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Extensive oral tasks or monologues of different types (e.g., presentations, storytelling) are often used as second language acquisition tasks in the fields of language learning and language testing. Pre-task planning time is a common provision to test-takers who may use different strategies to prepare their response. High-stakes tests, such as the LanguageCert IESOL suite of tests, include planning time prior to monologic tasks and offer test-takers the opportunity for note-making. While the language assessment literature supports planning time for reasons of face validity and fairness, research studies do not consistently support correlations between planning and performance. The current study examined the differences between the scores of test-takers who used note-making as a strategy and those who did not. The research questions investigated: (i) whether test-takers who make notes during planning time in the monologue task of an L2-English B2 speaking task are awarded higher scores on their spoken performances than test-takers who do not and (ii) test-takers' perceptions of their use of planning time. The findings suggest that making notes did not improve test-takers' performance against any of the rating criteria used in the assessment. It also revealed that most test-takers use their planning time to generate their main propositions.

For shared book reading to be effective for language development, the adult and child need to be highly engaged. The current paper adopted a mixed-methods approach to investigate caregiver's language-boosting behaviours and children's engagement during shared book reading. The results revealed there were more instances of joint attention and caregiver's use of prompts during moments of higher engagement. However, instances of most language-boosting behaviours were similar across episodes of higher and lower engagement. Qualitative analysis assessing the link between children's engagement and caregiver's use of speech acts, revealed that speech acts do seem to contribute to high engagement, in combination with other aspects of the interaction.

Abstract Introduction Nail psoriasis is highly prevalent among patients with psoriasis yet remains one of the most challenging areas to treat. To better understand the treatment landscape for psoriatic nail disease, more studies are needed that compare the effectiveness of different biologics for patients with nail psoriasis. This study contributes to this objective by directly comparing the effectiveness of approved biologics in improving nail psoriasis for patients up to month 12 in a real-world setting. Methods Psoriasis Study of Health Outcomes (PSoHO) is an ongoing 3-year, prospective, non-interventional cohort study of adults with chronic moderate-to-severe plaque psoriasis initiating or switching to a new biologic. This study assessed the change in modified Nail Psoriasis Severity Index (mNAPSI) score from baseline to months 3, 6 and 12 for 763 patients and compared the effectiveness of anti-interleukin (IL)-17A biologics versus other approved biologics, as well as ixekizumab versus secukinumab, guselkumab, risankizumab and adalimumab. Comparative adjusted analyses used frequentist model averaging (FMA). Least square mean difference (LSMD) in mNAPSI scores are presented as observed. Results Irrespective of the severity of nail psoriasis at baseline, the anti-IL-17A cohort had greater mean mNAPSI reductions from baseline compared to the other biologics cohort through month 12, reaching significance at months 3 and 6 in the adjusted analysis. For patients with moderate-to-severe nail psoriasis, ixekizumab showed numerically higher mean reductions in mNAPSI scores compared to all other studied biologics, reaching significance versus guselkumab at all timepoints and risankizumab at month 6. Conclusion This real-world study showed that patients with moderate-to-severe psoriasis and any severity of concomitant nail involvement had significantly faster and more substantial improvements in nail psoriasis up to month 6 in the anti-IL-17A cohort compared to the other biologics cohort. Of the individual biologics studied, ixekizumab showed the highest numerical improvements in nail psoriasis at month 12. Trial registration EUPAS24207.

Abstract Introduction The National Psoriasis Foundation (NPF) recommends evaluating patient response to treatment at week 12, with a target response of ≤ 1% body surface area (BSA) affected by plaque psoriasis and an acceptable response of BSA ≤ 3% or ≥ 75% improvement. This post hoc analysis compared the achievement of NPF target and acceptable responses for ixekizumab (IXE) versus other biologics. Methods Outcomes were evaluated at week 12 for patients with moderate-to-severe plaque psoriasis from four head-to-head randomized clinical trials (RCTs; UNCOVER-2, UNCOVER-3, IXORA-R, and IXORA-S) and one real-world prospective observational study (Psoriasis Study of Health Outcomes; PSoHO). RCT patients were treated with IXE or etanercept (ETN; UNCOVER-2/3), guselkumab (GUS; IXORA-R), or ustekinumab (UST; IXORA-S). PSoHO patients were treated with anti-interleukin (IL)-17A biologics (IXE, secukinumab, SEC) and other approved biologics for the treatment of plaque psoriasis. Patients with missing outcomes were imputed as non-responder imputation. For RCT data, statistical comparisons between treatment groups were performed using Fisher’s exact test with no multiplicity adjustments. For real-world data, adjusted comparative analyses were performed using frequentist model averaging (FMA) and reported as odds ratio (OR). Results Across the four head-to-head clinical trials analyzed, significantly higher proportions of patients achieved target and acceptable responses at week 12 with IXE versus ETN, GUS, or UST. Likewise, the proportion of PSoHO patients achieving target and acceptable response at week 12 was higher with IXE compared with other individual biologics. Adjusted comparative analyses showed that IXE had significantly greater odds of target and acceptable response at week 12 versus SEC, GUS, risankizumab (RIS), adalimumab (ADA), UST, and tildrakizumab (TILD) and numerically greater odds of target and acceptable response at week 12 versus brodalumab (BROD). Conclusion Across both clinical studies and real-world settings, more patients treated with IXE achieved NPF target and acceptable responses at week 12 compared with those treated with other biologics. Trial Registration UNCOVER-2 (NCT01597245); UNCOVER-3 (NCT01646177); IXORA-R (NCT03573323); IXORA-S (NCT02561806); PSoHO (EUPAS24207).

