Temporal covariation of island arc Sr isotopes and seawater chemistry over the past 2 billion years.

The chemical compositions of island arc basalts (IAB) reflect contributions from the mantle as well as fluids and melts from the subducting slab. Addition of radiogenic seawater Sr to oceanic crust through hydrothermal alteration and subsequent subduction is often invoked to explain elevated 87Sr/86Sr signatures in modern IAB. However, changes in the 87Sr/86Sr of island arc magmatic rocks through time has not been investigated, limiting our understanding of the factors influencing the Sr budgets of arcs throughout Earth's history. To address this, we compiled 87Sr/86Sr values from island arc magmatic rocks ranging in age from modern to Paleoproterozoic, only including data from island arc localities that best preserve initial magmatic 87Sr/86Sr. Median initial 87Sr/86Sr values are consistently elevated compared to depleted mantle 87Sr/86Sr over this period, indicating persistent enrichment in radiogenic Sr in island arcs. Moreover, the elevation in island arc 87Sr/86Sr relative to the depleted mantle is variable. A notable rise in island arc 87Sr/86Sr during the late Neoproterozoic coincides with a steep increase in seawater 87Sr/86Sr and Sr concentration. To investigate this potential connectivity, we modeled the 87Sr/86Sr of island arc magmas between 0 and 830 Ma with inputs of depleted mantle 87Sr/86Sr, seawater 87Sr/86Sr, and seawater Sr concentration. The model reproduces the overall trajectory of the compiled data. We interpret the observed temporal variation in island arc 87Sr/86Sr values and its close association with fluctuations in seawater chemistry as evidence that changes in marine geochemistry have strongly influenced the Sr isotopic record of island arc magmas over time.

An Examination of the Usefulness of a Human Resource Development Tool of New Visiting Nurses.

Japan's aging rate is among the highest in the world these days. Consequently, home-visiting nursing stations ("stations") are increasing rapidly, but visiting nurses do not remain working at them for long. We developed a human resource promotional tool using spreadsheet software (Excel®; Microsoft Corp.) to support the education of newly appointed nurses working at the stations. Through this research we report findings of an examination concerning the usefulness of this tool on a trial basis. The results show that use of the tool led to increased motivation and decreased educational needs, a visualization of the skills acquired by newcomer nurses had an impact on their motivation to learn along with learning effectiveness.

The nature and functions of appearance-related comparisons in body dysmorphic disorder.

Appearance-related comparisons (A-RCs) in body dysmorphic disorder (BDD) are under researched despite their probable role in disorder maintenance. The present study therefore aimed to explore the nature (frequency, direction and automaticity), and functions of A-RCs in BDD. N = 43 including people with BDD (n = 23) and controls (n = 20) matched approximately on age and sex were recruited. A mixture of standardized and devised questionnaires on body image and A-RCs were completed. A-RCs were significantly more frequent, generally more upward (to more attractive standards of comparison), and more automatic in people with BDD relative to the control group. People with BDD also held significantly stronger agreement with beliefs about A-RCs as serving functions of: self-evaluation, self-improvement, self-enhancement, and in particular, self-loathing (a way to confirm beliefs about physical unattractiveness) and social threat management. This research presents evidence that the nature and functions of A-RCs in BDD have a role in this disorder's maintenance. Clinical implications, limitations, and future directions for research are discussed.

[Clinical and functional evaluation of pediatric patients with pelvic fracture treated in a third level Hospital]. / Evaluación clínica y funcional de pacientes pediátricos con fractura de pelvis tratados en un Hospital de Tercer Nivel.

