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Normally endometrial carcinoma presents with post-menopausal bleeding in the majority of cases. It rarely presents with haematometra. If it does, it rarely reaches the term pregnant uterus size. This case report is a rare presentation of endometrial carcinoma which was at first diagnosed as a huge ovarian mass later found out to be haematometra intraoperatively. There was a discordant finding between the endometrial invasions with distant metastasis (Local invasion of stage 1A with lung metastasis which should be stage 4B). It is an uncommon combined occurrence but at least we learnt there can be possible different presentation for endometrial cancer. It further proved that almost all of haematometra can turn out to be associated with endometrial carcinoma.

The NGO Fauna & Flora started working in the Myeik Archipelago, southern Myanmar in 2013, and in 2017 three locally managed marine areas were established to aid sustainable fisheries management and support biodiversity conservation. These sites are the first protected areas specifically established for co-management of marine fisheries in Myanmar, in which long-term management rights have been formally granted to local fishing communities. The establishment of a further four locally managed marine areas is now in progress, with ambitions for a network to be established throughout the archipelago. To track changes in these habitats over time, assess effectiveness and inform adaptive fisheries management, annual coral reef monitoring will be conducted at these community-managed sites. We provide an overview of the locally managed marine areas recently established in Myanmar and of proposed new sites, and detail the establishment of the first permanent coral reef monitoring transects. In sharing the initial evidence gathered on the impact of new, local management measures, we aim to highlight the importance and benefit of developing marine resource management systems to strengthen fisheries management while simultaneously establishing a monitoring framework to fill a national and global coral reef data gap.

Background: Staphylococcus aureus is the common cause of food poisoning and its rising antibiotic resistance poses a severe threat to public health. In Myanmar, S aureus isolation and AMR pattern in food and non-food objects studied at the markets are still limited. This research filled the information gaps regarding the prevalence of S aureus in food and non-food items from market food shops relation to hygienic practices of the food handlers and assessed its antimicrobial resistance. Methods: Cross-sectional study was conducted at sixteen markets in Yangon during 2022. The study included 75 food handlers to assess their hygiene practices. From each shop, one food and one non-food samples were taken to reach the total 150 samples. Chi-square test was used for analysis. Results: S aureus was found in 4% of food samples and 5.3% of non-food samples. Bacterial contamination in food was satisfactory, 17.3% to unsatifactory, 60% while non-food samples were 4%, clean to 73.3%, very contaminted. Drug resistance to Benzyl penicillin, azithromycin, erythromycin, clindamycin, lincomycin in food samples and tetracycline in both samples were found. Hygiene practices was good among 57.3% of food handlers and there was no association between practices and S aureus prevalence although positivity was higher among the samples taken from the shops of handlers with poor hygiene practices. Conclusions: The prevalence of S aureus was not different between food and non-food samples and not associated with the hygiene practices of food handlers.

Objective: To examine temporal changes in coverage with a complete primary series of coronavirus disease 2019 (COVID-19) vaccination and staffing shortages among healthcare personnel (HCP) working in nursing homes in the United States before, during, and after the implementation of jurisdiction-based COVID-19 vaccination mandates for HCP. Sample and setting: HCP in nursing homes from 15 US jurisdictions. Design: We analyzed weekly COVID-19 vaccination data reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network from June 7, 2021, through January 2, 2022. We assessed 3 periods (preintervention, intervention, and postintervention) based on the announcement of vaccination mandates for HCP in 15 jurisdictions. We used interrupted time-series models to estimate the weekly percentage change in vaccination with complete primary series and the odds of reporting a staffing shortage for each period. Results: Complete primary series vaccination among HCP increased from 66.7% at baseline to 94.3% at the end of the study period and increased at the fastest rate during the intervention period for 12 of 15 jurisdictions. The odds of reporting a staffing shortage were lowest after the intervention. Conclusions: These findings demonstrate that COVID-19 vaccination mandates may be an effective strategy for improving HCP vaccination coverage in nursing homes without exacerbating staffing shortages. These data suggest that mandates can be considered to improve COVID-19 coverage among HCP in nursing homes to protect both HCP and vulnerable nursing home residents.