AbstractPurpose Currently, in the treatment of moderate-to-severe psoriasis (PsO) there is a lack of evidence demonstrating optimal biologic treatment response with respect to disease duration. The aim of this post-hoc analysis, using real world data from the Psoriasis Study of Health Outcomes (PSoHO), is to provide evidence if early intervention with biologics is associated with better treatment outcomes and if there is any difference among drug classes or individual biologics.Materials and methods For this post-hoc analysis patients were categorised into two subgroups according to shorter (≤2 years) or longer (>2 years) disease duration. Analysis was performed on anti-interleukin (IL)-17A cohort vs other biologics cohort, anti-IL-17A vs other drug classes, and pairwise comparisons of ixekizumab vs individual biologics, provided that the statistical models converged. Analysis investigated the association of disease duration with the proportion of patients achieving 100% improvement in Psoriasis Area Severity Index score (PASI 100) at week 12. Adjusted comparative analyses, reported as odds ratio (OR), were performed using Frequentist Model Averaging (FMA) for each cohort or treatments within each subcategory of the subgroups.Results At week 12, anti-IL-17A and other biologics cohorts displayed minimal differences in numerical response rate for PASI 100 with respect to disease duration. The anti-IL-17A cohort showed a higher numerical PASI 100 response rate compared to the other biologic cohort irrespective of disease duration (≤2 years: 36.7% vs 21.8%; >2 years: 35.8% vs 21.9%).Conclusion Overall, the results do not clearly indicate that treating patients early is critical in achieving optimal patient outcomes. Furthermore, patients treated with ixekizumab show numerically higher response rates relative to other individual biologics irrespective of disease duration.

Summary: Human genetic studies of critical COVID-19 pneumonia have revealed the essential role of type I interferon-dependent innate immunity to SARS-CoV-2 infection. Conversely, an association between the HLA-B∗15:01 allele and asymptomatic SARS-CoV-2 infection in unvaccinated individuals was recently reported, suggesting a contribution of pre-existing T cell-dependent adaptive immunity. We report a lack of association of classical HLA alleles, including HLA-B∗15:01, with pre-omicron asymptomatic SARS-CoV-2 infection in unvaccinated participants in a prospective population-based study in the United States (191 asymptomatic vs. 945 symptomatic COVID-19 cases). Moreover, we found no such association in the international COVID Human Genetic Effort cohort (206 asymptomatic vs. 574 mild or moderate COVID-19 cases and 1,625 severe or critical COVID-19 cases). Finally, in the Human Challenge Characterisation study, the three HLA-B∗15:01 individuals infected with SARS-CoV-2 developed symptoms. As with other acute primary infections studied, no classical HLA alleles favoring an asymptomatic course of SARS-CoV-2 infection were identified.

This paper reports reactions by candidates to the use of online proctoring (OLP), 'invigilation', in the delivery of high-stakes English language examinations. The paper first sets the scene in terms of the move from face-to-face to online modes of delivery. It explores the challenges and benefits that both modes offer, in terms of accessibility, fairness, security and cheating. Evidence is then presented from a survey exploring the reactions to and perceptions of OLP by candidates who had taken an English language examination via OLP. A strong endorsement of OLP was generally recorded. Feedback revealed that respondents perceived OLP to be a more personal as well as a more efficient way of taking a test. Some pertinent negative comments from a smaller number of respondents could be construed as constructive and are also discussed. The results are indicative of a broad acceptance of OLP, pointing to strong future uptake of the OLP mode of test delivery.

During the second decade of the 21st century families and schools world-wide have been affected by several critical events, with economic recession, the refugee crisis, and lately the COVID-19 pandemic being the most prominent. Pertaining to the school community (students, educators, administration, parents, school personnel etc.), evidence-based interventions for improving mental health and supporting psychosocial adjustment are necessary. In this paper the development, implementation, and evaluation of the international WeCARE (We Connect, Accept, Respect, Empower) program, an online multilevel intervention for promoting well-being and resilience in the school community during unsettling times, is presented. The Program has a multicultural perspective and provides the opportunity to students from different countries to cooperate and develop multicultural skills. The intervention is based on a conceptual model for enhancing positive development, resilience, social and emotional skills, and competence. The interventions were implemented on individual and system levels over four consecutive years, including web-based teachers' training and supervision, seminars for parents, and classroom implementation. Furthermore, collaboration amongst schools and educational settings was highlighted, in the form of networking at national and international level. Based on the evaluation results, the necessity for further development and implementation of programs for the promotion of resilience and well-being during unsettling times is discussed.

This article explores the issue of identifying guessers -- with a specific focus on multiple-choice tests. Guessing has long been considered a problem due to the fact that it compromises validity. A test taker scoring higher than they should through guessing does not provide a picture of their actual ability. After an initial description of issues associated with guessing, the article then outlines approaches which have been taken to either discourage test takers from guessing or which attempt statistically to handle the problem. From this, the article moves to a novel way of identifying potential guessers: from the post hoc use of Rasch fit statistics. Two datasets, each consisting of approximately 200 beginner level English language test takers were split into two. In each dataset, half the test takers' answers were randomised -- to approximate guessing. Results obtained via a Rasch analysis of the data was then passed to an analyst who used the Rasch fit statistics to identify possible guessers. On each dataset, 80% of guessers were identified.

The aim of the present paper was to highlight the work of Chrysospathis, Garofalidis and Chartofylakidis, who dedicated themselves to the emergence of orthopaedics as an independent branch of medical science in modern Greece. The ancient Greek physicians Hippocrates, Galen and Paulus of Aegina laid the foundations for the emergence of orthopaedics and ancient Greek civilisation undoubtedly played a significant role in the evolution of this medical art throughout the following centuries. In modern Greece, Ioannis Chrysospathis fought for orthopaedics to be a separate medical branch rather than a practice within the context of general surgery. Theodoros Garofalidis also contributed to the evolution of orthopaedics in Greece, while Georgios Hartofilakidis brought pioneer knowledge to the Greek area, contributed to the creation of specialised orthopaedic departments and internationally contributed to the study of hip diseases and the art of total hip arthroplasty.