INTRODUCTION: pelvic fracture in children is considered one of the most important injuries due to its high mortality. They are rare, but have a major impact on patients' functional outcomes. OBJECTIVE: to evaluate the clinical evolution and functional grade in pediatric patients with pelvic fractures who have already been treated, either conservatively or surgically. MATERIAL AND METHODS: descriptive-cross-sectional-retrospective study. Sample of 24 patients, aged five to 16 years with pelvic fracture, treated from 2016 to 2021. Clinical and functional outcome was assessed using the Barthel index and hip range of motion, as well as surgical or conservative treatment, accompanying lesions and injury mechanism. RESULTS: to find out if there is an association between the Torode and Zieg classifications with the Barthel index and hip range of motion, an association analysis was performed with the 2 statistic, obtaining a 2 value = 19.213. with p = 0.004 for the Barthel index and a 2= 14.253 with p = 0.0026 for hip ranges of motion; these results indicate that there is statistically significant association. CONCLUSION: the most frequent type of pelvic fracture in pediatric patients treated is type III on the Torode and Zieg scale, which according to the Barthel index is associated with a degree of independence and complete hip mobility arches, so the clinical and functional outcome in these patients is high in severe injuries.

INTRODUCCIÓN: la fractura de pelvis en edad pediátrica es considerada de las lesiones más importantes debido a su alta mortalidad; son poco frecuentes, pero tienen gran impacto en el resultado funcional de los pacientes. OBJETIVO: evaluar la evolución clínica y grado funcional en niños con fracturas de pelvis tratados de forma conservadora o quirúrgica. MATERIAL Y MÉTODOS: estudio descriptivo-transversal-retrospectivo. Muestra de 24 pacientes, de cinco a 16 años de edad, con fractura de pelvis, tratados del 2016 al 2021. Se valoró el resultado clínico y funcional mediante el índice de Barthel y arcos de movilidad de cadera, tratamiento quirúrgico o conservador, lesiones acompañantes y mecanismo de lesión. El análisis estadístico se realizó con el software IBM SPSS Statistics®. RESULTADOS: se realizó un análisis de asociación mediante 2 entre las clasificaciones de Torode y Zieg con el índice de Barthel y arcos de movilidad de cadera, obteniendo un valor de 2 = 19.213 con p = 0.004 para índice de Barthel y un valor de 2= 14.253 con p = 0.0026 para arcos de movilidad de cadera; estos resultados indican que hay una asociación estadísticamente significativa. CONCLUSIÓN: el tipo de fractura de pelvis más frecuente en pacientes tratados es el tipo III en la escala de Torode y Zieg, la cual, según el índice de Barthel, se asocia con un grado de independencia y arcos de movilidad de cadera completos, por lo que el resultado clínico y funcional en estos pacientes es alto en lesiones severas.

ArcS from Thermococcus kodakarensis transfers L-lysine to preQ0 nucleoside derivatives as minimum substrate RNAs.

Archaeosine (G+) is an archaea-specific tRNA modification synthesized via multiple steps. In the first step, archaeosine tRNA guanine transglucosylase (ArcTGT) exchanges the G15 base in tRNA with 7-cyano-7-deazaguanine (preQ0). In Euryarchaea, preQ015 in tRNA is further modified by archaeosine synthase (ArcS). Thermococcus kodakarensis ArcS catalyzes a lysine-transfer reaction to produce preQ0-lysine (preQ0-Lys) as an intermediate. The resulting preQ0-Lys15 in tRNA is converted to G+15 by a radical S-adenosyl-L-methionine enzyme for archaeosine formation (RaSEA), which forms a complex with ArcS. Here, we focus on the substrate tRNA recognition mechanism of ArcS. Kinetic parameters of ArcS for lysine and tRNA-preQ0 were determined using a purified enzyme. RNA fragments containing preQ0 were prepared from Saccharomyces cerevisiae tRNAPhe-preQ015. ArcS transferred 14C-labeled lysine to RNA fragments. Furthermore, ArcS transferred lysine to preQ0 nucleoside and preQ0 nucleoside 5'-monophosphate. Thus, the L-shaped structure and the sequence of tRNA are not essential for the lysine-transfer reaction by ArcS. However, the presence of D-arm structure accelerates the lysine-transfer reaction. Because ArcTGT from thermophilic archaea recognizes the common D-arm structure, we expected the combination of T. kodakarensis ArcTGT and ArcS and RaSEA complex would result in the formation of preQ0-Lys15 in all tRNAs. This hypothesis was confirmed using 46 T. kodakarensis tRNA transcripts and three Haloferax volcanii tRNA transcripts. In addition, ArcTGT did not exchange the preQ0-Lys15 in tRNA with guanine or preQ0 base, showing that formation of tRNA-preQ0-Lys by ArcS plays a role in preventing the reverse reaction in G+ biosynthesis.

