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Objective: The purpose was to investigate the risk factors for delayed upper gastrointestinal transit (DUGT) in small bowel capsule endoscopy (SBCE) and to improve the efficacy of SBCE. Methods: The medical records of patients who underwent SBCE in Renji hospital between January 2015 and January 2023 were retrospectively reviewed. Data collection included patient demographics and potential risk factors for DUGT such as indications for the examination, underlying diseases, hospitalization status, anemia, inflammation. Risk factors were analyzed using univariable and multivariable logistic regression models. DUGT was defined as failure of a capsule to pass through the pylorus within 1 h. Results: A total of 1459 patients who underwent SBCE were included in the study. 306 Cases (21%) experienced DUGT and all received conservative observation, medication treatment, endoscopic intervention, and other measures based on specific circumstances. The overall completion rate (CR) of the examination was 95.5% (1394/1459). Logistic regression analysis showed that hospitalization status (p = 0.030), diarrhea (p = 0.017), diabetes (p = 0.027) and cerebrovascular disease (p = 0.038) were significant risk factors for DUGT. Conclusions: In our study, DUGT of SBCE was associated with hospitalization status, diarrhea, diabetes and cerebrovascular disease. Therefore, for the patients with the above risk factors, we should closely check the capsule status during the examination process, in order to take appropriate intervention measures as soon as possible. [ABSTRACT FROM AUTHOR]

Abstract Background Capsule endoscopy (CE) is useful for managing patients with suspected small bowel diseases. However, the effect of prolonged CE examination time on CE performance is unknown. Aim To evaluate the completeness and diagnostic yield of prolonged CE imaging in patients with suspected small bowel bleeding. Methods We reviewed consecutive records of adult CE examinations via an overnight protocol from Jan 2016 to Dec 2020 at a tertiary center in Taiwan. We subcategorized the CE records by recording length into within 8 h, within 12 h and throughout the whole procedure and compared the completion rate and diagnostic yield between the groups. Cochran’s Q test was used for statistical analysis. Results A total of 88 patients were enrolled with 78.4% inpatients (median age 72 years). The small bowel evaluation completion rate was 93.2%, which was significantly greater than the 79.5% rate within 12 h (p = 0.025) and the 58% rate within 8 h (p

In order to solve the problems of spout hole, collapse hole, plugging hole and buried drilling in gas extraction drilling operation in broken soft coal seam, a type of ZDY4500LFK automatic drilling machine suitable for broken soft coal seam is developed. This paper focuses on the difficulties in the automatic construction of broken soft coal seam, introduces the mechanical structure and control principle of the drill, and studies and analyzes the technical principles of adaptive drilling, automatic positioning and correction of drill pipe, cooperative drill pipe loading and unloading path planning in broken soft coal seam. The field test verifies the advantages of the drill such as high porosity, high per capita efficiency, high safety and high rod carrying capacity, which provides technical support for the safe and efficient production of soft crushed coal seam.

Abstract Background Tuberculosis preventive therapy is vital in caring for HIV-positive individuals, as it prevents the progression from latent tuberculosis infection to tuberculosis disease. The aim of the study is to assess the completion of tuberculosis preventive therapy and associated factors among clients receiving antiretroviral therapy in Debre Berhan town, Ethiopia, in 2022. Method Institutional based cross sectional study was conducted. Random sampling methods were used to select both study participants and health facilities. Both bivariate and multivariate logistic regression analyses were performed. P-values less than 0.05 were statistically significant. Result The study found that, 83% of participants were completed tuberculosis preventive therapy. Completed tuberculosis preventive therapy was associated with no adverse drug events, taking first-line ART, and good ART adherence. Conclusion According to the Ethiopian ART guidelines, the study found a low completion rate of tuberculosis preventive therapy among HIV-positive clients on antiretroviral therapy. Factors like no adverse drug events, first-line antiretroviral regimen, and good adherence were significantly associated with completing tuberculosis preventive therapy.

Background: Tuberculosis preventive therapy is vital in caring for HIV-positive individuals, as it prevents the progression from latent tuberculosis infection to tuberculosis disease. The aim of the study is to assess the completion of tuberculosis preventive therapy and associated factors among clients receiving antiretroviral therapy in Debre Berhan town, Ethiopia, in 2022. Method: Institutional based cross sectional study was conducted. Random sampling methods were used to select both study participants and health facilities. Both bivariate and multivariate logistic regression analyses were performed. P-values less than 0.05 were statistically significant. Result: The study found that, 83% of participants were completed tuberculosis preventive therapy. Completed tuberculosis preventive therapy was associated with no adverse drug events, taking first-line ART, and good ART adherence. Conclusion: According to the Ethiopian ART guidelines, the study found a low completion rate of tuberculosis preventive therapy among HIV-positive clients on antiretroviral therapy. Factors like no adverse drug events, first-line antiretroviral regimen, and good adherence were significantly associated with completing tuberculosis preventive therapy. [ABSTRACT FROM AUTHOR]

Backgrounds: A recent randomized control trial (JCOG1202; ASCOT trial) demonstrated the efficacy of adjuvant S-1 chemotherapy (ASC) for biliary tract cancer (BTC) after surgical resection; however, the significance of the completion of ASC in the real-world setting remains unknown. Methods: Data of consecutive patients who underwent surgical resection for biliary tract cancer (BTC) from 2011 to 2021 were retrospectively reviewed. Of these, patients who underwent ASC were enrolled in this study. Patients were divided into two groups according to whether ASC was completed: the completion group and the non-completion group. Clinicopathological features and survival outcomes were assessed. Results: Of the 223 patients with BTC who underwent surgical resection, 75 patients who underwent ASC were included for analysis. Among them, 48 (64.0 %) completed the intended ASC course, while 27 cases (36.0 %) discontinued the treatment. The most common reason for the discontinuation was adverse event (n = 16, 59.3 %), followed by disease recurrence (n = 9, 33.3 %). Patients in the completion group showed significantly better overall survival (OS) (p

Intervention with motivational emails can have a positive effect on course retention in e-learning. It is, however, not yet clear whether different forms of emails affect course retention and how students make progress during the sending of emails. We therefore used a voluntary asynchronous online course with 206 students. Students were randomly divided into four groups: text–picture personalised email vs. text personalised email vs. generalised email vs. no email. Emails were sent weekly for 3 months. Results yield that more students made progress in the text–picture personalised email group than in the control group. Students in all email groups progressed by more units than students in the control group. Only students in email groups completed the course and only students in personalised email groups reacted to the emails. Emails were accepted by most students enrolled. The findings suggest that cost-effective and easily implemented emails can encourage students to progress from unit to unit. [ABSTRACT FROM AUTHOR]