Abstract Introduction Given the chronic nature of psoriasis (PsO), more studies are needed that directly compare the effectiveness of different biologics over long observation periods. This study compares the effectiveness and durability through 12 months of anti-interleukin (IL)-17A biologics relative to other approved biologics in patients with moderate-to-severe psoriasis in a real-world setting. Methods The Psoriasis Study of Health Outcomes (PSoHO) is an ongoing 3-year, prospective, non-interventional cohort study of 1981 adults with chronic moderate-to-severe plaque psoriasis initiating or switching to a new biologic. The study compares the effectiveness of anti-IL-17A biologics with other approved biologics and provides pairwise comparisons of seven individual biologics versus ixekizumab. The primary outcome was defined as the proportion of patients who had at least a 90% improvement in Psoriasis Area and Severity Index score (PASI90) and/or a score of 0 or 1 in static Physician Global Assessment (sPGA). Secondary objective comparisons included the proportion of patients who achieved PASI90, PASI100, a Dermatology Life Quality Index (DLQI) score of 0 or 1, and three different measures of durability of treatment response. Unadjusted response rates are presented alongside the primary analysis, which uses frequentist model averaging (FMA) to evaluate the adjusted comparative effectiveness. Results Compared to the other biologics cohort, the anti-IL-17A cohort had a higher response rate (68.0% vs. 65.1%) and significantly higher odds of achieving the primary outcome at month 12. The two cohorts had similar response rates for PASI100 (40.5% and 37.1%) and PASI90 (53.9% and 51.7%) at month 12, with no significant differences between the cohorts in the adjusted analyses. At month 12, the response rates across the individual biologics were 53.5–72.6% for the primary outcome, 27.6–48.3% for PASI100, and 41.7–61.4% for PASI90. Conclusions These results show the comparative effectiveness of biologics at 6 and 12 months in the real-world setting.

The Fe-skarns from the Greek Island of Serifos in Cyclades has been utilized only for the exploitation of magnetite ores, while significantly vast amounts of red and yellow hematite ores remained unexploited as mining wastes. This study explores the effective utilization of such mining wastes per se, as active mesoporous catalysts for energy applications, taking CO oxidation as a model reaction. The results of our multi-analytical study have illustrated that the physicochemical characteristics of the hematite materials can be positively influenced by the implementation of a simple calcination step, while the characteristics of magnetite remained unaffected. The calcined yellow and red mineral hematite from Serifos Fe-skarns mining wastes per se, act beneficial in the catalytic activity with respect to calcined magnetite catalyst. The calcinated counterparts of hematite, and especially yellow hematite, can efficiently be used as a support for depositing Au nanoparticles, and thus achieving even higher activity for CO oxidation (90% CO conversion), at much lower temperatures (T ∼62.0 °C). The mining wastes per se of Serifos, mainly of mesoporous hematite, are particularly active for CO oxidation, without any complex pretreatments or activation or functionalization in the context of circular economy.

Arabinogalactan proteins (AGPs) are proteoglycans with an unusual molecular structure characterised by the presence of a protein part and carbohydrate chains. Their specific properties at different stages of the fruit ripening programme make AGPs unique markers of this process. An important function of AGPs is to co-form an amorphous extracellular matrix in the cell wall-plasma membrane continuum; thus, changes in the structure of these molecules can determine the presence and distribution of other components. The aim of the current work was to characterise the molecular structure and localisation of AGPs during the fruit ripening process in transgenic lines with silencing and overexpression of SlP4H3 genes (prolyl 4 hydroxylase 3). The objective was accomplished through comprehensive and comparative in situ and ex situ analyses of AGPs from the fruit of transgenic lines and wild-type plants at specific stages of ripening. The experiment showed that changes in prolyl 4 hydroxylases (P4H3) activity affected the content of AGPs and the progress in their modifications in the ongoing ripening process. The analysis of the transgenic lines confirmed the presence of AGPs with high molecular weights (120–60 kDa) at all the examined stages, but a changed pattern of the molecular features of AGPs was found in the last ripening stages, compared to WT. In addition to the AGP molecular changes, morphological modifications of fruit tissue and alterations in the spatio-temporal pattern of AGP distribution at the subcellular level were detected in the transgenic lines with the progression of the ripening process. The work highlights the impact of AGPs and their alterations on the fruit cell wall and changes in AGPs associated with the progression of the ripening process.

This study explores the development and pilot testing of an exergame designed for the rehabilitation of individuals with upper limb deficits. While traditional physiotherapy is effective, it often fails to fully engage patients due to its repetitive nature. This research integrates a novel exergame into physiotherapy regimens, aiming to enhance patient motivation through a gaming experience that complements conventional sessions. The exergame is structured around a narrative-driven adventure, with exercises embedded in gameplay that mirror adjustable physiotherapy routines. It utilizes the Myo armband, a wearable electromyography device, to capture muscle activity and movement. The system, part of a web-based platform, is easily deployable in various settings, including home environments. Comprehensive evaluations with health professionals and neurological patients indicate that the exergame significantly improves patient engagement. This study not only demonstrates the potential of exergames in enhancing traditional therapy but also underscores the importance of patient-centered therapeutic tools.

Abstract Background Penetrating injuries of the abdomen and spinal canal that involve organic material of animal origin are extremely rare and derive from domestic and wild animal attacks or fish attacks. Case presentation In this case report we present the unique, as far as the literature is concerned, unprovoked woman's injury to the abdomen by a swordfish. There are only four cases of swordfish attacks on humans in the literature - one resulted to thoracic trauma, two to head trauma and one to knee trauma, one of which was fatal - none of which were unprovoked. Three victims were professional or amateur fishermen whereas in the last reported case the victim was a bather as in our case. Our case is the only case where organic debris of animal's origin remained in the spinal canal after penetrating trauma. Conclusions Although much has been written about the management of penetrating abdominal and spinal cord trauma, controversy remains about the optimal management. Moreover, there is little experience in the management of patients with such spinal injuries, due to the fact that such cases are extremely rare. In this report we focus on the patient's treatment with regard to abdominal and spinal trauma and present a review of the literature.