Modelling Inductive Sensors for Arc Fault Detection in Aviation.

Modern aircraft are being equipped with high-voltage and direct current (HVDC) architectures to address the increase in electrical power. Unfortunately, the rise of voltage in low pressure environments brings about a problem with unexpected ionisation phenomena such as arcing. Series arcs in HVDC cannot be detected with conventional means, and finding methods to avoid the potentially catastrophic hazards of these events becomes critical to assure further development of more electric and all electric aviation. Inductive sensors are one of the most promising detectors in terms of sensitivity, cost, weight and adaptability to the circuit wiring in aircraft electric systems. In particular, the solutions based on the detection of the high-frequency (HF) pulses created by the arc have been found to be good candidates in practical applications. This paper proposes a method for designing series arc fault inductive sensors able to capture the aforementioned HF pulses. The methodology relies on modelling the parameters of the sensor based on the physics that intervenes in the HF pulses interaction with the sensor itself. To this end, a comparative analysis with different topologies is carried out. For every approach, the key parameters influencing the HF pulses detection are studied theoretically, modelled with a finite elements method and tested in the laboratory in terms of frequency response. The final validation tests were conducted using the prototypes in real cases of detection of DC series arcs.

Lexicographic optimization-based planning for stereotactic radiosurgery of brain metastases.

AIM: To validate a fully-automated lexicographic optimization-planning system (mCycle, Elekta) for single-(SL) and multiple-(ML, up to 4 metastases) lesions in intracranial stereotactic radiosurgery (SRS, 21 Gy, single fraction). METHODS: A pre-determined priority list, Wish-List (WL), represents a dialogue between planner and clinician, establishing strict constraints and pursuing objectives. In order to satisfy the clinical protocol without manual intervention, four patients were required to tweak and fine-tune each WL (SLp, MLp) for coplanar arcs. Thirty-five testing plans (20 SLp, 15 MLp) were automatically re-planned (mCP). Automatic and manual plans were compared including dose constraints, conformality, modulation complexity score (MCS), delivery time, and local gamma analysis (2%/2 mm). To ensure plan clinical acceptability, two radiation oncologists conducted an independent blind plan choice. RESULTS: Each WL-tuning took 3 days. Estimated median manual plans and mCP calculation time were 8 and 3 h, respectively. Significant increases in SLp and MLp target coverage and conformity were registered. mCP showed a not significant and clinically acceptable higher median brain V12Gy. SLp registered a -5.8% MU decrease with comparable median delivery time (MP 2.0 min, mCP 1.9 min) while MLp showed a +9.8% MU increase and longer delivery time (MP 3.5 min, mCP 4.4 min). mCP MCS resulted significantly higher without affecting gamma passing rates. At blind choice, mCP were preferred in the majority of cases. CONCLUSIONS: Lexicographic optimization produced acceptable SRS plans with coplanar arcs significantly reducing the overall planning time in cases with up to 4 brain metastases. These planning improvements suggest further investigations by setting high-quality non-coplanar arc plans as a reference.

Best practice for embryology staffing in HFEA licensed assisted conception centres-guidance from Association of Reproductive & Clinical Scientists.