A recent randomized control trial (JCOG1202; ASCOT trial) demonstrated the efficacy of adjuvant S-1 chemotherapy (ASC) for biliary tract cancer (BTC) after surgical resection; however, the significance of the completion of ASC in the real-world setting remains unknown. Data of consecutive patients who underwent surgical resection for biliary tract cancer (BTC) from 2011 to 2021 were retrospectively reviewed. Of these, patients who underwent ASC were enrolled in this study. Patients were divided into two groups according to whether ASC was completed: the completion group and the non-completion group. Clinicopathological features and survival outcomes were assessed. Of the 223 patients with BTC who underwent surgical resection, 75 patients who underwent ASC were included for analysis. Among them, 48 (64.0 %) completed the intended ASC course, while 27 cases (36.0 %) discontinued the treatment. The most common reason for the discontinuation was adverse event (n = 16, 59.3 %), followed by disease recurrence (n = 9, 33.3 %). Patients in the completion group showed significantly better overall survival (OS) (p < 0.001) and recurrence-free survival (RFS) (p < 0.001) compared to the non-completion group. Further, after excluding the patients in the non-completion group who discontinued ASC due to disease recurrence, the significance of ASC completion was retained for both OS and RFS. The completion of ASC was associated with improved prognosis in patients with BTC after surgical resection. The achievement of ASC should be the goal after surgical resection, while further study may be warranted regarding the resistance of ASC. [ABSTRACT FROM AUTHOR]

Abstract HIV post- exposure prophylaxis (PEP) is a prevention tool for individuals with a recent potential exposure to HIV. Doravirine has been available since 2019 in combination with tenofovir disoproxil fumarate and lamivudine and has not been evaluated as a PEP. DOR/3TC/TDF is our department’s most commonly prescribed PEP treatment since 2021. This study evaluates the completion rate of the DOR/3TC/TDF as compared to EVG/c/FTC/TAF for PEP, which was the regimen prescribed until 2020 in our hospital. This retrospective observational study was conducted between January 2020 and September 2021. The subjects included consecutively were adults who consulted for an HIV sexual exposure accident and for whom DOR/3TC/TDF in 2021 or EVG/c/FTC/TAF in 2020 was prescribed. The outcomes were the completion rate to the end of treatment (28 days), the seroconversion rate, and the description of side effects. During the study period, 311 people were included: 140 treated with DOR/3TC/TDF and 171 treated with EVGc/FTC/TAF. Considering subjects with a follow-up visit, the completion rate was 96.8% (90/93) in the DOR/3TC/TDF group, and 94.6% (123/130) in the EVG/c/FTC/TAF group (p-value: 0.53). The number of people lost to follow-up was nearly equivalent in both groups: 27.1% (38/140) in the DOR/3TC/TDF group and 23.4% (40/171) in the EVG/c/FTC/TAF group (p-value: 0.45). A side effect was described for 38% (36/94) in the DOR/3TC/TDF group, and 29.7% (38/128) in the EVG/c/FTC/TAF group. No cases of seroconversion were observed. DOR/3TC/TDF appears to have a similar safety profile to EVG/c/FTC/TAF. Due to its lower cost, it seems to be a treatment option for consideration in the context of HIV-exposure accidents.

Abstract Background Lung cancer has been the leading cause of American deaths from cancer. Although Medicare started covering lung cancer screening (LCS) with low-dose computed tomography (LDCT) in 2015, the uptake of LDCT-LCS remains low. This study examines the changes in adherence to provider referrals for LDCT-LCS and the factors at patient, provider, and health system levels that influence the completion rate of LDCT-LCS orders before and during the COVID-19 pandemic. Methods Our study examined electronic health record data (December 2013 - December 2020) from a large, community-based clinical healthcare delivery system in California. We plotted monthly trends in the frequency of LDCT-LCS orders and completion rate and compared the annual LDCT-LCS completion rate between LCS-eligible, LCS-ineligible, and unknown eligibility groups. We then explored multilevel factors associated with the completion of LDCT-LCS orders using hierarchical generalized linear models. Results There was an increase in LDCT-LCS orders (N = 12,469) from 2013 to 2019, followed by a sharp decline in March 2020 due to the onset of the COVID-19 pandemic. Thereafter, LDCT-LCS orders slowly increased again in June 2020. The completion rate of LDCT-LCS increased from 0% in December 2013 to approximately 70% in 2018–2019 but declined to 50–60% in 2020 during the pandemic. Ineligible patients had lower completion rates of LDCT-LCS. Patients who were new to the healthcare system, Black, received the LDCT-LCS order in the first few years after Medicare coverage (2016 or 2017), during the pandemic, had major comorbidities, and smoked less than 30 pack-years were less likely to complete an order. Patients were more likely to complete LDCT-LCS orders if they were younger, received the LDCT-LCS order from a physician (vs. nonphysician provider), from family medicine or other specialties (vs. internal medicine), or saw a provider with more experience in LDCT-LCS. Conclusions The beginning of the COVID-19 pandemic largely decreased the volume of LDCT-LCS orders, but rates have since been slowing recovering. Future interventions to improve lung cancer screening should consider doing more targeted outreach to new patients and Black patients as well as providing additional education to nonphysician practitioners and those providers with lower rates of LDCT-LCS referral orders.

Introduction: This study aimed to compare the paediatric endocrinology curriculum across Southern Nigeria medical schools, using reports from learners. It also checked the learners’ perceptions about different learning patterns and competency in some expected core skills. Methods: This mixed (quantitative and qualitative) study was conducted with 7 medical schools in Southern Nigeria. A multi-staged randomized selection of schools and respondents, was adopted for a focus group discussion (FGD), and the information derived was used to develop a semi-structured questionnaire, which 314 doctors submitted. The FGD discussed rotation patterns, completion rates of topics and perceptions for some skills. These themes were included in the forms for general survey, and Likert scale was used to assess competency in skills. Data generated was analysed using statistical package for social sciences, SPSS 24, and p values < 0.05 were considered significant. Results: Lectures and topics had various completion rates, 42.6% - 98%, highest being “diabetes mellitus”. Endocrinology rotation was completed by 58.6% of respondents, and 58 – 78 % perceived competency in growth measurement and charting. Significantly more learners, 46.6% who had staggered posting got correct matching of Tanner staging, versus learners who had block posting, 33.3%, p = 0.018. Conclusion: Respondents reported high variability in the implementation of the recommended guidelines for paediatric endocrinology curriculum between schools in Southern Nigeria. Variabilities were in the courses’ completion, learners’ skills exposure and how much hands-on were allowed in various skills acquisitions. This variability will hamper the core objectives of human capital development should the trend continue.