The COVID-19 pandemic has had an unprecedented impact on the lives of adults and children worldwide. Schools were among the first settings to be influenced by this crisis. Home confinement and school closure were implemented as necessary preventive measures creating a new way of living based on web-based communication. The aim of the study is to explore school community needs during the COVID-19 outbreak in Greece. The study followed a mixed methods design, consisting of a teacher, a parent and an adolescent survey. The sample entailed 1,157 participants (414 teachers, 487 parents and 256 adolescents). Quantitative data were collected using questionnaires. Qualitative data were collected using open-ended questions to explore participants' adjustment and needs during the pandemic. Parents and teachers showed high propensity for anxiety and high levels of resilient coping. Health and adaptation concerns were evident in all samples. Teachers, parents and adolescents described helpful coping practices, primarily related to social support. The findings highlight the importance of supporting all school community members to cope with feelings of stress and anxiety during the pandemic and to identify and make use of helpful personal and social resources.

Introduction: The differential diagnosis of focal biliary strictures comprises both malignant and benign conditions. We report a rare case of follicular cholangitis presenting with segmental stricture of the left hepatic duct. Case description: An asymptomatic 59-year-old male with no past medical history presented with dilation of the left intrahepatic bile ducts revealed as an incidental finding on an abdominal ultrasound. Blood examinations showed only a slightly elevated gamma- glutamyl transferase (gammaGT) value, while carbohydrate antigen 19-9 (Ca 19-9) and serum immunoglobulin G4 (IgG4) were within normal range. Abdominal computed tomography and magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) scans revealed a high grade focal intrahepatic stricture of the left hepatic duct (FIHS type III) with proximal dilatation. Given that a diagnosis of cholangiocarcinoma could not be ruled out, the patient was referred for a left hepatectomy with regional lymph node dissection. Histological analysis showed a lymphoplasmacytic infiltration of the left hepatic duct with fibrosis and follicle formations in the submucosa, findings consistent with follicular cholangitis. The postoperative course was uneventful and there is no evidence of recurrence 8 months after the surgery. Discussion: The clinical and imaging presentation of follicular cholangitis is very similar to cholangiocarcinoma, rendering it a challenging diagnosis preoperatively. Conclusion: The approach to these cases should be primarily surgical. Even though it is very rare -- our report is the 13th case reported worldwide -- follicular cholangitis should be included in the differential diagnosis of focal biliary strictures.

The mental health benefits of forgiveness are well-established in the literature. The growing research on dispositional forgiveness in adolescence is indicative of the need to better understand its role in youth’s well-being. In order to examine dispositional forgiveness in adolescence, measures regarding Big 5 personality factors (individual level), family relationships, school climate (system level), and sociodemographic variables at an individual and system level were used. Participants were 1,378 adolescents attending junior and senior high schools located in the broader area of Attica, Greece, randomly selected. Younger age, lower levels of neuroticism, and higher levels of extraversion, agreeableness and quality communication with the mother predicted higher forgiveness of self. Higher levels of openness to experience, agreeableness, quality communication with the father, positive behavior, positive attitude, and lower levels of lack of respect in the school predicted higher forgiveness of others. Finally, lower levels of neuroticism, higher levels of extraversion, agreeableness, and positive behavior in the school predicted higher levels of forgiveness of situations. The findings highlight the important role of personality factors and indicate the significance of primary prevention interventions in the school community regarding school climate that could contribute to the promotion of dispositional forgiveness and well-being of adolescents.

The Functional Gait Assessment (FGA) was cross-culturally adapted into Greek, according to international guidelines. The final Greek version of the scale (FGAGR) was evaluated for its reliability and was correlated with the mini-Balance Evaluation Systems Test (mini-BESTest), the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falls Efficacy Scale-International (FES-I) questionnaire, for testing the concurrent validity. The discriminant validity between individuals reporting low and those reporting high concern about falls as well as the predictive validity in identifying people with high risk of falls were assessed. The FGAGR was characterized as comprehensible in its content and orders. Psychometric testing in 24 Greek-speaking individuals (six men and eighteen women, 66 ± 7 years old) yielded excellent test-retest (ICC = 0.976) and inter-rater reliability (ICC = 0.984), but moderate internal consistency (Cronbach’s alpha = 0.660). The FGAGR scale proved its concurrent and discriminant validity while a maximum cutoff point of 25, with sensitivity of 84% and specificity of 100%, was identified to be optimal for predicting risk of falls in the elderly. The good psychometric characteristics of the FGAGR confirm its applicability in assessing gait of Greek-speaking older adults.

Hyperthermia has the potential to damage cancerous tissue by increasing the body temperature. However, targeting cancer cells whilst protecting the surrounding tissues is often challenging, especially when implemented in clinical practice. In this direction, there are data showing that the combination of nanotechnology and hyperthermia offers more successful penetration of nanoparticles in the tumor environment, thus allowing targeted hyperthermia in the region of interest. At the same time, unlike radiotherapy, the use of non-ionizing radiation makes hyperthermia an attractive therapeutic option. This review summarizes the existing literature regarding the use of hyperthermia and nanoparticles in cancer, with a focus on nanoparticle-induced cytotoxicity mechanisms.

School climate is a topic of increasing importance internationally. The current study investigated the established measurement invariance of an eight-factor school climate scale using a multinational sample of secondary students. School climate factor means across 14 international groups were compared and findings on the association between school climate factors and mental health were also investigated. Findings, from this study, illustrate several cross-national similarities regarding the ways in which secondary students perceive school climate and the influence of school climate on student mental health. These findings can support school psychologists' efforts to identify strategies and supports that improve the school environment in areas that are most consistently related to student experiences, such as school safety and school connectedness. Implications, limitations, and future directions are discussed.