The Association of Reproductive and Clinical Scientists (ARCS) has long promoted the importance of externally accredited training and assessment of scientific staff within assisted conception centres to ensure professional registration and relevant training at all levels. This not only gives scientific staff the opportunity to empower themselves but also acts to ensure assisted conception centres maintain the highest standards of care and quality for patients whilst meeting HFEA requirements for staffing and training. It also provides assurance to patients that treatment is being delivered by highly trained and competent staff. Clinical embryology practice requires intense concentration, with increasingly complex treatment plans and options coupled with the ever-present consequences of clinical error at the forefront of practitioners' minds, exhaustion and burn out are very real risks. Overloading embryology teams is likely to lead to increased error rates and serious incidents. This guideline aims to bring the sector in line with other Clinical Science specialities to optimise patient care, increase safety, reduce risk (including the risk of legal action against centres and individuals), ensure the use of recognised job titles with appropriate levels of remuneration, and provide centres with a template to work towards for appropriate levels of scientific staffing.

Theories of motivation: A comprehensive analysis of human behavior drivers.

This paper explores theories of motivation, including instinct theory, arousal theory, incentive theory, intrinsic theory, extrinsic theory, the ARCS model, self-determination theory, expectancy-value theory, and goal-orientation theory. Each theory is described in detail, along with its key concepts, assumptions, and implications for behavior. Intrinsic theory suggests that individuals are motivated by internal factors like enjoyment and satisfaction, while extrinsic theory suggests that external factors like rewards and social pressure drive behavior. Arousal theory says that to feel motivated, people try to keep an optimal level of activation or excitement. Incentive theory suggests that behavior is driven by the promise of rewards or the threat of punishment. The ARCS model, designed to motivate learners, incorporates elements of attention, relevance, confidence, and satisfaction. Self-determination theory proposes that individuals are motivated by their needs for autonomy, competence, and relatedness. The expectation-value theory suggests that behavior is influenced by individuals' beliefs about their ability to succeed and the value they place on the task. The goal-orientation theory suggests that individuals have different goals for engaging in a behavior. By understanding these different theories of motivation, educators, coaches, managers, and individuals may analyze what drives behavior and how to harness it to achieve their goals. In essence, a nuanced comprehension of these diverse motivation theories equips individuals across varied domains with a strategic toolkit to navigate the complex landscape of human behavior, fostering a more profound understanding of what propels actions and how to channel these insights toward the attainment of overarching goals.

Single isocenter dynamic conformal arcs-based radiosurgery for brain metastases: Dosimetric comparison with Cyberknife and clinical investigation.

Purpose: To compare the dosimetric quality of automatic multiple brain metastases planning (MBM) with that of Cyberknife (CK) based on the clinical tumor condition, such as the tumor number, size, and location. Methods: 76 treatment plans for 46 patients treated with CK were recalculated with the MBM treatment planning system. Conformity index (CI), homogeneity index (HI), gradient index (GI), lesion underdosage volume factor (LUF), healthy tissue overdose volume factor (HTOF), geometric conformity index (g) and mean dose to normal organs were compared between CK and MBM for tumor number, size, shape and distance from the brainstem or chiasm. Results: The results showed that the mean brain dose was significantly smaller in MBM than CK. CI did not differ between MBM and CK; however, HI was significantly more ideal in CK (p = 0.000), and GI was significantly smaller in MBM (P = 0.000). LUF was larger in CK (p = 0.000) and HTOF and g was larger in MBM (p = 0.003, and 0.012). For single metastases, CK had significantly better HTOF (p = 0.000) and g (p = 0.002), but there were no differences for multiple tumors. Brain dose in MBM was significantly lower and CI was higher for tumors < 30 mm (p = 0.000 and 0.000), whereas HTOF and g for tumors < 10 mm were significantly smaller in CK (p = 0.041 and p = 0.016). Among oval tumors, brain dose, GI and LUF were smaller in MBM, but HTOF and g were smaller in CK. There were no particular trends for tumors close to the brainstem, but HTOF tended to be smaller in CK (0.03 vs. 0.29, p = 0.068) for tumors inside the brainstem. Conclusions: MBM can reduce the brain dose while achieving a dose distribution quality equivalent to that with CK.