The purpose of this article is to provide an overview of white light colon capsule endoscopy's current clinical application, concentrating on its most recent developments. Second-generation colon capsule endoscopy (CCE2) is approved by the FDA for use as an adjunctive test in patients with incomplete colonoscopy and within Europe in patients at average risk, those with incomplete colonoscopies or those unwilling to undergo conventional colonoscopies. Since the publication of European Society of GI Endoscopy guidelines on the use of CCE, there has been a significant increase in comparative studies on the diagnostic yield of CCE. This paper discusses CCE2 in further detail. It explains newly developed colon capsule system and the current status on the use of CCE, it also provides a comprehensive summary of systematic reviews on the implementation of CCE in colorectal cancer screening from a methodological perspective. Patients with ulcerative colitis can benefit from CCE2 in terms of assessing mucosal inflammation. As part of this review, performance of CCE2 for assessing disease severity in ulcerative colitis is compared with colonoscopy. Finally, an assessment if CCE can become a cost-effective clinical service overall. [ABSTRACT FROM AUTHOR]

This study was carried out to examine causes of slow completion among postgraduate students of the Information Studies Programme at the University of Dar es Salaam. The study used both quantitative and qualitative research approaches. It involved 61 respondents, including 56 postgraduate students involved in a questionnaire survey and 5 lecturers interviewed. Findings revealed that the majority of students took more than the university-stipulated time to complete their studies. Factors responsible include students' failure to comprehend comments from supervisors, poor relationships between students and supervisors, multiple roles and a poor research environment. Incompetence in research skills and financial constraints were also noted to contribute to slow completion. The study concludes that slow completion among students is not a function of a single factor. Addressing these factors is critical in enhancing the timely completion of studies. Accordingly, this study recommends that the programme should create supportive learning environment for its students such that learning outcomes are improved. [ABSTRACT FROM AUTHOR]

The time required to implement projects is one of the basic elements for evaluating the performance of these projects, as the project is considered successful if it is delivered on time, and there are many and multiple reasons that lead to delay in the project time. Delay in time is considered one of the important problems that affect the performance of projects. This research aims to know the role of the structural systems used in the construction of multi-storey concrete buildings in reducing construction time and thus reducing the total time required to implement projects. A group of structural systems commonly used locally in the city of Mosul were applied, such as (1- Traditional building system - in-situ pouring of concrete 2- The Tunnel system and 3- The prefabricated system - pre-casting of concrete, in addition to 4- A proposed system within the study, which is a combination of 1 and 3) on a model of a multi-storey residential project, in view of the great need for residential units and the importance of implementing them at an appropriate time compared to the cost achieved from that. This can be considered the optimal time for implementation while maintaining the necessary efficiency for these projects. To test the research hypothesis which states that the construction system has an important role in achieving the optimal time for project implementation, the data obtained from each system was extracted and compared, then the completion rates for the first 100 hours of work were calculated. In an attempt to determine the system that achieves the optimal time required for construction, it was concluded that it is difficult to determine the optimal system directly, but it can be considered that the prefabricated building system can be considered the optimal system on the one hand, and the time and Mixed System can be considered the optimal system in terms of cost, and the results. The study may help decision-makers who are specialists in the construction industry to take appropriate measures and determine the appropriate construction system in constructing projects. [ABSTRACT FROM AUTHOR]

ABSTRACTThe recombinant zoster vaccine (RZV) was licensed in the US for prevention of herpes zoster (HZ) in 2017. We conducted a literature search (January 1, 2017–August 1, 2023) using PubMed, Embase, and Scopus to consolidate the real-world evidence related to RZV. Overall, RZV effectiveness against HZ was high across the studied populations in real-world settings, including adults aged ≥ 50 years and patients aged ≥ 18 years with immunodeficiency or immunosuppression. Effectiveness was higher with two doses versus one dose, especially in elderly people and immunocompromised individuals. The safety profile of RZV was broadly consistent with that established in clinical trials. RZV does not appear to increase the risk of disease flares in patients with immune-mediated diseases. Approximately two-thirds of individuals received a second RZV dose within 2–6 months after the first dose. Collectively, RZV effectiveness against HZ was high, and these real-world studies reaffirm its favorable benefit–risk profile.

HIV post- exposure prophylaxis (PEP) is a prevention tool for individuals with a recent potential exposure to HIV. Doravirine has been available since 2019 in combination with tenofovir disoproxil fumarate and lamivudine and has not been evaluated as a PEP. DOR/3TC/TDF is our department's most commonly prescribed PEP treatment since 2021. This study evaluates the completion rate of the DOR/3TC/TDF as compared to EVG/c/FTC/TAF for PEP, which was the regimen prescribed until 2020 in our hospital. This retrospective observational study was conducted between January 2020 and September 2021. The subjects included consecutively were adults who consulted for an HIV sexual exposure accident and for whom DOR/3TC/TDF in 2021 or EVG/c/FTC/TAF in 2020 was prescribed. The outcomes were the completion rate to the end of treatment (28 days), the seroconversion rate, and the description of side effects. During the study period, 311 people were included: 140 treated with DOR/3TC/TDF and 171 treated with EVGc/FTC/TAF. Considering subjects with a follow-up visit, the completion rate was 96.8% (90/93) in the DOR/3TC/TDF group, and 94.6% (123/130) in the EVG/c/FTC/TAF group (p-value: 0.53). The number of people lost to follow-up was nearly equivalent in both groups: 27.1% (38/140) in the DOR/3TC/TDF group and 23.4% (40/171) in the EVG/c/FTC/TAF group (p-value: 0.45). A side effect was described for 38% (36/94) in the DOR/3TC/TDF group, and 29.7% (38/128) in the EVG/c/FTC/TAF group. No cases of seroconversion were observed. DOR/3TC/TDF appears to have a similar safety profile to EVG/c/FTC/TAF. Due to its lower cost, it seems to be a treatment option for consideration in the context of HIV-exposure accidents. [ABSTRACT FROM AUTHOR]