Introduction Mining of electronic health record (EHRs) data is increasingly being implemented all over the world but mainly focuses on structured data. The capabilities of artificial intelligence (AI) could reverse the underusage of unstructured EHR data and enhance the quality of medical research and clinical care. This study aims to develop an AI-based model to transform unstructured EHR data into an organised, interpretable dataset and form a national dataset of cardiac patients.Methods and analysis CardioMining is a retrospective, multicentre study based on large, longitudinal data obtained from unstructured EHRs of the largest tertiary hospitals in Greece. Demographics, hospital administrative data, medical history, medications, laboratory examinations, imaging reports, therapeutic interventions, in-hospital management and postdischarge instructions will be collected, coupled with structured prognostic data from the National Institute of Health. The target number of included patients is 100 000. Natural language processing techniques will facilitate data mining from the unstructured EHRs. The accuracy of the automated model will be compared with the manual data extraction by study investigators. Machine learning tools will provide data analytics. CardioMining aims to cultivate the digital transformation of the national cardiovascular system and fill the gap in medical recording and big data analysis using validated AI techniques.Ethics and dissemination This study will be conducted in keeping with the International Conference on Harmonisation Good Clinical Practice guidelines, the Declaration of Helsinki, the Data Protection Code of the European Data Protection Authority and the European General Data Protection Regulation. The Research Ethics Committee of the Aristotle University of Thessaloniki and Scientific and Ethics Council of the AHEPA University Hospital have approved this study. Study findings will be disseminated through peer-reviewed medical journals and international conferences. International collaborations with other cardiovascular registries will be attempted.Trial registration number NCT05176769.

Urinary incontinence affects approximately 200 million people worldwide. The objective of this study was to investigate the effect of pelvic floor muscle (PFM) training with biofeedback (BF) in women with urinary incontinence in comparison to PFM training alone. The primary outcome was PFM strength with secondary outcomes being the severity of incontinence, other PFM parameters, quality of life (QoL), social life, satisfaction and adherence to treatment. Randomized controlled trials (RCTs) published from 2005 to 2023 in PubMed, MEDLINE, Scopus and Google Scholar were searched and evaluated with the PEDro scale. Nine moderate and two high methodological quality RCTs were selected. There was a statistically significant improvement in all parameters. In five studies, muscle strength and the severity of incontinence were statistically better in the BF group compared to the non-BF group. In most studies, no differences were found for QoL and social life between the groups. For adherence to treatment, the results were ambiguous. Τhe remaining variables (endurance, precontraction, function, adherence and satisfaction) had few studies to support the results. There was moderate level evidence that the group utilizing PFM exercises with BF showed significant improvements in the management of urinary incontinence. Concerning muscle strength and the severity of incontinence, findings were inconclusive, as only in some studies the results were statistically better in the BF group compared to the non-BF group.

During the last decades, a significant increase in empirical studies concerning school violence is observed. Evidence-based interventions that promote positive school climate have been found to improve social competence, resilience, and students' well-being in schools, resulting in team bonding, feelings of acceptance, respect, and a sense of belonging. The present study explores junior high school students' perceptions regarding school climate dimensions referring to safety and relationships (i.e., discipline/order, positive peer relations, bullying prevention, respect of diversity). The sample consisted of 726 students from junior high schools in the broader area of Athens (mean age 14.4 years). Questionnaires regarding school climate dimensions focusing on safety and relationships, subjective well-being, economic crisis difficulties, and demographic data including gender, school grade, and academic performance were completed. Using conditional process analyses, the effect of a three-way interaction between school climate, academic performance, and economic difficulties on junior high school students' subjective well-being is examined. Gender and school grade are also studied. Results suggest that positive peer relations, bullying prevention, and respect for diversity associated with academic performance (but not with gender and school grade) moderate the relationship between economic difficulties and subjective well-being. The development and implementation of several intervention programs in diverse school settings in the Greek educational system are briefly discussed focusing on their effectiveness and usefulness regarding the promotion of school well-being and prevention of bullying and school violence.

This paper presents social justice principles as core concepts in school psychology practice via a conceptual framework that combines theory, research, training, and practical applications. Focusing on the specific needs of Greece (i.e. economic recession, influx of migrant and refugee students, etc.), we discuss the inclusion of multicultural and international components of school psychology practice as well as implications for socially just practice. Specific examples of interventions and activities developed and implemented by the Laboratory of School Psychology of the National and Kapodistrian University of Athens, which emphasizes the application of social justice principles to practice, are also presented. Finally, we discuss specific guidelines for developing interventions that embrace social justice principles globally as well as explore transnational implications.

The aim of this study was to examine fathers' involvement with their deaf children, and to compare it with the involvement of fathers of children with other disabilities and of typical children. A sample of 172 fathers of preschool-aged children participated in the study. Of these, 25 had deaf children, 23 had children with intellectual disability, 30 had children with autism spectrum disorder and 94 had children without disabilities. Fathers completed questionnaires measuring childcare involvement, beliefs concerning parental role, parental stress, marital satisfaction and social support. Results revealed no differences in the overall level of childcare involvement between fathers of deaf children and fathers of the other groups. Fathers of deaf children experienced less stress than fathers of children with autism spectrum disorder or children with intellectual disability, but more stress when compared to fathers of children without disabilities. Marital satisfaction was found to be the factor that most influences fathers' involvement with their deaf children.

