model constructed is the first one to explore factors associating with the compliance with infection control measures in healthcare students amid the COVID-19 outbreak. As the infection control behaviours of healthcare students, whom are still under training and are the high-risk group of being infected and infecting others in the community, are rarely reported in literature, this study has provided empirical evidence to nurses and other healthcare professionals to identify students susceptible to poor compliance and provide early monitoring and education to suppress the COVID-19 transmission.

Effects of a group mindfulness-based cognitive programme on smartphone addictive symptoms and resilience among adolescents: study protocol of a cluster-randomized controlled trial.

BACKGROUND: Smartphone addiction in adolescent is a significant global health issue since the last decade. Evidence has shown that the uncontrolled use of smartphone would lead to undesirable impact on their growth and development. However, evidence-based interventions to manage adolescents' smartphone addictive behaviors is lacking. The proposed study aims to examine the effect of a group mindfulness-based cognitive programme(MBCP) on resilience, smartphone behavior and addictive symptoms in young adolescents. METHODS: It is an open-label, parallel-group, cluster-randomized controlled trial with repeated measurement analysis. Four primary schools in Hong Kong will be recruited and randomly allocated in a ratio of 1:1 to the intervention/control group. A convenience sample of 240 class level 5 primary school students, 60 from each school, will be recruited. Participants in the intervention group will receive a 12-week MBCP which comprises 90-minute supervised practice at school and daily home practice. Resilience will be measured by Connor-Davidson Resilience Scale - 25 (Chinese version); smartphone behavior will be represented by time spent/day using the smartphone and types of functions used; addictive symptoms will be measured by Smartphone Addiction Scale-Short Version (Chinese Version). Baseline assessment(T0) will be conducted before the intervention starts. Post-tests will be conducted in weeks 4, 8, 12 of the intervention, and 3 months follow-up. Intention-to-Treat analysis will be applied to the variables. Generalized Estimating Equation model will be used to compare differences in resilience scores, smartphone behavior and addiction scores between and within groups, adjusted for socio-demographic factors. P < 0.05 with two-tailed test will be regarded as significance. DISCUSSION: It is expected that adolescents will demonstrate better resilience and lesser smartphone addictive symptoms after joining the MBCP. The study will be the first provided empirical evidence to support the promising application of MBCP to manage smartphone use among adolescents. It introduces community stakeholders including community nurses a non-invasive and simple-to-administer intervention to tackle problematic smartphone use among adolescent clients. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000033273, Registered on 26 May 2020.

A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals.

BACKGROUND: It is widely acknowledged that the experiences of frontline primary health care professionals during COVID-19 are important to understand how they respond and act under situations of pandemic as the gatekeepers in primary health care system. School nurses are primary health care professionals who lead health care in schools and practice in a holistic manner to address the needs of schoolchildren and school personnel. There are rising mental health concerns of frontline health care professionals with anxiety and panic disorders, somatic symptoms, and feeling isolated. No studies use a qualitative study approach to document community frontline school nursing professionals' experiences and challenges during the COVID-19 pandemic. Hence, understanding the school nurses' experiences and challenges to fight against COVID-19 in the communities is important. PURPOSE: This study aims to explore the experiences of school nurses during the COVID-19 pandemic in Hong Kong. METHODS: A qualitative study design adopted the principles of thematic analysis. Nineteen school nurses were recruited to participate in individual semistructured interviews and shared their roles and responsibilities during the COVID-19 pandemic. FINDINGS: Three themes indicated the school nurses' expand professional responsibilities to fight against COVID-19 emerged from the data analysis. These were "Managing Stress," "Navigating the School Through the Pandemic," and "Raising the Profile of the School Nurse Professional," DISCUSSION: Findings reveal the important role of school nursing professionals in minimizing the community-wide risk posed by pandemics and the need to integrate them into planning and implementation of school health policies and guidelines in the primary health care system. This essential role in schools is necessary to assess, implement, monitor, prevent, and reduce the spread of virus in school communities and to minimize the burden to and extra health care resources utilized in the acute care setting during COVID-19 pandemic.