Background: Lung cancer has been the leading cause of American deaths from cancer. Although Medicare started covering lung cancer screening (LCS) with low-dose computed tomography (LDCT) in 2015, the uptake of LDCT-LCS remains low. This study examines the changes in adherence to provider referrals for LDCT-LCS and the factors at patient, provider, and health system levels that influence the completion rate of LDCT-LCS orders before and during the COVID-19 pandemic. Methods: Our study examined electronic health record data (December 2013 - December 2020) from a large, community-based clinical healthcare delivery system in California. We plotted monthly trends in the frequency of LDCT-LCS orders and completion rate and compared the annual LDCT-LCS completion rate between LCS-eligible, LCS-ineligible, and unknown eligibility groups. We then explored multilevel factors associated with the completion of LDCT-LCS orders using hierarchical generalized linear models. Results: There was an increase in LDCT-LCS orders (N = 12,469) from 2013 to 2019, followed by a sharp decline in March 2020 due to the onset of the COVID-19 pandemic. Thereafter, LDCT-LCS orders slowly increased again in June 2020. The completion rate of LDCT-LCS increased from 0% in December 2013 to approximately 70% in 2018–2019 but declined to 50–60% in 2020 during the pandemic. Ineligible patients had lower completion rates of LDCT-LCS. Patients who were new to the healthcare system, Black, received the LDCT-LCS order in the first few years after Medicare coverage (2016 or 2017), during the pandemic, had major comorbidities, and smoked less than 30 pack-years were less likely to complete an order. Patients were more likely to complete LDCT-LCS orders if they were younger, received the LDCT-LCS order from a physician (vs. nonphysician provider), from family medicine or other specialties (vs. internal medicine), or saw a provider with more experience in LDCT-LCS. Conclusions: The beginning of the COVID-19 pandemic largely decreased the volume of LDCT-LCS orders, but rates have since been slowing recovering. Future interventions to improve lung cancer screening should consider doing more targeted outreach to new patients and Black patients as well as providing additional education to nonphysician practitioners and those providers with lower rates of LDCT-LCS referral orders. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to compare the paediatric endocrinology curriculum across Southern Nigeria medical schools, using reports from learners. It also checked the learners' perceptions about different learning patterns and competency in some expected core skills. Methods: This mixed (quantitative and qualitative) study was conducted with 7 medical schools in Southern Nigeria. A multi- staged randomized selection of schools and respondents, was adopted for a focus group discussion (FGD), and the information derived was used to develop a semi-structured questionnaire, which 314 doctors submitted. The FGD discussed rotation patterns, completion rates of topics and perceptions for some skills. These themes were included in the forms for general survey, and Likert scale was used to assess competency in skills. Data generated was analysed using statistical package for social sciences, SPSS 24, and p values < 0.05 were considered significant. Results: Lectures and topics had various completion rates, 42.6% - 98%, highest being "diabetes mellitus". Endocrinology rotation was completed by 58.6% of respondents, and 58 -- 78 % perceived competency in growth measurement and charting. Significantly more learners, 46.6% who had staggered posting got correct matching of Tanner staging, versus learners who had block posting, 33.3%, p = 0.018. Conclusion: Respondents reported high variability in the implementation of the recommended guidelines for paediatric endocrinology curriculum between schools in Southern Nigeria. Variabilities were in the courses' completion, learners' skills exposure and how much hands-on were allowed in various skills acquisitions. This variability will hamper the core objectives of human capital development should the trend continue. [ABSTRACT FROM AUTHOR]

Background: Colon capsule endoscopy (CCE) was introduced in our department on two indications; following incomplete colonoscopy as an alternative to CT colonography, and in patients with a history of incomplete colonoscopy as an alternative to anesthesia-assisted (AA) colonoscopy. We aimed to compare the quality of CCE, defined by completion rate and polyp detection rate (PDR), with that of CT colonography and AA colonoscopy, respectively. Methods: Patients referred for CCE from May 2020 until November 2021 were consecutively included in this prospective cohort study. Demographics, indication and CCE outcomes were registered from the electronic patient record. Completion rate and PDR in CCE as an alternative to CT colonography were compared with those of a historical cohort undergoing CT colonography following incomplete colonoscopy. Completion rate and PDR in CCE as an alternative to AA colonoscopy were compared with those of a time true parallel cohort undergoing AA colonoscopy. Results: In 65 patients undergoing CCE, 36 (57%) were referred as an alternative to CT colonography. The completion rate in this group was 44% compared to 96% in CT colonography (p < 0.001). The PDR in complete CCE in this group was 75% in CCE compared to 20% in CT colonography (p < 0.001). The remaining 27 (43%) of the sample were referred for CCE as an alternative to AA colonoscopy. The completion rate in this group was 33% compared to 100% in AA colonoscopy (p < 0.001). The PDR in complete CCE in this group was 78% in CCE compared to 35% in AA colonoscopy (p = 0.013). Conclusions: The completion rate of CCE following incomplete colonoscopy is inferior to that of CT colonography and AA colonoscopy. The PDR of CCE was high, indicating an acceptable sensitivity in complete investigations, but in our settings the completion rate of CCE on this indication is unacceptably low. Clinical trial registration: NCT04307901 (ClinicalTrials.gov, March 13, 2020). [ABSTRACT FROM AUTHOR]