Juxtaglomerular cell tumour (JGCT) is an unusually encountered clinical entity. A 33-year-old man with severe long-standing hypertension and hypokalaemia is described. The patient also suffered from polyuria, polydipsia, nocturia and severe headaches. On admission, laboratory investigation revealed hypokalaemia, kaliuresis, high aldosterone and renin levels, and the abdomen CT identified a mass of 4 cm at the right kidney. Kidney function was normal. Following nephrectomy, the histological investigation revealed the presence of a JGCT. Immunostaining was positive for CD34 as well as for smooth muscle actin and vimentin. Following surgery, a marked control of his hypertension with calcium channel blockers and normalization of the serum potassium, renin or aldosterone levels were reached. According to our findings, JGCT could be included in the differential diagnosis of secondary hypertension as it consists of a curable cause. The association of JGCT with hypertension and hypokalaemia focusing on the clinical presentation, diagnostic evaluation and management is herein discussed and a brief review of the existing literature is provided. Juxtaglomerular cell tumour (JGCT) is an unusually encountered clinical entity. A 33-year-old man with severe long-standing hypertension and hypokalaemia is described. The patient also suffered from polyuria, polydipsia, nocturia and severe headaches. On admission, laboratory investigation revealed hypokalaemia, kaliuresis, high aldosterone and renin levels, and the abdomen CT identified a mass of 4 cm at the right kidney. Kidney function was normal. Following nephrectomy, the histological investigation revealed the presence of a JGCT. Immunostaining was positive for CD34 as well as for smooth muscle actin and vimentin. Following surgery, a marked control of his hypertension with calcium channel blockers and normalization of the serum potassium, renin or aldosterone levels were reached. According to our findings, JGCT could be included in the differential diagnosis of secondary hypertension as it consists of a curable cause. The association of JGCT with hypertension and hypokalaemia focusing on the clinical presentation, diagnostic evaluation and management is herein discussed and a brief review of the existing literature is provided.

New treatment modalities have been recently introduced in the management of ovarian cancer (OC). Herein, we sought to investigate their implementation in routine clinical practice and examine the real-world management of OC in Greece. EpOCa was a non-interventional, multicenter, retrospective study in patients with advanced epithelial OC. The primary outcome was to estimate the proportions of the different treatment regimens used per line of therapy, while progression-free survival (PFS) and overall survival (OS) were the key secondary endpoints. A total of 154 patients were enrolled in the study, among whom, 40% were tested for BRCA mutations and 30% were found to be positive. Nearly 90% of patients underwent debulking surgery at diagnosis, with few operations being also recorded upon relapse. Platinum-based chemotherapy (CT) was predominantly used in the first line with half of patients also receiving angiogenesis inhibitor (AI), while non-platinum-based CT was preferred in later lines. The median PFS was 18.2 and 8.8 months in the first- and second-line setting, respectively, whereas the median OS was approximately 50 months. Our study adds to the available, but limited, real world data on the management of ovarian cancer providing evidence regarding the applied treatment strategies and outcomes of patients in Greece.

History and the modern world co-exist in Greece’s landscape. The urban spaces of Greek cities contain structures from ancient history alongside contemporary constructions, but intense urban development from the 1960s onwards, as in the historic center of Athens, has led to imbalances with respect to cultural heritage protection. The 1975 Greek Constitution defined the preservation and protection of the cultural environment as a constitutional mandate, and severe restrictions on the exploitation of private properties deemed to be of historical or architectural importance were imposed. Property owners were deprived of their property development rights (DRs), whereas the preservation and conservation of protected constructions became costly, resulting in abandoned buildings and a downgraded urban environment. As the debate over cultural heritage protection and urban regeneration is more topical than ever, the recent legal reintroduction of the transfer of development rights (TDRs) provides new opportunities for property exploitation with respect to cultural heritage protection legislation. Herein is presented a methodological framework on the classification and 3D visualization and representation of DRs and TDRs in relation to the cultural heritage protective framework and its implementation in a selected area of Athens’ historic center. Legal and technical aspects that affect 3D DRs and TDRs are emphasized as key elements in the successful implementation of the TDR process.

Guidance through an exercise program improves balance and gait in older adults, but the efficacy of the timing these are given is unclear. The objective of this study is to evaluate the effects of guidance delivery time on balance, gait, falls, and cognitive functions. In a single (participants)-blinded clinical trial, a convenient sample of 24 older adults (aged 74 ± 6 years) were separated in two age-matched groups, both of which received a progressive 12-week Otago Exercise Program (OEP) for strength and balance. Group 1 received visual and verbal guidance before the performance of each of the exercises, while group 2 received the visual and verbal guidance only synchronously with the exercises. Balance, gait, fear of falling, and cognitive function were evaluated at baseline, week 6, and week 12 of the program. Fall incidence and exercise adherence were also documented. Significant improvements (p < 0.05) were revealed in all assessed variables post intervention, regardless of the guidance delivery time. Only the mental function and the adherence to the exercise tended to be better when the guidance was given in advance of the exercise execution, but further studies of a bigger sample size and with a control group should be conducted before safe conclusions are extracted.

We are reviewing the current state of knowledge on the virological and immunological correlates of long COVID, focusing on recent evidence for the possible association between the increasing number of SARS-CoV-2 reinfections and the parallel pandemic of long COVID. The severity of reinfections largely depends on the severity of the initial episode; in turn, this is determined both by a combination of genetic factors, particularly related to the innate immune response, and by the pathogenicity of the specific variant, especially its ability to infect and induce syncytia formation at the lower respiratory tract. The cumulative risk of long COVID as well as of various cardiac, pulmonary, or neurological complications increases proportionally to the number of SARS-CoV-2 infections, primarily in the elderly. Therefore, the number of long COVID cases is expected to remain high in the future. Reinfections apparently increase the likelihood of long COVID, but less so if they are mild or asymptomatic as in children and adolescents. Strategies to prevent SARS-CoV-2 reinfections are urgently needed, primarily among older adults who have a higher burden of comorbidities. Follow-up studies using an established case definition and precise diagnostic criteria of long COVID in people with or without reinfection may further elucidate the contribution of SARS-CoV-2 reinfections to the long COVID burden. Although accumulating evidence supports vaccination, both before and after the SARS-CoV-2 infection, as a preventive strategy to reduce the risk of long COVID, more robust comparative observational studies, including randomized trials, are needed to provide conclusive evidence of the effectiveness of vaccination in preventing or mitigating long COVID in all age groups. Thankfully, answers not only on the prevention, but also on treatment options and rates of recovery from long COVID are gradually starting to emerge.