Malaysia recently entered third-wave of COVID-19 pandemic starting from October 2020 to end of January 2021. Therefore, objective of our study was to identify the prevalence of depression and its associated factors among adults during third wave of COVID-19 pandemic in Malaysia. A total of 1468 Malaysian adults participated in this cross-sectional web-based survey. A standardized questionnaire was generated using the Google Form, and the link was shared through social media such as Facebook, Twitter, Instagram and WhatsApp. Patient Health Questionnaires (PHQ-9) was used to assess the levels of depression. Among 1468 participants, 320 (22 %) and 358 (24.6 %) indicated to have moderate to severe depression during third-wave of COVID-19 in Malaysia. Multiple predictors were identified that contributed to depression. These included female gender, family’s source income affected by the pandemic, do not perform exercise, victim of abuse and those with family and/or friends infected with COVID-19 virus. COVID-19 pandemic had caused the implementation of lockdown and physical distancing in Malaysia and nations across the globe. The pandemic had brought serious negative impacts on mental health of the adults especially depression especially during third wave of pandemic. The findings of our study suggested that new interventions or strategies are needed to be developed to address the severity of depression among Malaysian adults.

Learning a language is no easy process. Although English is a worldwide language, mastering all four micro skills is difficult. There are several problems and stumbling blocks to mastering English, particularly for non-native speakers such as Myanmar students. For example, insufficient teaching and learning materials, large numbers of students in classes, utilizing their native language in spite of English, not being in an English-speaking setting, less confident in speaking English and using the incorrect syllabus. These are only a few examples. I occasionally teach English in Myanmar. In both teaching and learning English in Myanmar, I encountered several hurdles and barriers. It motivates me to conduct particular studies on the difficulties that students and instructors face in Myanmar.I used the quantitative research approach to determine the specific issues and impediments experienced in teaching and learning English. I implemented Google Form to identify the most relevant 15 questions for instructors, which took about two months, and I received 47 replies out of 50 surveys on obstacles in teaching English. Through the survey findings, we could clearly see what hurdles and obstacles Myanmar instructors had throughout their teaching and how they dealt with all of these concerns, as well as their dos and don'ts remarks and wise advise. Then I concluded by outlining how we should use the recommended strategies and implementations to overcome all of the obstacles that we have when teaching and learning English.

Background: Patients with hip fractures frequently face the problem of a longer stay in the ward after surgery and being readmitted, falls, and being unable to carry out daily activities after discharge from the hospital. A nursing discharge plan is widely recognised as one of the strategies for addressing these issues. In Malaysia, however, it is unknown for patients with hip fractures. As a result, this study was carried out to investigate the impact of nursing discharge planning on patients with hip fractures in Hospital Melaka, Malaysia. Methods: A total of 58 patients aged 50 years and above in the orthopaedic ward of Hospital Melaka were randomised using sealed envelopes to the intervention group (n = 29) and the control group (n = 29). The intervention group received an adapted nursing discharge plan with health education activities in the form of pamphlets and oral instructions within 24 hours of ward admission until discharge while the control group received routine discharge practices. Demographic data were taken from the study subjects while clinical data and length of stay in the ward were taken from the subjects’ medical records before discharge. After one month discharged, data for ward readmission rate and drop rate were taken from the subject's medical records while data for the subject's daily life activities were obtained through telephone calls using The Barthel Index survey form. Results: The results of the study showed that the intervention group had a shorter ward stay (U = 254.00, p = 0.008) and a higher level of independence than the control group (U = 205.00, p = 0.001). The control group had 100% of subjects who were not able to be independent in daily activities of life compared to 75.9% of the intervention group (p