A novel lung SBRT treatment planning: Inverse VMAT plan with leaf motion limitation to ensure the irradiation reproducibility of a moving target.

This study exposed the implementation of a novel technique (VMATLSL) for the planning of moving targets in lung stereotactic body radiation therapy (SBRT). This new technique has been compared to static conformal radiotherapy (3D-CRT), volumetric-modulated arc therapy (VMAT) and dynamic conformal arc (DCA). The rationale of this study was to lower geometric complexity (54.9% lower than full VMAT) and hence ensure the reproducibility of the treatment delivery by reducing the risk for interplay errors induced by respiratory motion. Dosimetry metrics were studied with a cohort of 30 patients. Our results showed that leaf speed limitation provided conformal number (CN) close to the VMAT (median CN of VMATLSL is 0.78 vs 0.82 for full VMAT) and were a significant improvement on 3D-CRT and DCA with segment-weight optimized (respectively 0.55 and 0.57). This novel technique is an alternative to VMAT or DCA for lung SBRT treatments, combining independence from the patient's breathing pattern, from the size and amplitude of the lesion, free from interplay effect and with dosimetry metrics close to the best that could be achieve with full VMAT.

Design and evaluation of a revised ARCS motivational model for online classes in higher education.

In recent years, online MOOCs (Massive Open Online Courses) have been quite popular among universities which helps learners to enhance their competency skills apart from learning the regular college/university curriculum. Although distance education and online learning have been adopted gradually recently, it has become the 'New Normal.' In this situation of uncertainty, facilitators must keep themselves updated with the various teaching/learning strategies and encourage learners to get accustomed to the online classroom environment. Furthermore, assisting the learners with active engagement in the classes is essential. Hence, to create an instigated environment for assessing the competency level and addressing the motivational behaviour of the learners in the online courses, a modified version of the "ARCS" (Attention, Relevance, Confidence, and Satisfaction) model is used in this research work. The core objective of this model is to apply a modified motivational model, namely "ARCS-PC," where PC represents Professional Competency. Professional competency includes Critical Thinking skills, Digital literacy, Creative Thinking, Problem-solving, and Time Management. The incorporation of digital quizzes, assignments, and interactive activities using Information and Communication Technology (ICT) tools was done in the ARCS-PC Model. The online classroom lectures and activities were conducted using the Microsoft Teams (MS Teams) educational platform. Linear regression is performed to analyze the modified ARCS-PC model. These technology-enabled online classes and ICT tools have helped teach lifelong learning, collaborative learning, a student-centric approach, and better competency skills to effectively engage students in online courses. In our proposed method, an improvement of 11.21 % was observed in the student's performance compared to a maximum of 8.8 % in the existing traditional models. Detailed analysis and quantification of the proposed method are given in the paper.

Dosimetric comparison in sparing normal tissue dosage by using auto-SBRT planning in oligo liver tumors.

Purpose: The study aimed to compare the dosimetric distribution of VMAT plans by increasing the number of half arcs in liver SBRT and investigate the effect by using automatic plan software in plan optimization. Method: Thirty-one patients with oligo liver tumors were randomly selected. VMAT treatment plans with different numbers of coplanar half arcs were generated. Result: Adding arcs significantly increased the PTV, D2%, D50%, and CI, but sacrificed the plan homogeneity. It also decreased the maximum dose of normal tissues such as the stomach, duodenum, and spinal cord and reduced Dmean, D500cc, and D700cc for the liver. Nevertheless, the diminishing effect gradually decayed into three arcs. Meanwhile, the addition of arcs substantially extended the beam-on time. Conclusion: In the context of SBRT for oligo liver tumors, increasing the number of coplanar half arcs will improve PTV conformity and offer better protection for OARs, albeit at the expense of increased treatment duration. Considering the trade-off between plan quality and treatment efficiency, a three-arc plan may be more suitable for clinical implementation.