Receptor activator of nuclear factor-κB ligand (RANKL) has been actively pursued as a therapeutic target for osteoporosis, given that RANKL is the master mediator of bone resorption as it promotes osteoclast differentiation, activity and survival. We employed a structure-based virtual screening approach comprising two stages of experimental evaluation and identified 11 commercially available compounds that displayed dose-dependent inhibition of osteoclastogenesis. Their inhibitory effects were quantified through TRAP activity at the low micromolar range (IC50 < 5 μΜ), but more importantly, 3 compounds displayed very low toxicity (LC50 > 100 μΜ). We also assessed the potential of an N-(1-aryl-1H-indol-5-yl)aryl-sulfonamide scaffold that was based on the structure of a hit compound, through synthesis of 30 derivatives. Their evaluation revealed 4 additional hits that inhibited osteoclastogenesis at low micromolar concentrations; however, cellular toxicity concerns preclude their further development. Taken together with the structure–activity relationships provided by the hit compounds, our study revealed potent inhibitors of RANKL-induced osteoclastogenesis of high therapeutic index, which bear diverse scaffolds that can be employed in hit-to-lead optimization for the development of therapeutics against osteolytic diseases.

Since the COVID-19 pandemic, adolescent mental health difficulties have increased. To understand adolescent adjustment, it is important to explore both mental health difficulties and indicators of resilience and well-being. The primary aim of this study was to explore the associations among resilience, subjective well-being (SWB), fear of COVID-19, and loneliness among adolescents during the second wave of the pandemic. Additionally, the study aimed to identify student profiles based on these variables. The sample consisted of 469 high school students (61% girls, 29% junior high school). Resilience was positively correlated with SWB and negatively with fear of COVID-19 and loneliness. Three student profiles were identified. The Resilient and Satisfied group (38%) consisted of students with the most positive adaptation, and the Average group (41%) involved students with middle scores in all variables, while the Vulnerable and Distressed group (21%) included those who struggled the most. The need for a tiered approach in providing school-based mental health support is discussed.

The prevalence of chronic maternal disease is rising in the last decades in the developed world. Recent evidence indicated that the incidence of chronic maternal disease ranges from 10 to 30% of pregnancies worldwide. Several epidemiological studies in mothers with chronic diseases have mainly focused on the risk for adverse obstetric outcomes. Evidence from these studies supports a correlation between maternal chronic conditions and adverse perinatal outcomes, including increased risk for preeclampsia, cesarean section, preterm birth, and admission in the Neonatal Intensive Care Unit (NICU). However, there is a knowledge gap pertaining to the management of these women during lactation. This review aimed at summarizing the available research literature regarding breastfeeding in mothers with chronic diseases. Adjusted and evidence-based support may be required to promote breastfeeding in women with chronic diseases; however, our comprehension of breastfeeding in this subpopulation is still unclear. The literature related to breastfeeding extends in various scientific areas and multidisciplinary effort is necessary to compile an overview of current evidence and knowledge regarding breastfeeding issues in mothers with chronic diseases.

Ovarian cancer (OC) is one of the deadliest cancers worldwide; late diagnosis and drug resistance are two major factors often responsible for high morbidity and treatment failure. Epithelial-to-mesenchymal transition (EMT) is a dynamic process that has been closely linked with cancer. Long non-coding RNAs (lncRNAs) have been also associated with several cancer-related mechanisms, including EMT. We conducted a literature search in the PubMed database in order to sum up and discuss the role of lncRNAs in regulating OC-related EMT and their underlying mechanisms. Seventy (70) original research articles were identified, as of 23 April 2023. Our review concluded that the dysregulation of lncRNAs is highly associated with EMT-mediated OC progression. A comprehensive understanding of lncRNAs’ mechanisms in OC will help in identifying novel and sensitive biomarkers and therapeutic targets for this malignancy.

Clays have been applied for centuries by people for many uses. From pottery to medicine, clays and clay minerals constitute part of individuals’ daily routines. Natural fine-grained earth material, commonly found at Xi beach coastal area of Lixouri in Kefalonia island, was used during the last few decades by local people as well as from tourists for pelotherapy, even though this material has never been examined for its suitability for this use. This work was conducted aiming to characterize this material and determine if it is harmless and beneficial for therapeutic purposes or skin care. Field work revealed that the material is not homogenous and, therefore, some of its parts could be characterized as suitable, non-suitable or even harmful. The collected samples from Kefalonia were characterized according to their petrographic and chemical features using Scanning Electron Microscopy (SEM), X-Ray Diffraction (XRD), X-Ray Fluorescence (XRF) and Transmission Electron Microscopy (TEM). Moreover, the microbial burden of the material was assessed analyzing the bacterial and fungi load. This study indicates that this geomaterial can be suitable for natural mud/peloid applications, but only in some parts of this area.

The aim of the study is to explore the way Greek junior high school students perceive school climate as a protective factor against the adversities due to the ongoing economic recession. The randomly selected sample consisted of 746 students from junior high schools (Gymnasia) in the broader area of Athens. The California School Climate Survey (2009), the Questionnaire of Subjective Well-Being/Youth Form (Grob et al., 1991) and the Economic Crisis Difficulties Questionnaire (LSP, 2011) were used for data collection. The findings indicated the existence of statistically significant relations between the effects of economic recession, subjective well-being and school climate. School climate moderated the interaction between economic recession and students' subjective well-being. Results provide a better understanding of adolescents' needs during unsettling times contributing to the development of effective evidence-based intervention programs in school communities.