High-throughput time-stretch imaging flow cytometry for multi-class classification of phytoplankton.

Time-stretch imaging has been regarded as an attractive technique for high-throughput imaging flow cytometry primarily owing to its real-time, continuous ultrafast operation. Nevertheless, two key challenges remain: (1) sufficiently high time-stretch image resolution and contrast is needed for visualizing sub-cellular complexity of single cells, and (2) the ability to unravel the heterogeneity and complexity of the highly diverse population of cells - a central problem of single-cell analysis in life sciences - is required. We here demonstrate an optofluidic time-stretch imaging flow cytometer that enables these two features, in the context of high-throughput multi-class (up to 14 classes) phytoplantkton screening and classification. Based on the comprehensive feature extraction and selection procedures, we show that the intracellular texture/morphology, which is revealed by high-resolution time-stretch imaging, plays a critical role of improving the accuracy of phytoplankton classification, as high as 94.7%, based on multi-class support vector machine (SVM). We also demonstrate that high-resolution time-stretch images, which allows exploitation of various feature domains, e.g. Fourier space, enables further sub-population identification - paving the way toward deeper learning and classification based on large-scale single-cell images. Not only applicable to biomedical diagnostic, this work is anticipated to find immediate applications in marine and biofuel research.

Effect of music breathing, a program based on mindful breathing and music listening therapy for promoting sense of coherence in young people: study protocol for a randomized controlled trial.

BACKGROUND: The negative impacts of the COVID-19 pandemic on public health have affected people socially, psychologically, and physically. Young people particularly are having to adjust many aspects of their personal lives: including transitions to work, college, and independent living. Personal resources are important in mitigating stress and improve mental well-being during pandemic. Sense of coherence-an orientation to life-could be considered as a personal resource. Currently, a number of interventions have been developed to target the reduction of stress in young people. Little emphasis has been placed on developing sense of coherence to reduce stress and promote mental well-being among young people. Young people consider music as a preferred leisure activity and an important means of stress relief in their daily lives. However, little research concerning music therapy and sense of coherence exists. METHODS: In the proposed randomized controlled trial, a sample of 290 young people (aged 18-30) will be recruited and allocated randomly into one of two groups: the experimental group and the control group. Participants in the experimental group will participate in a 6-week Music Breathing program that will include music listening and mindful breathing guided by a certified music therapist. Participants in the control group will receive a control condition for 6 weeks Mental Health Education Programme. The primary outcome of the study will be measured using Sense of Coherence Scale. The secondary outcomes will be measured using the Coping Self-Efficacy Scale, Difficulties in Emotion Regulation Scale, Mindful Attention Awareness Scale, Depression Anxiety Stress Scales, BBC Subjective Well-being scale, and salivary cortisol levels. Repeated measures analysis will be used to compare the outcomes between the two groups. DISCUSSION: The results will inform practice in coping with stress through promoting sense of coherence. Individuals will benefit from the long-term effect of this intervention to enhance their sense of coherence to cope with stressful events and promote better mental well-being. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05655234. Registered on December 8, 2022.

Validation of a novel traditional chinese medicine pulse diagnostic model using an artificial neural network.

In view of lacking a quantifiable traditional Chinese medicine (TCM) pulse diagnostic model, a novel TCM pulse diagnostic model was introduced to quantify the pulse diagnosis. Content validation was performed with a panel of TCM doctors. Criterion validation was tested with essential hypertension. The gold standard was brachial blood pressure measured by a sphygmomanometer. Two hundred and sixty subjects were recruited (139 in the normotensive group and 121 in the hypertensive group). A TCM doctor palpated pulses at left and right cun, guan, and chi points, and quantified pulse qualities according to eight elements (depth, rate, regularity, width, length, smoothness, stiffness, and strength) on a visual analog scale. An artificial neural network was used to develop a pulse diagnostic model differentiating essential hypertension from normotension. Accuracy, specificity, and sensitivity were compared among various diagnostic models. About 80% accuracy was attained among all models. Their specificity and sensitivity varied, ranging from 70% to nearly 90%. It suggested that the novel TCM pulse diagnostic model was valid in terms of its content and diagnostic ability.