Effects of Infection Control Education Program Using Flipped Learning Based on the ARCS Model for Nursing Students: A Mixed Method.

This study was conducted to verify the effect of an infection control education program, using flipped learning based on the ARCS model, for nursing students. The study was a mixed-method study, composed of a nonequivalent control group, a pretest-posttest design, and focus group interviews. The total number of participants was 37, with 18 in the experimental group and 19 in the control group. The mean age of the participants was 24.32 ± 5.60 years, consisting of three males (8.1%) and thirty-four females (91.9%). The collected data were analyzed using a linear mixed-effects method. The data regarding experiences of participation were analyzed using conventional content analysis. The experimental group had a higher degree of learning motivation, self-directed learning ability, and confidence in infection control practice than the control group. In the results of the focus group interviews, the themes were derived from 'Engaging learning experience, although difficult, in new ways of learning'. It was confirmed that the infection control education program, using flipped learning based on the ARCS model, was an effective intervention for improving nursing students' self-directed learning ability. Therefore, it is strongly recommended to use the educational program developed in this study for infection control education for nursing students and new nurses.

The effect of nursing students' perceptions of ARCS motivational teaching on their academic self-efficacy and attitudes towards learning: A structural equation modeling.

BACKGROUND: Nursing education is a curriculum that assists individuals to manage nursing practices in health, illness, and rehabilitation processes. The curriculum aims to train nurses who will work in healthcare systems. OBJECTIVE: This study was conducted to examine the effect of the perception of Attention, Relevance, Confidence, and Satisfaction (ARCS) motivation-based teaching method on attitudes and academic self-efficacy of nursing students towards learning. DESIGN: A cross-sectional, correlational study. SETTINGS: This study was performed in the nursing department of a state university located in Elazig in the east of Türkiye. PARTICIPANTS: A total sample of nursing students (n = 344). METHODS: Data were collected using a personal information form, ARCS motivation theory-based teaching scale, academic self-efficacy scale and attitude towards learning scale. RESULTS: According to the research model, it was found that the perception of teaching with ARCS motivation positively and significantly affected the academic self-efficacy (ß = 0.301) and attitudes towards learning (ß = 0.242) of nursing students. In addition, their academic self-efficacy also had a positive and significant effect on their attitudes towards learning (ß = 0.289). The indirect effect of the perception of teaching with ARCS motivation on students' attitudes towards learning through their academic self-efficacy (ß = 0.087) was found to be positive and significant. The total effect of perception of teaching with ARCS motivation method on nursing students' attitudes towards learning (ß = 0.329) was found to be positive and significant. In the model, the perception of teaching with ARCS motivation method was found to explain 9 % of students' academic self-efficacy and the total of the model was found to explain 18 % of students' attitudes towards learning. Model fit indices values have been detected as; χ2/df = 2.16, RMSEA = 0.058, SRMR = 0.080, CFI = 0.821 and TLI = 0.814. CONCLUSIONS: It is seen that the perception of teaching with ARCS motivation supports the attitudes of nursing students towards learning. Moreover, it also shows that teaching with ARCS motivation positively affects the attitudes of students towards learning through their level of self-efficacy.

Gantry triggered x-ray verification during single-isocenter stereotactic radiosurgery: Increased certainty for a no-margin strategy.