The COVID-19 pandemic gave off a huge impact on face-to-face or physical learning and the world now is going virtual online learning and teaching until this pandemic settles. The COVID-19 epidemic has created new obstacles for employees in terms of change adaptation and job security, as well as a significant impact on employee well-being and satisfaction, especially for women. Since 2005, female enrolment in academia has continued to grow, and in many countries, females make up more than fifty per cent of the total enrolment in higher education. However, women remain underrepresented in top academic positions globally. This systematic review aimed to look for available articles related to the job satisfaction and perception of female academics before and during the COVID-19 pandemic. The PRISMA flow diagram was used to search the literature systematically, and the study's inclusion and exclusion criteria were established prior to the search. The CASP and MMAT were used to conduct the quality assessment. There are six themes emerged from 26 articles in this review and those are an overview of job satisfaction, factors that contribute to job satisfaction, gender gaps related to job satisfaction, academics perception, the mental health of academicians, and the relationship between work from home and job satisfaction. This study recommended for the faculty and university have a serial discussion about maintaining and increasing female academics’ job satisfaction. Therefore, surveys for academicians were vital to learn about their current circumstances, whether in teaching and learning or their psycho-social well-being. Although the university already provides the guidelines for online teaching, it was advisable to review the efficacy of the teaching modalities and infrastructure for the academicians.

A combined flight profile is being considered, in which the Falcon 9 launch vehicle launches the spacecraft into elliptical intermediate orbit from the Cape Canaveral launch site. In the process of analyzing the problem, the value of the height of the perigee and the inclination of the intermediate orbit are fixed, and the height of the apogee of the intermediate orbit varies. After separation from the last stage of the launch vehicle, the spacecraft carries out transfer to geostationary orbit using electric propulsion system. At the stage of insertion spacecraft from intermediate orbit to geostationary orbit using electric propulsion system, the problem of minimizing the mass of the propellant, multi-revolutionary transfer is considered. The number of revolution and the height of the apogee of the intermediate orbit vary in order to analyze the effect of these parameters on the duration of the transfer and the delivered mass of the spacecraft into geostationary orbit. The main purpose of this paper is to calculate the optimal values of the apogee height of the intermediate orbit and the optimal number of revolution that ensure the delivery of the maximum mass of the spacecraft to the geostationary orbit in a given time delta(t)*. To solve the optimization problem, the Pontryagin maximum principle is applied. After apply ing the maximum principle, the optimization problem is reduced to solving the boundary value problem, which is solved by the continuation method by parameter. The paper presents the results of the optimization problem of multi-revolutionary transfer and analysis of the energy characteristics of combined flight profile for insertion of spacecraft into geostationary orbit.

Background: Pediatric patients with multiple sclerosis (POMS) and related disorders, clinically isolated syndrome (CIS), myelin oligodendrocyte glycoprotein antibody disorder (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD), are commonly treated with immunosuppressants. Understanding the impact of SARS-CoV-2 infection in patients may inform treatment decisions. Objective: Characterize SARS-CoV-2 infection prevalence and severity among a cohort of patients with POMS and related disorders, as well as the impact of disease-modifying therapies (DMTs). Methods: POMS and related disorders patients enrolled in a large, prospective registry were screened for COVID-19 during standard-of-care neurology visits. If confirmed positive of having infection, further analysis was undertaken. Results: Six hundred and sixty-nine patients were surveyed between March 2020 and August 2021. There were 73 confirmed COVID-19 infections. Eight of nine hospitalized patients (89%), and all patients admitted to the ICU were treated with B cell depleting therapy. The unadjusted odds ratio of hospitalization among those who tested positive of having had COVID-19 was 15.27 among those on B-cell-depleting therapy ( p = 0.016). Conclusions: B-cell-depleting treatment was associated with a higher risk of COVID-19, higher rates of hospitalization, and ICU admission, suggesting this therapy carries a higher risk of severe infection in POMS and related disorders.

