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A number of models, methodologies and conceptual frameworks have been proposed on how to design digital educational games aiming at better learning outcomes, while offering a fun experience. Our study combines two different methods, namely Delphi study and electroencephalograms (EEG), in order to provide an integrated digital educational game design model. Firstly, a Delphi survey was conducted in order academic experts in the field of digital educational games give their opinion and propose guidelines for designing digital educational games. Secondly, EEG recordings were used to examine how the game element of feedback for earned and lost points would be best incorporated in the game and how these elements affect players' experience. The results from the Delphi survey showed that the most important features to be included in the games are constructive elements, learning environments suitable for authentic learning, as well as elements which promote fun. Moreover, the experts highlighted that learning objectives should be included in activities in a way that the learners will not realize the actual learning process, but feel that they participate in everyday life experiences and examples. Bloom's taxonomy was also proposed as a way to match the learning elements with the game elements. EEG data combined with empirical data from questionnaires showed that players prefer to have audio feedback when gaining or loosing points during the gameplay rather than visual feedback or no feedback at all and contributed to the development of our digital educational game design guidelines.

Objectives: HIV late presentation (LP) has been increasing in recent years in Europe. Our aim was to investigate the characteristics of LP in Greece using in addition to the traditional definition for LP, the time interval between HIV infection and diagnosis. Methods: Our nationwide sample included HIV‐1 sequences generated from 6166 people living with HIV (PLWH) in Greece during the period 1999–2015. Our analysis was based on the molecularly inferred HIV‐1 infection dates for PLWH infected within local molecular transmission clusters of subtypes A1 and B. Results: Analysis of the determinants of LP was conducted using either CD4 counts or AIDS‐defining condition at diagnosis or the time from infection to diagnosis. Older age, heterosexual transmission risk group and more recent diagnosis were associated with increased risk for LP. In contrast to previous studies, people who inject drugs (PWID) had a shorter median time to diagnosis (0.63 years) compared to men who have sex with men (MSM) (1.72 years) and heterosexuals (2.43 years). Using HIV infection dates that provide an unbiased marker for LP compared to CD4 counts at diagnosis, which are age‐dependent, we estimated that the time to diagnosis increased gradually with age. Migrants infected regionally do not differ with respect to LP status compared to native Greeks. Conclusions: We demonstrate that older people and heterosexuals are among those at higher risk for LP; and given the growing number of older people among newly diagnosed cases, tailored interventions are needed in these populations. [ABSTRACT FROM AUTHOR]

Aims To (i) describe an intervention implemented in response to the HIV-1 outbreak among people who inject drugs (PWIDs) in Greece (ARISTOTLE programme), (ii) assess its success in identifying and testing this population and (iii) describe socio-demographic characteristics, risk behaviours and access to treatment/prevention, estimate HIV prevalence and identify risk factors, as assessed at the first participation of PWIDs. Design A 'seek, test, treat, retain' intervention employing five rounds of respondent-driven sampling. Setting Athens, Greece (2012-13). Participants A total of 3320 individuals who had injected drugs in the past 12 months. Intervention ARISTOTLE is an intervention that involves reaching out to high-risk, hard-to-reach PWIDs ('seek'), engaging them in HIV testing and providing information and materials to prevent HIV ('test') and initiating and maintaining anti-retroviral and opioid substitution treatment for those testing positive ('treat' and 'retain'). Measurements Blood samples were collected for HIV testing and personal interviews were conducted. Findings ARISTOTLE recruited 3320 PWIDs during the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7113 visits. HIV prevalence was 15.1%. At their first contact with the programme, 12.5% were on opioid substitution treatment programmes and the median number of free syringes they had received in the preceding month was 0. In the multivariable analysis, apart from injection-related variables, homelessness was a risk factor for HIV infection in male PWIDs [odds ratio (OR) yes versus no = 1.89, 95% confidence interval (CI) = 1.41, 2.52] while, in female PWIDS, the number of sexual partners (OR for > 5 versus one partner in the past year = 4.12, 95% CI = 1.93, 8.77) and history of imprisonment (OR yes versus no = 2.76, 95% CI = 1.43, 5.31) were associated with HIV. Conclusions In Athens, Greece, the ARISTOTLE intervention for identifying HIV-positive people among people who inject drugs (PWID) facilitated rapid identification of a hidden population experiencing an outbreak and provided HIV testing, counselling and linkage to care. According to ARISTOTLE data, the 2011 HIV outbreak in Athens resulted in 15% HIV infection among PWID. Risk factors for HIV among PWID included homelessness in men and history of imprisonment and number of sexual partners in women. [ABSTRACT FROM AUTHOR]

This essay addresses the issue of cuts in the cultural sector in Greece during the last five years and its consequences on the sustainability of artistic production, institutional survival and emerging forms of collaboration, self-management and art in public space. It describes new practices and strategies of cultural institutions and the relationship between the private and public spheres. Long-term artistic projects, such as the Athens and Thessaloniki Biennale, public museums like the State Museum of Contemporary Art, private organizations and artist initiatives are discussed in the context of crisis. [ABSTRACT FROM AUTHOR]