Digitalizing traditional chinese medicine pulse diagnosis with artificial neural network.

OBJECTIVES: The increasing popularities of traditional Chinese medicine (TCM) and telehealth indicate a need for digitalizing major clinical assessment methods used during TCM consultations. In this study, an electronic TCM pulse diagnostic system was developed, and its validity was explored. MATERIALS AND METHODS: The system was developed with an artificial neural network (ANN). The output neurons were TCM pulse qualities operationalized as the intensity of eight elements (depth, rate, regularity, width, length, smoothness, stiffness, and strength) at six locations (left and right cun, guan, and chi). The input neurons were physical parameters of arterial pressure waveform acquired from the six locations by a pulse acquisition device. TCM pulse quality was rated by a TCM doctor on a 0-10 visual analog scale. Physical parameters were extracted from the arterial pressure waveform with a pulse extraction program developed in-house. The model structure, including number of hidden neurons and hidden layers, and training algorithms were manipulated to optimize model performance. The value of r² was the outcome measure indicating model performance. RESULTS: Two hundred twenty-nine subjects were recruited. Four-layer ANN models trained with 45 hidden neurons and the Levenberg-Marquardt algorithm performed the best. The r² ranged from 0.60 to 0.86. CONCLUSIONS: The validity of the proposed system generated by ANN is established and can assist TCM doctors in collecting relevant health data during telehealth consultation.

Compliance with Standard Precaution and Its Relationship with Views on Infection Control and Prevention Policy among Chinese University Students during the COVID-19 Pandemic.

BACKGROUND: COVID-19 has placed tremendous pressure on the global public health system and has changed daily life. AIM: To examine the relationships between the perceived threat, perceived stress, coping responses and infection control practices towards the COVID-19 pandemic among university students in China. METHODS: Using a cross-sectional survey, 4392 students were recruited from six universities in two regions of China. METHODS: Data were collected via an online platform using self-reported questionnaires. Hierarchical multiple regression analyses were performed to predict the variables on COVID-19 infection control practices. RESULTS: Pearson correlation coefficients showed a significant negative relationship between perceived stress and COVID-19 infection control practices. A significant positive relationship was observed between wishful thinking and empathetic responding, and infection control practices. Hierarchical multiple regression analyses revealed that gender, geographical location, perceived stress and emotion-focused and relationship-focused coping responses were predictors of COVID-19 infection control practices. CONCLUSIONS: The findings suggest that university students displayed moderate levels of stress, using wishful thinking and empathetic responses as coping strategies. Counselling services should therefore emphasise reassurance and empathy. Male university students tended to be less compliant with social distancing. Both counselling and public health measures should recognise the importance of gender differences. Nurses should integrate these findings into future health programme planning and interventions.

Prediction of problem gambling by demographics, gaming behavior and psychological correlates among gacha gamers: A cross-sectional online survey in Chinese young adults.

Objective: The objective of this study is to explore the association of problem gambling with demographics, psychological distress, and gaming behavior in young adult gacha gamers in Hong Kong. Materials and methods: Cross-sectional data was collected in the first and fifth waves of COVID-19 pandemic in Hong Kong online. Participants who aged 18-25 years and had been playing gacha games over the past 12 months were recruited. Stepwise multiple regression was used to explore the association among risk of problem gambling, gaming behavior, participation in gaming activities and psychological distress. A two-sided p-value <0.05 was considered as statistical significance. Results: Three hundred and thirty-seven completed questionnaires were received with no missing data. 34.7% (n = 117) of the participants had non/low-risk of problem gambling. About 40% (n = 136) of them had moderate-risk and the remaining 25% (n = 84) were at high risk of problem gambling. A higher proportion of female participants (78.6%) were found in high-risk group as compared to 39.7% and 55.6% only in the non/low-risk and moderate-risk groups, respectively. The regression model (R 2 = 0.513, F = 71.895, p < 0.001) showed that 51.3% of the variance of the total problem gambling score could be explained by stress, anxiety, monthly expenses on gacha purchases, number of motives for gacha purchase and number of gambling activities engaged. Conclusion: The present study provides empirical evidence to support the association between problem gambling and microtransaction especially for gacha which is the most popular type of video game microtransaction in Asia. The established regression model suggests that gacha gamers with higher risk of problem gambling tend to have greater stress, higher anxiety level, spend more on gacha purchase, have more motives for gacha purchases and engage in more gambling activities. In contrast to the extant literature, higher proportion of female participants in high-risk group indicates that female gacha gamers are also at very high risk of becoming problem gamblers.