Sisi Zhang,1 Houjuan Zuo,1 Xiaoping Meng,2 Dayi Hu1,3 1Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Affiliated Hospital of Changchun Traditional Chinese Medicine, Changchun, People’s Republic of China; 3People’s Hospital of Peking University, Beijing, People’s Republic of ChinaCorrespondence: Xiaoping Meng, Affiliated Hospital of Changchun Traditional Chinese Medicine, Gongnong Avenue No. 1478, Chaoyang District, Changchun, 130000, People’s Republic of China, Tel +86-13180889540, Email xiopingmeng@126.com Dayi Hu, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Qiaokou District, Wuhan, 430000, People’s Republic of China, Tel +86-13901389171, Email hudayihust@126.comAim: To describe a new model, the Support Life Club (SLC), for participants of Phase II cardiac rehabilitation (CR) programs and to evaluate this model for adherence, completion rates, and clinical outcomes.Methods: This retrospective study involved 391 consecutive patients who participated in an outpatient CR program between September 2016 and May 2020. The intervention group (SLC) was comprised of 198 patients who participated in education, WeChat-based group activity as well as outdoor activities, while the control group (non-intervention) was comprised of 193 cases. All patients attended a 12-week supervised outpatient CR program (three sessions per week, each lasting 40min). The intervention and control groups were compared for completion rates, Cardiopulmonary Exercise Test (CPET) results, Six-minute Walk Test (6MWT) distances, and Patient Health Questionnaire-9 (PHQ-9) scores.Results: Patients in the intervention group attended at least 75% of the exercise training sessions more often than those in the control group (72.5% vs 40.41%, adjusted odds ratio (OR): 27.385; 95% CI: 10.2 to 73.6; P = 0.0000). Analysis of variance (2 × 2 ANOVA) revealed a significant group-by-time interaction in PHQ9 and 6MWT test results (p = 0.000).Conclusion: The addition of SLC to a cardiac rehabilitation program resulted in better outcomes for PHQ9 and 6MWT tests and may be a useful strategy to improve exercise adherence.Keywords: cardiac rehabilitation, support life club, adherence, completion rate, WeChat platform

The implementation experiences of a new asynchronous online inter-university creativity course-titled "Creativity, responsibility, and entrepreneurship" will be presented through the lens of the course designer. Aside from introducing the identified challenges of how the regular on-site courses can be adjusted to the needs of remote education, with the aim to reach a high completion rate, the main focus remains the introduction of the different level abilities of the students in relation to social responsibility. The unique patterns of positioning the course among its internal and external competitors are created from the combination of theoretical and methodological approaches while also considering the special attitudes of the prospective Eastern European entrepreneur and social responsibility as a distinctive character. Since there was no evidence from the students on how positive social impact as a value in entrepreneurship can be ensured through online courses, the analysis of this potential effect could rely on multiple data sources from a questionnaire, answers to a quiz, and targeted analysis of the final assignments. The aim to improve new iterations call for qualitative data collection. The experimental consequences can guide the prospective course designer through the most important steps of establishing a new online course that leverages the uncommon approach that social responsibility can be an unmissable factor in the competition. [ABSTRACT FROM AUTHOR]

For teachers, obtaining a bachelor's degree represents an important turning point in their academic careers and is unquestionably a positive step forward. Even while earning a bachelor's degree is an impressive accomplishment, it frequently is not enough to make the most impact on student's lives. Thus, upgrading themselves through enrollment in graduate programs equips them with an advanced technical understanding of their subject matter. The study focused on the trend analysis of admission, enrollment, and completion in the graduate programs of Surigao del Norte State University from SY 2010-2011 to SY 2021-2022. Data were taken from the Registrar's Office. At the same time, the factors contributing to the late and low completion rate in the programs were obtained purposively from sixty (60) respondents; most of them were graduate students who were identified to stop schooling in the semester where they were supposed to write their thesis and dissertation due to lack of funds needed to spend during the writing period of their research. The study revealed a growing trend in the admission, enrollment, and completion rates from SY 2010-2011 to SY 2021-2022. The growing trend is because adequate knowledge and skills can be obtained from enrolling in the graduate program, which could be primarily used in maximizing the teaching-learning process in the classroom by having the students as the recipient of learning. However, there is a low rate in terms of completion, which encouraged the author to recommend to the management to review the existing policies on writing research and improve its learning environment. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide an overview of white light colon capsule endoscopy’s current clinical application, concentrating on its most recent developments. Second-generation colon capsule endoscopy (CCE2) is approved by the FDA for use as an adjunctive test in patients with incomplete colonoscopy and within Europe in patients at average risk, those with incomplete colonoscopies or those unwilling to undergo conventional colonoscopies. Since the publication of European Society of GI Endoscopy guidelines on the use of CCE, there has been a significant increase in comparative studies on the diagnostic yield of CCE. This paper discusses CCE2 in further detail. It explains newly developed colon capsule system and the current status on the use of CCE, it also provides a comprehensive summary of systematic reviews on the implementation of CCE in colorectal cancer screening from a methodological perspective. Patients with ulcerative colitis can benefit from CCE2 in terms of assessing mucosal inflammation. As part of this review, performance of CCE2 for assessing disease severity in ulcerative colitis is compared with colonoscopy. Finally, an assessment if CCE can become a cost-effective clinical service overall. [ABSTRACT FROM AUTHOR]

Many cancer patients express interest in using herbal medicine during chemotherapy, but little is known about its benefits and risks. This study aimed to evaluate the effects of the Chinese herbal medicine JianPi-BuShen formula (JPBS) on adjuvant chemotherapy completion in colon cancer patients. This multi-center, phase III, randomized, placebo-controlled trial included patients with stage II (high risk for recurrence) and stage III colon cancer following surgery, planning to receive CAPOX (capecitabine and oxaliplatin) chemotherapy. Patients were randomized 1:1 to receive either JPBS or a placebo. The primary outcome was the completion rate of planned chemotherapy cycles. Secondary outcomes included relative dose intensity (RDI), chemotherapy-induced toxicities, quality of life (measured by the Edmonton Symptom Assessment System - ESAS), adverse events (AEs), and serious AEs (SAEs). Predefined subgroup analyses were performed by age (>65/≤65) and TNM stage (II/III). A total of 376 participants were analyzed, with a median age of 60.3 years; 56.9 % were male, and 67.6 % had stage III disease. Chemotherapy completion was significantly higher in the JPBS group than in the placebo group (63.0 % vs. 47.6 %, P = 0.003). Oxaliplatin RDI was also higher in the JPBS group (P = 0.049). Subgroup analyses showed JPBS significantly improved completion rates for stage II patients (73.0 % vs. 42.4 %, P = 0.001) and younger patients (66.9 % vs. 48.8 %, P = 0.004). JPBS reduced grade ≥ 2 vomiting (3.8 % vs. 6.4 %, P = 0.007) but increased grade ≥ 2 thrombocytopenia (16.2 % vs. 12.4 %, P = 0.012). Quality of life improved in stage II and younger patients. JPBS improved chemotherapy completion rates in stage II and younger colon cancer patients without compromising tolerability. Further research is needed to explore its mechanisms and long-term effects. • Our RCT evaluated herbal medicine's effect and safety for colon cancer chemotherapy. • JPBS can improve adjuvant chemotherapy completion rate by 15.4 % versus placebo. • The JPBS arm experienced 2.6 % less incidence of grade ≥ 2 vomiting than placebo arm. • Stage II and age ≤ 65 patient subgroups experienced greater benefits from JPBS. • No other differences were observed in AEs and SAEs between the arms. [ABSTRACT FROM AUTHOR]