The culinary tourism is one of the alternative forms of tourism which although, it may contribute to further development of Greek product, is not utilized. The objective of this research is its development through gastronomic festivals. Our survey is studied participants motives in such events and their perceived level of satisfaction in order to proposed effective marketing strategies which contribute to adoption and growth. In this specific case, 'Tomato Festival', was the gastronomic festival which had been chosen in order our survey took place. A questionnaire was developed in order socio-demographics and trip characteristics, motives and perceived level of satisfaction of participants, in such kind of festivals, to be examined. The target - group, for our survey, was both women and men over 18 years old and the questionnaires were answered from festival's attendees, when they left, at the entrance. [ABSTRACT FROM AUTHOR]

Many developed countries have implemented surveillance systems for monitoring occupational exposure to HIV. The aim of the present study was to analyze surveillance data on HIV postexposure prophylaxis (PEP) for health care workers (HCWs) in Greece. Design: All data reported to the Hellenic Centre for Disease Control and Prevention between January 1996 and June 2005 were analyzed. Sample and measurement: 188 reported occupational exposures to HIV were analyzed, retrospectively. Results: Most exposures were in the physicians (37.8%), followed by the nursing personnel (18.6%). Nearly 38% of the HCWs were males and the predominant type of biological material involved in the exposure was blood (74.5%). Two drugs were used for PEP in 23.4% of the HCWs, and 3 drugs in 66.5% of the reported cases. Conclusions: Greek guidelines provide guidance for treating HCWs after occupational exposure to HIV. In our study, antiretroviral treatment, a three-drug regimen in the majority of the cases, was prescribed after evaluation of specially appointed physicians. The surveillance system of occupational exposure to HIV in HCWs should be further developed and enhanced in order to monitor and evaluate the risk factors surrounding the incidents. [ABSTRACT FROM AUTHOR]

• A new HIV outbreak among PWID was identified in Greece during 2019–2021. • Homelessness and syringe sharing were risk factors of HIV seroconversion. • A peer-driven seek-test-treat intervention allowed to early identify an emerging HIV outbreak. • Cases were linked to HIV care and two-thirds initiated ART despite the COVID-19 pandemic. • This approach could be used as an example of good practice for other settings as well. Multiple HIV outbreaks have been recorded among people who inject drugs (PWID) since 2010. During an intervention for PWID in 2019–2021 in Thessaloniki, Greece, an increasing number of HIV cases was documented. Here, we provide an analysis of this new outbreak. ALEXANDROS was a community-based program and participation included interviewing, rapid HIV/HCV tests, counselling and linkage to care. PWID were recruited through Respondent-Driven Sampling (RDS) in five sampling rounds. Crude and RDS-weighted HIV prevalence estimates were obtained. HIV incidence was estimated from data on 380 initially seronegative PWID with at least two tests. Multivariable Cox proportional hazards model was used to assess risk factors for HIV seroconversion. In total, 1,101 PWID were recruited. At first participation, 53.7% were current PWID, 20.1% homeless, 20.3% on opioid substitution treatment and 4.8% had received syringes in the past 12 months. HIV prevalence (95% CI) was 7.0% (5.6–8.7%) and an increasing trend was observed over 2019–2021 (p = 0.002). Two-thirds of the cases (67.5%) were new diagnoses. HIV incidence was 7.0 new infections/100 person-years (95% CI:4.8–10.2). Homelessness in the past 12 months (HR:2.68; 95% CI:1.24–5.81) and receptive syringe sharing (HR:3.86; 95% CI:1.75–8.51) were independently associated with increased risk of seroconversion. By the end of the program, 67.3% of the newly diagnosed cases initiated antiretroviral treatment. A new HIV outbreak among PWID was documented in Greece during the COVID-19 pandemic with homelessness and syringe sharing being associated with increased risk of HIV acquisition. Peer-driven programs targeting the population of high-risk underserved PWID can be used to early identify emerging outbreaks and to improve linkage to HIV care. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolic events (VTEs) frequently occur in cancer patients. Risk assessment models (RAMs) for cancer-associated thrombosis have been proposed. However, advanced urinary tract cancer (aUTC) was not adequately represented in these models. We studied the incidence of VTEs, the risk factors, and the applicability of recently described RAMs., Patients and Methods: Data from 335 patients with aUTC treated with chemotherapy between April 1995 and September 2015 in a single institution were analyzed., Results: A total of 95.2% received platinum-based first-line chemotherapy. Twenty-nine patients (8.7%) experienced VTEs. The 6-, 12-, and 24-month VTE incidence was 7.4% (95% confidence interval [CI], 4.8-10.6), 8.1% (95% CI, 5.4-11.5) and 9.4% (95% CI, 6.4-13.1), respectively. No significant association of VTE incidence with the Khorana risk score was observed. History of vascular event (VTE and/or arterial thromboembolic event) was significantly associated with the development of VTE. Patients with such history had a 6-, 12-, and 24-month VTE incidence of 16.2% (95% CI, 6.6-29.7), 19.2% (95% CI, 8.4-33.3), and 25.2% (95% CI, 12.5-40.1) compared to 6.2% (95% CI, 3.7-9.4), 6.6% (95% CI, 4.1-10), and 7.1% (95% CI, 4.4-10.6) of those who did not. The discriminatory ability of this factor adjusted for leucocyte count, sex, Eastern Cooperative Oncology Group performance status, and type of chemotherapy reached 0.79 (95% CI, 0.71-0.87) compared to the 0.58 (95% CI, 0.49-0.66) for the Khorana risk score., Conclusion: Development of tumor-specific algorithms for the risk of VTEs is advisable. Patients with aUTC and a history of vascular events are at high risk for VTE development, and prophylaxis should be prospectively studied in this group., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background :Metastatic RCC (mRCC) treatment has been revolutionized with 11 approved targeted agents. We report patterns of practice, outcomes and pharmacoeconomic analyses after the introduction of targeted therapy. Patients and methods : CRISIS was a retrospective multicenter study of mRCCpatients who received targeted therapy . Results were related to the start of 1st-line therapy, with a cut off at 1 January 2011 in order to depict the impact of increased availability of effective options. Results : 164 patients, were included. 70.1% and 44.5% received 2nd and 3rd-line therapy, respectively. More patients were treated in 2nd-line after 1 January 2011. After a median follow-up of 55.1 months, median progression-free (PFS) and overall survival (OS) were 10.7 (95% confidence intervals [CI]: 8.3-13.7), 7.3 (95% CI: 5.1-8.6), 5.8 (95% CI: 3.8-7.8) and 34 (95% CI: 28.5-39.8), 22.4 (95% CI: 16-32.1), 18.3 (95% CI: 12.4-26.4) months for first, second and third line, respectively. Efficacy of sunitinib and pazopanib in 1st-line were similar. The mean total cost/patient was 35,012.2 Euros (standard deviation [SD]: 28,971.5). Conclusions : Our study confirms previous real-world data suggesting that continuing advances in the treatment of mRCC produce favorable outcomes in everyday practice. Pharmacoeconomic analyses are important for cost-effective utilization of emerging novel therapies.