BACKGROUND: Single-isocenter linac-based stereotactic radiosurgery (SRS) has emerged as a dedicated treatment option for multiple brain metastases. Consequently, image-guidance for patient positioning and motion management has become very important. The purpose of this study was to analyze intra-fraction errors measured with stereoscopic x-rays and their impact on the dose distribution. MATERIALS AND METHODS: Treatments were planned with non- coplanar dynamic conformal arcs for 33 patients corresponding to 127 brain lesions and 356 arcs. Intra-arc positioning errors were measuredusing stereoscopic x-rays (ExacTrac Dynamic, Brainlab), triggered during arc delivery. Couch corrections above 0.7 mm and 0.5° were always applied. Intra-arc positioning data was analyzed. The dose impact was evaluated by applying the measured errors to the dose given in each arc. RESULTS: Median residual errors were 0.10 mm, 0.13 mm and 0.08 mm for the lateral, longitudinal and vertical directions and 0.10°, 0.08° and 0.13° for the pitch, roll and yaw angles respectively. 90% of the treatment arcs showed shifts of less than 0.4 mm and 0.4°in all directions. Dosimetric impact of motion showed the largest losses in coverage on small targets. All targets achieved at least 95% of the prescription dose to 95% of their volume, even when planned without margins. CONCLUSIONS: Intra-fractional errors measured during beam delivery were found to be notably low with a dose impact that showed acceptable target coverage when applying these intra-arc errors to the dose distributions of the individual treatment arcs. Using an adequate immobilization and intra-fraction imaging prior to and during irradiation, no margins need to be added to compensate for intra-fraction motion.

Preconception education program for non-invasive prenatal testing focused on interest in genetics among female university students in Japan: a quasi-experimental study comparing pre-intervention, post-intervention, and three-month follow-up results.

BACKGROUND: Non-invasive prenatal testing (NIPT) is offered as a reproductive choice in many countries. However, pregnant women, particularly those who are primipara or lack knowledge of prenatal testing, experience difficulties understanding adequate information and making decisions on NIPT. This study developed a preconception education program about NIPT, focusing on interest in genetics, and aimed to clarify the effectiveness of the program to help women make decisions on future NIPT. METHODS: This was a one-group, quasi-experimental, pre-post-test study. The study population was female undergraduate students in Japan who participated in the education program. This program included two games and was based on the Attention, Relevance, Confidence, and Satisfaction (ARCS) model, which is an instructional design that stimulates learning interest and motivation. The data of 73 pre-pregnant women who completed all three questionnaires-before, immediately after, and three months after the intervention-were analyzed to clarify the time effects. Moreover, all variables were analyzed using logistic regression analysis to investigate factors related to decisional conflict. RESULTS: Interest in genetics, knowledge of genetics and prenatal testing, and indecisive attitudes toward NIPT significantly improved immediately after the intervention, and consequently, these changes and reduction of decisional conflict were maintained at three months. Moreover, low decisional conflict at follow-up was significantly associated with a high interest in genetics (adjusted odds ratio, 3.42). CONCLUSIONS: These findings provide preliminary evidence that this preconception education program, which focused on facilitating interest in genetics, assists pre-pregnant women to reduce decisional conflict about future NIPT. TRIAL REGISTRATION: The trial was registered at the UMIN-CTR registry (January 16, 2023), registration number UMIN000050047.

Leveraging MOOCs for learners in economically disadvantaged regions.

While Massive Online Open Courses (MOOCs) have seen a surge in enrollments in higher education around the world especially during the Covid-19 pandemic, it is unclear if learners from the economically disadvantaged regions (EDR) are also able to capitalize on them. Specifically, challenges related to using MOOCs in these regions have been reported in the literature. Thus, the objective of this paper is to address the pedagogical challenge by investigating approaches to leverage MOOCs for learners in EDR. Drawing from the ARCS (i.e. Attention, Relevance, Confidence and Satisfaction) model, we proposed an embedded MOOCs approach where bite-sized MOOCs segments are integrated into in-class lectures under the guidance of the instructors. The effectiveness of the embedded MOOCs approach was evaluated and compared with other instructional methods. Results from randomized experiments showed that the embedded MOOCs approach had higher evaluations in terms of attention, relevance and satisfaction than face-to-face learning approach. In addition, the embedded MOOCs approach outperformed asynchronously blended MOOCs in enhancing students' relevance perception. Regression analysis further revealed that attention, confidence, and satisfaction perceptions were positively associated with students' intention to adopt the embedded MOOCs approach in their future studies. The findings shed light on how to utilize MOOCs and re-use content in MOOCs for global benefits and enable new pedagogical developments. The findings also underscore the importance of local social support and offline interactions to support the online learning materials.