Factors Associated with COVID-19 Vaccine Acceptance among Healthcare Professionals and Community Stakeholders in Hong Kong: A Cross-Sectional Study.

BACKGROUND: Acceptance of vaccination in both healthcare professionals and the general public in the community is vital for efficacious control of the virus. Vaccine acceptance associates with many factors. Little research has been dedicated to examining attitudes and behaviors of healthcare professionals and community stakeholders regarding COVID-19 vaccine acceptance in Hong Kong. METHODS: An online cross-sectional survey was sent between February and April 2021 (N = 512). Multivariable regression modeling was used to identify associated variables with outcomes using adjusted odds ratios (AOR) and 95% of confidence intervals (CI). RESULTS: Two demographic variables-age group of over 40 years old (40-59: ORm = 3.157, 95% CI = 2.090-4.467; 60 or over: ORm = 6.606, 95% CI = 2.513-17.360) and those who had previously received a flu vaccination (ORm = 1.537, 95% CI = 1.047-2.258)-were found to be associated with high vaccine intent. Adjusting for these two variables, the results showed that five factors on knowledge variables as perceived benefits for vaccine intent were statistically significant: "Closed area and social gathering are the major ways of SAR-CoV-2 transmission" (AOR = 4.688, 95% CI = 1.802-12.199), "The vaccine can strengthen my immunity against COVID-19, so as to reduce the chance of being infected with it" (AOR = 2.983, 95% CI = 1.904-4.674), "The vaccine can lower the risk of transmitting the viruses to my family and friends" (AOR = 2.276, 95% CI = 1.508-3.436), "The benefits of COVID-19 vaccination outweigh its harm" (AOR = 3.913, 95% CI = 2.618-5.847) and "Vaccination is an effective way to prevent COVID-19" (AOR = 3.810, 95% CI = 2.535-5.728). CONCLUSIONS: High vaccine intent was associated with age and having previously received a flu vaccination. Knowledge and attitudes of healthcare professionals and community stakeholders were associated with high vaccine intent. Training and continuing education programs for healthcare providers and community stakeholders focusing on the delivery of evidence-based data on the benefits of vaccination campaigns for populations to increase the vaccination rates is recommended.

Learning Experience of Chinese Nursing Students during Clinical Practicum: A Descriptive Qualitative Study.

The change in clinical environment can have a significant impact on nursing students' clinical learning and as a consequence, to their competency. Students' learning experiences could provide important insights for improving the existing approach towards clinical education. This descriptive qualitative study aimed to explore nursing students' clinical learning experience. Focus group interviews were conducted with 20 final year nursing students studying a bachelor nursing programme at a self-financing tertiary institution in Hong Kong. Thematic analysis was conducted. 16 female and four male students were recruited. Six themes were identified: Anxiety towards clinical practicum, expectations of roles and responsibilities in practicum, ward environment, adequacy of support, learning attitude, and practicum arrangement. The findings suggest that nursing students are more discontented with their clinical training than before. Nursing faculty must look for possible ways to improve the clinical learning environment.

Learning Experience of Baccalaureate Nursing Students with Challenge-Based Learning in Hong Kong: A Descriptive Qualitative Study.