IntroductionThe provision of a continuum of care to women throughout pregnancy, labor, and after delivery has become a fundamental strategy for improving maternal and neonatal health. A better understanding of where the gaps are in seeking care along the pathway and what factors contribute to the gaps is required for successful program implementation. Hence, this study was targeted to determine the status and determinant factors of the completion rate of a continuum of care in maternal health services.MethodsA prospective follow-up study was conducted among 2,198 sampled pregnant women and followed for 11 months in Benishangul-Gumuz region. A multistage clustered sampling technique was employed to select the study participants. Data were collected via face-to-face interviews using a pretested, semi-structured questionnaire, and logbook registry. Collected data were edited, cleaned, and analyzed using STATA software. The multilevel regression model was used to examine the effects of individual- and community-level factors and expressed as AOR with 95% CI.ResultsThe completion rate of a continuum of care via visit-based, content-based, and space dimensions was 33.1, 20, and 37.2%, respectively. The enabling factors were having information on maternal health services (AOR = 2.25; 95% CI: 1.11–4.55), iron and folic acid supplementation (AOR = 2.58; 95% CI: 1.37–4.86), tetanus toxoid vaccination during pregnancy (AOR = 2.21; 95% CI: 1.39–3.52), having pregnant-related problems (AOR = 2.1; 95% CI: 1.15–3.71), dry and stimulate newborn (AOR = 2.61; 95% CI: 1.42–4.77), appropriate cord care (AOR = 2.01; 95% CI: 1.07–3.79), and immunizing newborn (AOR = 6.9; 95% CI: 3.79–12.59), whereas risk factors were ever having a stillbirth (AOR = 0.52; 95% CI: 0.32–0.85) and delay of 1st ANC initiation at 4–6 months of pregnancy (AOR = 0.45; 95% CI: 0.3–0.68).ConclusionThe completion rates via visit-based, content-based, and space dimensions were low. Different determinant factors which have a programmatically important implication were identified. Thus, interventions should focus on increasing women's awareness and improving the availability and accessibility of the whole packages of maternal health services to facilitate the completion rate.

The study aims to describe gender inequalities in female participation in mathematics education in the University of Education, Winneba (UEW). The study investigated, particularly, the trends in access and successful completion (of female undergraduate students studying mathematics in UEW from 2009 to 2018. The study was based on quantitative secondary data extracted from the university's admission and graduation records. The study therefore employed the methodology of secondary data analysis (SDA) which was adopted to replace the original questionnaire survey research which had to be abandoned as a result of the COVID-19 lockdown of the institution for nearly one year. A template was developed to capture the data from the UEW Planning Unit and others were obtained online from statistical publications to authenticate the Planning Unit data. The main findings of the study were that the trend in access for qualified undergraduate students provided by the Mathematics Education Department has been consistently high (i.e., nearly all qualified female applicants were admitted). But the proportion of female applicants ranged from 6.2% to 14.2% with a mean of 8.9% of the total applicants. The proportion of undergraduate female students actually graduating was consistently high with the females usually obtaining the middle grades (i.e., no Pass or First-class grade). It is recommended that the Department, and for that matter the University, embarks on an admission drive at the senior high school level to sensitize female students to select mathematics education for their tertiary education. [ABSTRACT FROM AUTHOR]

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Although Massive Open Online Courses (MOOCs) are increasing in popularity, they have been subject to criticism due to the high dropout rate. This study examined the impact of an instructor's personalized email intervention on the rate of completion of a nine week course, which included seven weekly quizzes, and the rate of completion of the final exam. The participants, who took an Israeli noncredit academic MOOC on negotiation management, were randomly assigned to two groups. Treatment group participants (N = 576) who did not complete the weekly quiz received a tailored reminder by email from their instructor encouraging them to complete the quiz and offering them assistance in order to deal with the past week's contents. The control group (N = 608) that did not complete the weekly quiz did not get any emails from the instructor. The impact of the intervention was measured in three different ways: the immediate-impact, the delayed-impact and a cumulative impact. The increase in quiz completion within a week after the instructor's email was defined as an immediateimpact. The increase in the completion of the next quiz was defined as a delayed impact. The increase in the final exam completion rates was defined as a cumulative impact. The results show that the weekly intervention had an immediate impact as well as a cumulative impact on the final exam completion rate. The results suggest that an instructor's acknowledgement and interest might increase learners' commitment to learning in a MOOC. This study aimed to gain insight into learners' propensity to stay active in a MOOC and to increase completion rates. Findings of this study can be useful to MOOC designers and instructors to design and facilitate more effective MOOCs for learners by using email interventions to prevent students from dropping out of courses. [ABSTRACT FROM AUTHOR]

PurposeMagnetic resonance imaging (MRI) is a high-cost imaging modality, and an optimized encounter ideally provides high-quality care, patient satisfaction, and capacity utilization. Our purpose was to assess the effectiveness of team training and its impact on patient show-up and completion rates for their MRI examinations.Materials and methodsA total of 97,712 patient visits from three tertiary academic medical centers over 1-year intervals were evaluated, totaling 49,733 visits at baseline and 47,979 after training. Each center's MRI team received team training skill training including advanced communication and team training techniques training. This training included onsite instruction including case simulation with scenarios requiring appropriate behavioral and communicative interventions. Orientation and training also utilized customized online tools and proctoring. The study completion rate and patient show-up rate during consecutive year-long intervals before and after team training were compared to assess its effectiveness. Two-sided chi-square tests for proportions using were applied at a 0.05 significance level.ResultsDespite differing no-show rates (5-22.2%) and study incompletion rates (0.7-3.7%) at the three academic centers, the combined patients' data showed significant (P < 0.0001) improvement in the patients' no-show rates (combined decreases from 11.2% to 8.7%) and incompletion rates (combined decreases from 2.3% to 1.4%).ConclusionOur preliminary results suggest training of the imaging team can improve the no-show and incompletion rates of the MRI service, positively affecting throughput and utilization. Team training can be readily implemented and may help address the needs of the current cost-conscious and consumer-sensitive healthcare environment. J. MAGN. RESON. IMAGING 2016;44:1040-1047.