Parental Response to Children's Chronic Pain.

AIMS: The aim of this study was to describe the behavior of Moroccan parents toward their children's chronic pain. METHODS: A cross-sectional study was conducted in different hospital wards. Parents of hospitalized children with chronic pain aged six or over participated in the study. The parents' behavior toward their children's pain was assessed using an Arabic version of the Adult Responses to Children's Symptoms (ARCS) scale. The scores for each dimension were calculated by summing the responses of the items related to that dimension, and then they were normalized to obtain scores ranging from 0 to 100. The comparison of scores was performed using Student's t-test or ANOVA. The association between quantitative variables was assessed using a correlation coefficient. RESULTS: A total of 100 parents of children with chronic pain participated in the study. The children's average age was 10.0 ± 2.7 years. The majority of children (62%) experienced pain for more than six months. The joints were the most common location of pain (43%), followed by the abdomen (35%). The "Protect" and "Monitor" dimensions had good reliability with Cronbach's alpha coefficients of 0.80 and 0.69, respectively. The highest mean normalized scores were noted for the "Monitor" and "Protect" dimensions, with means of 82.1 and 70.8, respectively. The "Minimize" dimension had the lowest mean score of 41.4. Parental behavior was not linked to child- or pain-related characteristics. There was no difference in how mothers and fathers behaved towards their children's pain. CONCLUSION: Parents of children with chronic pain in Morocco scored higher on all dimensions of the ARCS, with the highest scores in the "protect" and "monitor" dimensions. These behaviors can negatively affect children's somatic symptoms, functional disability, and anxiety. Our study revealed the importance of providing support to both children and parents of children with chronic pain to manage the pain and related behaviors.

Breastfeeding at Any Cost? Adverse Effects of Breastfeeding Pain on Mother-Infant Behavior.

Breast milk is considered the ideal infant nutrition, and medical organizations encourage breastfeeding worldwide. Moreover, breastfeeding is often perceived as a natural and spontaneous socio-biological process and one of the fundamental roles of new mothers. While breastfeeding is beneficial, little scientific consideration has been given to its potential psychological challenges. Here, we investigate the phenomenon of breastfeeding pain in mothers and its association with maternal and infant behavioral regulation. During the postpartum weeks, the mother-infant dyad can be considered one allostatic unit directed at infant regulation and development. We hypothesize that pain comprises an allostatic challenge for mothers and will thus impair the capacity for dyadic regulation. To test this, we recruited 71 mothers with varying levels of breastfeeding pain and videotaped them with their infants (2-35 weeks old) during spontaneous face-to-face interactions. We quantified the individual differences in dyadic regulation by behaviorally coding the second-by-second affective expressions for each mother and infant throughout their interactions. We tested the extent to which breastfeeding pain alters affect regulation during mother-infant interactions. We discovered that mothers with severe breastfeeding pain express less affective expressions and less infant-directed gaze during interactive moments of engagement and play than mothers with no or moderate pain. Moreover, infants of mothers experiencing pain during breastfeeding express less affective expressions and more mother-directed gaze while interacting with their mothers than infants of mothers who are not in pain. This demonstrates that the allostatic challenge of maternal pain interferes with the behavioral regulation of both mothers and infants. Since the mother-infant dyad is a codependent allostatic unit, the allostatic challenges of one partner can impact the dyad and thus potentially impact child development, bonding, and mother and infant well-being. The challenges of breastfeeding should be considered in addition to the nutritional advances.