Nursing education has recently adopted challenge-based learning (CBL) to enhance nursing students' competency in the 21st-century healthcare environment. Previous studies have not yet fully explored nursing students' perceptions of CBL. This descriptive qualitative study aimed to investigate the learning experience of first-year baccalaureate nursing students engaging with CBL. Videotaped focus group interviews were conducted in a tertiary education institution in Hong Kong, China. The participants recruited for the study included ten Year 1 nursing students enrolled in a public health course delivered using CBL over the study period. The participants included four female and six male students. Five themes were identified: facilitation by teachers, familiarity with CBL, team communication, facilitating metacognitive development, and the application of theories into actual practices. The findings shed light on the potential application of CBL in nursing training as it can foster students' metacognition, an important attribute for the modern-day workforce. Facilitating theoretical application into practice implies that CBL helps to fill the theory-practice gap that has long been a persistent issue in nursing training. Nonetheless, students encountered frustrating obstacles throughout the learning process, including ineffective group communication, unfamiliarity with the CBL process, and insufficient facilitation by teachers. Better preparation on the part of both teachers and students is critical to ensure that nursing students are gaining optimal benefits from the CBL process.

Factors associated with self-directed learning among undergraduate nursing students: A systematic review.

BACKGROUND: Self-directed learning (SDL) is encouraged in professional education because it nurtures students' self-motivation and promotes accountability to their own learning. SDL is crucial to fostering collaborative skills for multi-disciplinary practice in today's healthcare settings. OBJECTIVE: To identify factors associated with SDL ability among undergraduate nursing students. DESIGN: A systematic review was conducted. METHODS: The PICO (population, intervention, comparison and outcomes) strategy was used as a guide. Searches were done of studies published between May 2010 and April 2020 via MEDLINE, CINAHL, and EMBASE, as well as print. Screening, selection, and data extraction were performed by two independent reviewers. All discrepancies were resolved through discussion or by consulting a third reviewer. RESULT: A total of 18 of 1576 articles were selected based on the PRISMA process. The methodological quality of all included studies was mostly moderate. Factors associated with SDL were identified from both quantitative and qualitative evidence. Upon the integration of all evidence, the results showed that SDL is developed with the interaction environmental influence (types of study programmes, study years, and teaching-learning strategies) and personal influence [personal characteristics (age and gender) and learning attributes (problem-solving ability, self-efficacy, learning attitude and learning interest). Strategies employing individual study and small group learning with adequate support by educators exert a great deal of positive effect on SDL improvement. CONCLUSION: All identified factors improve students' SDL. The results of the review revealed SDL development with the interaction of environmental/situation influence and personal influence. Nurse educators should be more aware of the effects of these factors on SDL development during different stages of study. Strategies with independent learning and small group learning are effective to enhance students' learning attributes. Importantly, continuous support and guidance provided by educators is crucial to achieve students' SDL enhancement for lifelong learning during study.

Erratum: Lee, R.L.T., et al. Effects of an Unstructured Free Play and Mindfulness Intervention on Wellbeing in Kindergarten Students. Int. J. Environ. Res. Public Health 2020, 17, 5382.

The authors wish to make the following corrections to their paper [...].

A Survey of Contact Lens Wearers and Eye Care Professionals on Satisfaction with a New Smart-Surface Silicone Hydrogel Daily Disposable Contact Lens.

PURPOSE: To assess the patient and ECP preference of verofilcon A lenses over approximately a one-week period when worn on a daily wear, daily disposable (DD) basis by current DD contact lens wearers (CLWs) and new CLWs. ECPs assessed the lens fit, performance on eye and lens preference (to habitual DD lens) for current wearers. METHODS: A total of 218 current DD CLWs and 129 new CLWs aged >18 years participated in the survey. Baseline demographics and one-week data were obtained by 31 ECPs after fitting up to 10 current and 10 new wearers each. The survey was conducted online for both the participants and the ECPs. The survey took place in Australia and New Zealand from April to May 2019. RESULTS: For new wearers, the surveyed results demonstrated strong wearer preference for the verofilcon A lens with quality of life as a main driver. For current wearers, comfort was the main driver for verofilcon A preference. Post survey, 73% of ECPs stated they would most likely continue to fit verofilcon A lenses.

To evaluate the effect of challenge-based learning on the approaches to learning of Chinese nursing students: A quasi-experimental study.