Introduction A great heterogeneity characterises the paediatric population with ataxia, which has been studied poorly. The lack of postural control and coordination, in addition with features of the ‘ataxic’ gait are linked with functional limitations. Studies on physiotherapy interventions for children with ataxia are highly needed for identifying optimal training strategies for improving motor and functional related skills.Methods and analysis A stratified randomised control clinical trial of a 4-week functional partial body weight support treadmill training, (5 days/week 45 min/day) and 2-month follow-up period will be applied in children with ataxia, aged 8–18 years old with Gross Motor Function Classification System II–IV. Participants will be allocated to experimental group (intervention and usual care) or control group (usual care), using stratified randomisation process into two strata (progressive and non-progressive ataxia). Participants will be assessed at baseline, by the end of the 4-week period and by the end of a 2-month period as a follow-up measurement. Motor and functional skills will be assessed using the Gross Motor Function Measure-D and E, the Pediatric Balance Scale, the 10-meter walk test, the 6-minute walk test, the Scale for Assessment and Rating Ataxia, the timed up and go test and children’s spatiotemporal gait features will be assessed through GaitSens software recording over a 2 min low treadmill gait speed, while three-dimensional gait analysis will be performed for kinetic and kinematic analysis of the lower limbs in all three levels of movement. Two-way mixed Analysis of Variance (ANOVA) with factors ‘intervention’ (between group) and ‘time’ (within group) will be used for the analysis of all parameters. Analysis of Covariance (ANCOVA) will be used in case of imbalance of baseline measurements. Statistical significance will be set at p

Στο άρθρο παρουσιάζεται μια πολυεπίπεδη παρέμβαση για την εκτίμηση αναγκών και τη στήριξη των σχολικών κοινοτήτων στο πλαίσιο της πανδημίας COVID-19 με έμφαση στη σύνδεση θεωρίας, εκπαίδευσης, έρευνας και πράξης. Το άρθρο περιλαμβάνει δύο αλληλένδετες ενότητες, στις οποίες περιγράφονται ο σχεδιασμός και ενδεικτικά ευρήματα ερευνητικού προγράμματος για την αξιολόγηση των αντιλήψεων των μελών της σχολικής κοινότητας σε σχέση με ψυχολογικές και εκπαιδευτικές διαστάσεις της πανδημίας, καθώς και εκπαιδευτικές δράσεις και παρεμβάσεις για τη στήριξη των σχολικών/εκπαιδευτικών κοινοτήτων. Τα ευρήματα αφορούν στα δεδομένα από τη χορήγηση -ανάλογα με την ομάδα συμμετεχόντων- της Κλίμακας Γενικευμένου Άγχους (GAD-7), της Σύντομης Κλίμακας Ψυχολογικής Ανθεκτικότητας (BRS), ερωτηματολογίου για την εξ αποστάσεως εκπαίδευση, καθώς και ειδικά διαμορφωμένων ανοικτών και κλειστών ερωτήσεων σε εκπαιδευτικούς (n = 414), γονείς (n = 499) και εφήβους (n = 256). Τα ευρήματα ανέδειξαν, μεταξύ άλλων, υψηλά επίπεδα άγχους και μέτρια προς χαμηλά επίπεδα ανθεκτικότητας σε εκπαιδευτικούς και γονείς και αισθήματα ανησυχίας σε εφήβους. Οι ενήλικες συμμετέχοντες αναφέρθηκαν στην ανάγκη κατάλληλης προετοιμασίας των σχολικών μονάδων για τη διαχείριση της παρούσας κρίσης. Τα ευρήματα σε συνδυασμό με τη διεθνή βιβλιογραφία έθεσαν τη βάση για την ανάπτυξη ποικίλων δράσεων στο πλαίσιο της κοινωνικής δικαιοσύνης σε κάθε φάση της πανδημίας, όπως ανάπτυξη/διάχυση ενημερωτικού υλικού, επιμόρφωση εκπαιδευτικών/γονέων, εκπαίδευση προπτυχιακών/μεταπτυχιακών φοιτητών/τριών, στήριξη σχολείων και διεθνείς συνεργασίες. Στο άρθρο γίνεται αναφορά στο ρόλο των πανεπιστημίων στην παροχή σχολικών ψυχολογικών υπηρεσιών και στην αναγκαιότητα ανάπτυξης ολοκληρωμένων σχεδίων δράσης σε επίπεδο πρόληψης για τη διαχείριση κρίσεων στη σχολική κοινότητα σε εθνικό επίπεδο.

We report an extremely rare case of extranodal B-cell NHL: DLBCL (diffuse large B-cell non-Hodgkin lymphoma), stage IVE, presenting with heart and bilateral adrenal involvement. On admission, adrenal and thorax imaging identified large bilateral adrenal masses and a 4.6 cm mass in the right atrium wall. An adrenal biopsy revealed the presence of a DLBCL, with triple expression of bcl2, bcl6, C-MYC(+70%). Following six cycles of systemic immunochemotherapy with R-DA-EPOCH, and high methotrexate dose for CNS prophylaxis a marked decrease of lymphoma infiltration was observed. The selection of the appropriate treatment modality can lead to profound response and improve patient's outcome.

Multiple primary cancer (MPC) is defined as more than one primary tumour diagnosed at the same patient, either simultaneously or sequentially. Its incidence is low and varies in reporting among medical centers. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL) while gastric cancer (GC) is the fifth most frequently diagnosed malignancy. The aim of this article is to present a rare case of a female patient who was diagnosed with two synchronous malignancies, an adenocarcinoma of the stomach (SRCC) and an aggressive extranodal NH lymphoma (DLBCL) within 2 months. Given the fact that there is an expanding availability of more sensitive diagnostic and screening methods, we aim to increase surveillance amongst medical doctors and provide valuable information for further systematic analysis and identification of such rare cases of concurrent malignancies.