MOOCs support the global need of learning resources with large impact through online access and no geographical boundaries. However, pedagogical design limitations in MOOCs are known to result in passive role of the learner, lack of learner connect and engagement, limited interactivity with course content and peers, all of which result in low completion rates. In this paper, we present the goals of a learner-centric MOOC (LCM) model aimed towards addressing some of the critical pedagogical challenges of MOOCs and exhibit the use of the model through its primary implementation phase. The LCM model collates and translates all integral pedagogical elements of a MOOC into a learner-centric dimension to promote active learner participation and enhanced engagement with learning content and peers through fostered interactions. To demonstrate the primary use and effectiveness of the model, it has been adopted in the design and conduct of 15 different MOOCs, which were offered through two different MOOC providers. Initial empirical evidence has been presented for the effectiveness of the model towards improved learner participation through several measures, including completion rates, engagement of participants with LCM elements and perception of learners on the usefulness of the model and its adoption. The average completion rate for 15 LCMs was found to be 36.35 ± 25.61, 95% CI: 10.74–61.96%, which is significantly higher than the completion rates reported in literature. The average persistent rates, defined as the rate of completion for active learners, was 59.38% for LCMs. The model elements were also found to be effective in engaging learners in formative assessment activities and meaningful peer discussions on the forum. The learners' perception on the adoption of the LCM model voiced several pedagogical benefits of the model which were categorized into themes. These included enhanced learner motivation and engagement with content, enhanced interactivity and peer learning, formative assessment and feedback, and catering to diversity. These themes directly aligned with desired pedagogical outcomes of the model to address some of the existing limitations of MOOCs. [ABSTRACT FROM AUTHOR]

Multiple enhancement strategies have been used to investigate the completion rate of preoperative care in the emergency department. Preoperative patient care was investigated based on the Ministry of Health and Welfare's annual goals in improving medical quality and surgical patients' safety in 2020-2021.The study showed the completion rate of preoperative care was 72.92% in November 2018. The rate of nursing staff acknowledging the standard and accuracy of the preoperative preparation was 81.90%. The following strategies were used to improve the preoperative care: (1) to establish standards of preoperative preparation in emergency department, (2) to develop a preoperative consent checklist, (3) to improve learning by incorporating a game in teaching, (4) to use an example to guide the patients to complete the preoperative consent form, (5) to include the items of preoperative care in a ready package, (6) to develop catchy phrase to help in the preoperative preparation, (7) to use a cartoon to help the staff and the patients acknowledge the preparation of the preoperative care. The completion rate of the preoperative preparation and the rate of the nursing staff acknowledging the standard and accuracy of the preoperative preparation have reached 100%. In conclusion, the multiple enhancement strategies showed an effective measure to improve the preoperative care in the emergency department. Acknowledgment: Our effort has been acknowledged by the surgical ward and was adapted to the surgical patient care. [ABSTRACT FROM AUTHOR]

The implementation experiences of a new asynchronous online inter-university creativity course-titled “Creativity, responsibility, and entrepreneurship” will be presented through the lens of the course designer. Aside from introducing the identified challenges of how the regular on-site courses can be adjusted to the needs of remote education, with the aim to reach a high completion rate, the main focus remains the introduction of the different level abilities of the students in relation to social responsibility. The unique patterns of positioning the course among its internal and external competitors are created from the combination of theoretical and methodological approaches while also considering the special attitudes of the prospective Eastern European entrepreneur and social responsibility as a distinctive character. Since there was no evidence from the students on how positive social impact as a value in entrepreneurship can be ensured through online courses, the analysis of this potential effect could rely on multiple data sources from a questionnaire, answers to a quiz, and targeted analysis of the final assignments. The aim to improve new iterations call for qualitative data collection. The experimental consequences can guide the prospective course designer through the most important steps of establishing a new online course that leverages the uncommon approach that social responsibility can be an unmissable factor in the competition.

Background: Both adherence rates to pulmonary rehabilitation (PR) programmes and long-term attendance in exercise training after PR remain a challenge. In our previous randomised controlled trial (RCT), effects were positively associated with a dose-response pattern, regardless of whether PR contained conventional physical exercise training (PExT) or Singing for Lung Health (SLH) as a training modality within a 10 weeks' PR programme for chronic obstructive pulmonary disease (COPD). However, long-term status of this RCT cohort remains unknown. In this study, we investigated whether current status (=attendance in supervised exercise training or a lung choir and scoring in quality of life (QoL)) was related to initial PR completion, randomisation, or adherence., Methods: We collected data via telephone, using a researcher-developed questionnaire on current self-reported attendance in supervised exercise training or a lung choir and on perceived benefits of the initial RCT intervention. Additionally, we used COPD-validated questionnaires (primarily: QoL (measure: St George's Respiratory Questionnaire; SGRQ)., Results: In 2023 (i.e., mean/median 4.7 years after initial PR), surviving participants were contacted ( n  = 196; 73% of 270), and 160 (82% of 196) were included. Out of the included participants, 30 (19%) had not completed initial PR. Compared to the initial PR-completers, non-completers reported less current attendance in exercise training or lung choir (24% vs. 46%, p  = 0.03) but SGRQ scores were comparable. Yet, those who attended exercise training or lung choir at present ( n  = 66/160; 41% out of 160) reported better QoL score than those with no current attendance (SGRQ; Attending: 39.9 ± 15.4; Not attending: 43.1 ± 16.7; p  = 0.02). Neither having had SLH instead of PExT, nor adherence level during initial PR, was related to current attendance or to QoL scores., Conclusion: This study indicates that long-term self-reported attendance and current QoL scores are positively related to initial completion of a PR programme. Surprisingly, neither initial PR content (PExT or SLH) nor initial PR adherence was related to long-term outcomes. We suggest that future PR programmes include special attention to those who do not complete PR to support long-term attendance and QoL status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Kaasgaard, Bodtger, Skou, Clift, Hilberg, Rasmussen and Løkke.)