Challenge-based learning (CBL) is a learner-centred, experimental learning strategy that aims to prepare students to manage unforeseeable and complex global issues in the 21st century. It cultivates an active and authentic learning environment that requires students' creative input, collaboration and community involvement. Studies in the past decade have shown that CBL strengthens soft skills essential for future society, such as critical thinking and creativity. However, its effect on students' metacognitive abilities is scarcely mentioned. This study - a quasi-experimental study with non-equivalent groups conducted in a self-financing tertiary institution in Hong Kong - aims to evaluate the effect of CBL on approaches to learning among nursing students. First-year students in the nursing programme who attended a nursing course using CBL were recruited for the intervention group and senior year-one students were included in the control group. Their approach to learning was measured by the Revised Two-Factor Study Process Questionnaire administered at the beginning and at the end of the semester. Analysis of Covariance (ANCOVA) was used to compare the mean difference in scores of deep and surface approaches between the groups. A total of 209 participants were recruited, with 130 in the intervention group and 79 in the control group. The response rates were 65.3% (130/199) and 78.2% (79/101) for the intervention and control groups, respectively. In the intervention group, the mean post-test deep approach score was significantly higher than the pre-test score (F = 5.2, p = 0.023), even though it had only a small effect. There was no statistically significant difference in baseline post-test mean surface scores (F = 2.4, p = 0.125). The results of this study indicate that CBL may facilitate deep learning in nursing students.

Effects of an Unstructured Free Play and Mindfulness Intervention on Wellbeing in Kindergarten Students.

Play is known as the core occupation of young children as it lays a foundation for their early development and physical, emotional and social wellbeing. Literature suggests that unstructured free play and mindfulness interventions may independently promote wellbeing among preschoolers. However, there is no clear evidence of their combination in supporting wellness in early learning environments. We conducted a quasi-experimental study with 42 children aged four to six years, attending two kindergartens in Hong Kong. The intervention included unstructured play with non-directional loose parts (play materials), conducted outdoors for one hour daily followed by a mindfulness intervention for 10 min per day indoors. The intervention lasted for five consecutive days. We examined happiness and aspects of playfulness before and after the intervention, finding a significant increase in all areas. Given greater freedom in play choice, children showed more disruptive behaviors during unstructured play than the control group engaging in recess as usual. We conclude that unstructured play in addition to mindfulness intervention is effective in promoting students' happiness and playfulness, both of which may help maintain mental health and wellbeing amid stressors such as transition and separation. The increased disruptive behavior requires additional investigation.

Adrenal insufficiency in neonates undergoing cardiopulmonary bypass and postoperative hypothalamic-pituitary-adrenal function after prophylactic glucocorticoids.

OBJECTIVES: Determine incidence of preoperative adrenal insufficiency in neonates >35 weeks gestation with congenital heart disease undergoing cardiothoracic surgery with bypass and effects of prophylactic methylprednisolone on postoperative hypothalamic-pituitary-adrenal function and hemodynamic stability. DESIGN: Prospective observational study in 36 neonates with preoperative adrenocorticotrophic hormone stimulation tests and serial total cortisol and adrenocorticotrophic hormone measurements before and after surgery. Data analyses: analysis of variance and regression. RESULTS: Baseline circulating adrenocorticotrophic hormone and cortisol were unchanged 4-20 days postnatal (P > 0.1); however, cortisol levels rose with increasing adrenocorticotrophic hormone, P = 0.02. Ten neonates (29%) demonstrated preoperative adrenal insufficiency (∆cortisol ≤9 µg/dl); one had postoperative hemodynamic instability. Growth-restricted neonates had lower baseline cortisol, but normal stimulation tests and responded well to surgical stresses. Seventy-five percent of neonates receiving perioperative methylprednisolone demonstrated postoperative hypothalamic-pituitary-adrenal inhibition. CONCLUSION: Adrenal insufficiency appears common in neonates >35 weeks gestation with congenital heart disease, but did not contribute to postoperative hemodynamic instability despite hypothalamic-pituitary-adrenal inhibition.