Background: Uterine sarcomas consist a heterogeneous group of mesenchymal gynecological malignancies with unclear therapeutic recommendations and unspecific but poor prognosis, since they usually metastasize and tend to recur very often, even in early stages., Methods: We retrospectively analyzed all female patients with uterine sarcomas treated in our institution over the last 17 years. Clinico-pathological data, treatments and outcomes were recorded. Kaplan-Meier curves were plotted and time-to-event analyses were estimated using Cox regression., Results: Data were retrieved from 61 women with a median age of 53 (range: 27-78) years, at diagnosis. Fifty-one patients were diagnosed with leiomyosarcoma (LMS), 3 with high grade endometrial stromal sarcoma (ESS), 5 with undifferentiated uterine sarcoma (UUS), 1 with Ewing sarcoma (ES) and 1 with Rhabdomyosarcoma (RS). 24 cases had stage I, 7 stage II, 14 stage III and 16 stage IV disease. Median disease-free survival (DFS) in adjuvant approach was 18.83 months, and median overall survival (OS) 31.07 months. High mitotic count (> 15 mitoses) was significantly associated with worse OS (P < 0.001) and worse DFS (P = 0.028)., Conclusions: Mitotic count appears to be independent prognostic factor while further insights are needed to improve adjuvant and palliative treatment of uterine sarcomas.

Objectives: HIV prevalence among older people is on the increase. The aim of this study was to evaluate the epidemiological and clinical features at diagnosis and survival of older patients., Methods: This was a retrospective analysis of the data of 558 newly diagnosed antiretroviral-naïve patients between January 1998 and December 2008. Patients were divided into two groups according to their age at diagnosis: ≥50 years (n=103) and 18-49 years (n=455)., Results: The most common risk factor for older patients was heterosexual contact (p<0.013). Older patients were more likely to suffer from hypertension (33.0% vs. 5.1%, p<0.0005), cardiovascular disease (20.4% vs. 2.9%, p<0.0005), neurological disorders (11.7% vs. 5.5%, p=0.02), renal dysfunction (12.6% vs. 5.3%, p=0.01), and infections (66.0% vs. 49.7%, p=0.003) than their younger counterparts, and to have more hospital admissions during follow-up (47.5% vs. 19.6%, p<0.0005). Older patients had a shorter survival time (p<0.0005). A statistically significant increase in CD4+ cell number through time was observed in both groups (p<0.0005). Younger patients reached higher magnitudes of absolute numbers of CD4+ cells during follow-up (p<0.0005) after the initiation of antiretroviral therapy. The total number of patients with clinical AIDS from baseline throughout the study period was also higher in the older age group (35.9% vs. 25.0%)., Conclusions: HIV-infected people aged ≥50 years differ in epidemiological and clinical features to younger HIV-infected people. The issue of increasing prevalence of HIV infection is a matter of concern due to existing comorbidities, which probably lead to higher mortality rates and faster progression to clinical AIDS., (Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)