Introduction: Intraoperative record form is one of the cardinal parts of anesthesia practices. Ideally, it should contain complete information about patients under anesthesia and intraoperative events. It serves as valuable information for subsequent patient management, research, or during medicolegal conditions. The objective of this study was to assess the practice and completeness of manual intraoperative anesthesia record keeping. Methods: A descriptive cross-sectional study was conducted from May 1 to July 31, 2021, in the postoperative ward of Kathmandu Medical College, which is a multispecialty tertiary care center. Approval from the ethical committee of Kathmandu Medical College Teaching Hospital was obtained (Reference: 2603202105) before conducting the study. Convenience sampling was used. The data were entered in Microsoft Excel and statistical analysis was done using Statistical Package for the Social Sciences version 20. Point estimate was done at 95% Confidence Interval and data present in numbers and percentages. We devised forty-two variables, which included demographics, personal identifiers, intraoperative events, anesthesia and airway management, intraoperative parameters, monitoring and medication. Results: The overall completion rate was 202 (52.59%) (47.6-57.57 at 95% Confidence Interval). Out of 42 variables, the completion rate of 14 variables was less than 50%. Among those were important parameters such as known allergies 94 (24.4%), Body mass index 50 (13%), intraoperative saturation of oxygen 104 (27%), intraoperative electrocardiogram recording 107 (27.8%), total fluid volume administered 45 (11.7%), patient status on transfer 84 (21.8%) had poor completion rate. Conclusions: Our intraoperative record form shows poor completion rate, which was similar to other studies. many important variables were missing and had incomplete data.

Colon capsule endoscopy (CCE) is a promising modality for colonic investigations, but completion rates (CR) and adequate cleansing rates (ACR) must be improved to meet established standards for optical colonoscopy. Improvements should be made with patient acceptability in mind. We aimed to compare a very low-volume polyethylene glycol (PEG) laxative to a conventional high-volume laxative. We carried out a single-center retrospective comparative cohort study including patients referred for CCE. One hundred and sixty-six patients were included in the final analysis, with eighty-three patients in each group. We found a CR and ACR of 77% and 67% in the high-volume group and 72% and 75% in the very low-volume group, respectively. In the high-volume group, 54% had complete transit and adequate cleansing, whereas this was the case for 63% in the very low-volume group. No statistically significant difference in CR, ACR, or a combination of the two was found. A very low-volume bowel preparation regimen was non-inferior to a high-volume regimen before CCE in terms of CR and ACR.

Completing colon capsule endoscopy (CCE) investigations rely on successful transit and acceptable bowel preparation quality. We investigated the effect of adding castor oil to the CCE bowel preparation regimen on the completion rate using a meta-analysis of existing literature. We conducted a systematic literature search in PubMed, Web of Science, and Embase. Included studies underwent quality assessment, and data for meta-analysis were extracted. Pooled estimates for excretion rate and acceptable bowel preparation rate were calculated. We identified 72 studies matching our search criteria, and six were included in the meta-analysis. Three of the studies had control groups, although two used historical cohorts. The pooled excretion rate (92%) was significantly higher in patients who received castor oil than in those who did not (73%). No significant difference in acceptable colonic cleanliness was observed. Castor oil has been used in a few studies as a booster for CCE. This meta-analysis shows the potential for this medication to improve excretion rates, and castor oil could be actively considered in conjunction with other emerging laxative regimens in CCE. Still, prospective randomized trials with appropriate control groups should be conducted before any conclusions can be drawn. Prospero ID: CRD42022338939.

Within the scope of this study, it is aimed to examine the dropout status of learners enrolled in Anadolu University Open Education Faculty during the 2018-2019 and 2019-2020 academic years. For this purpose, a descriptive research method was used to describe the current situation. The findings obtained within the scope of this studywere examined; It provides information about variables such as enrollment type, program type, education period in which they dropped out their education, gender, and the exam centers they are affiliated with. According to this, the dropout behavior of the learners who enrolled in the open education faculty with the higher education institutions exam is higher than the others. Another result is that the dropout learners are mostly enrolled in the business program. This situation is followed by the Political Science and Public Administration, Paralegal Studies, Theology, Social Services, International Relations, Sociology and Economics Programs. One of the striking results of the study is that the number of dropout learners is higher in the spring semester within all variables. In addition, males exhibited more dropout behaviors than females. Based on findings, suggestions for reducing dropout rates of education are listed. [ABSTRACT FROM AUTHOR]

Background/Aims: Approximately 20–30% of small bowel capsule endoscopies (SBCEs) do not reach the cecum at the completion of the examination. We aimed to determine whether hypokalemia influences the completion rate and small bowel transit time (SBTT) of SBCE. Patients and Methods: From January to December 2017, 112 patients (18–75 years old) who underwent SBCE were assessed consecutively for enrolment in our study. On the day of the procedure, a blood test was performed prior to capsule ingestion. The completion rate, gastric transit time (GTT), SBTT, and diagnostic yield were recorded for each SBCE. Results: The SBCE completion rate was lower in the hypokalemia group than that in the normal potassium group (55.6% (15/27) vs. 76.5% (65/85), P = 0.036). The median GTT was 55.5 ± 47.1 min in the hypokalemia group and 46.7 ± 44.5 min in the normal potassium group (P > 0.05). The median SBTT was 412.8 ± 123.3 min in the hypokalemia group and 367.3 ± 172.5 min in the normal potassium group (P > 0.05). The diagnostic yields of the hypokalemia and normal potassium groups were 74.1% and 78.8%, respectively (P = 1.00). Conclusion: Hypokalemia may decrease the SBCE completion rate. Physicians should consider the possibility of hypokalemia after bowel preparation because this condition is not rare. Potassium deficiencies should be rectified prior to performing SBCE procedures to increase the SBCE completion rate.

This study investigates the effectiveness of different online language teaching practices by comparing participation of four groups of learners and teachers in two tasks in asynchronous discussion forums. The tasks are carried out in the context of an online English as a Foreign Language (EFL) B2 course at a Catalan university. Teacher posts to the forums are analysed qualitatively with the aim of identifying different types of teacher posts; we then run inferential statistics to compare student participation data in classrooms with different course completion rates and in two types of task. Findings indicate that when teachers participate in forum discussions as peers and ask questions that generate discussion, they are more likely to encourage learners to participate, a pattern that seems to emerge more clearly in classrooms with higher course completion rates.