Background: Medical education has experienced important changes in recent times. The concern for patient's safety is one of the key reasons for the change in medical curricula. Innovative instructional methods like simulation-based medical education (SBME) has evolved to address this problem. SBME has become an essential part of education and training for health professionals in many parts of the world. There are evidences that support that high-fidelity simulation (HPS) training has enhanced clinical knowledge among medical students. Aims: The objective of this study was to note the differences in the knowledge made by high-fidelity simulation-based medical education among undergraduate medical education. Study Design: It was a quasi-experimental time series study with Pre-test and Post-test interventions. Place and Duration of Study: Clinical Skills Lab, Faculty of Medicine, Manipal University College Malaysia, Melaka, between October 2015 and September 2017. Methodology: The study involved 347 final year undergraduate medical students. The participants were divided into groups during the simulation sessions and their knowledge was assessed individually with Multiple Choice Questions (MCQ) and also self-reported Pre-test and Post-tests. Paired t-test was used to determine the difference of MCQ scores between pre and post simulation sessions. One-way repeated measure ANOVA was performed to determine the significant difference in knowledge assessment of self-reported Pre-test and Post-test scores. P value < .001 was taken to be of statistical significance. Results: In the unpaired t-test, Post-test MCQ scores were higher than Pre-test scores but not statistically significant (P = .013). A one-way repeated measured ANOVA with Bonferroni post hoc analysis demonstrated that the total scores of the self-reported knowledge tests were significantly increased over time (P < .001). Conclusion: There is enhancement of knowledge as perceived by the students with self-reported knowledge tests but not statistically significant as revealed by the MCQ scores.

Background: This study aimed to identify risk factors and assess their significance concerning childhood stunting in Myanmar. Methods: This study was conducted through the analysis of a secondary dataset based on the 2015-2016 Myanmar Demographic and Health Survey (MDHS 2015-2016), a program funded by the United States Agency for International Development (USAID). Among the 5239 under-five children who participated in the Myanmar DHS 2015-2016 survey, 4172 children with complete anthropometric measurements were included in this study. This was a cross-sectional study, and Chi-squared analysis was applied to determine the association of each risk factor with stunting. In addition, logistic regression was used for multivariate analysis of all risk factors combined. Results: Out of 4172 children who participated in the study, 1146 (27.5%) were stunted. Type of place of residence, household wealth index, and maternal education level have a significant effect on stunting of under-five children with (χ2=52.79, df=1, p=0.000), (χ2=82.03, df=2, p=0.000) and (χ2=72.31, df=3, p=0.000) respectively. When applied to multivariate logistic regression analysis, all three factors remained significant predictors of stunting in under-five children. Conclusions: Individual- and community-level factors determining the stunting of under-five children in Myanmar were explored. Government support programs for the occupation and income of the household heads and household members, as well as education programs targeting women in both the short term and long term, may help improve the condition.

Background and Aim: People who used to rear companion animals are healthier than others who do not. Gastrointestinal (GI) helminths are common in cats and serve as reservoirs for zoonotic diseases. However, the prevalence of GI parasites in cats in Myanmar has never been reported. This study aimed to estimate the prevalence of GI parasites in cats in Myanmar and identify the potential risk factors associated with GI parasites. Materials and Methods: A total of 230 fecal samples were collected from seven veterinary clinics and two shelters within the Yangon region from January to May 2022. Sampled cats were classified according to age, gender, and deworming and rearing practices. Fecal samples were analyzed by fecal wet mount, ethyl acetate centrifugal sedimentation, and zinc sulfate centrifugal flotation techniques. Descriptive data were described, and Pearson's χ2 test was used to identify associated risk factors, such as age, gender, and deworming and rearing practices. Results: The overall prevalence of GI parasites was 79.56%, and 57.82% of cats were infected with a diagnostic stage of more than one parasite species. Seven GI parasites were detected, including Ancylostoma spp. (55.65%), Toxocara spp. (46.08%), Trichuris spp. (20.86%), Platynosomum spp. (11.73%), Dipylidium caninum (7.39%), Taenia spp. (4.34%), and Cystoisospora spp. (32.17%). Based on statistical analysis, deworming and rearing practices were significantly associated (p < 0.05) with GI parasitic infections. Conclusion: This study is the first to reveal the prevalence of GI parasites that could assist the need for effective control measures for zoonotic hookworm and roundworm infections in cats. Even with simple microscopic examination, the remarkably high prevalence of GI parasitic infections warrants regular deworming practice. Further molecular studies should also be performed to understand their genetic diversity.

Background We evaluated the relevance of PD-1+CD8+ T-cells in gastric cancer (GC) including prognostic significance, association with chemotherapy and immunotherapy sensitivity and correlations with the tumor microenvironment (TME). Methods Discovery cohort: GC samples were evaluated for AE1/3, CD8, PD-1, Ki-67 and Granzyme-B expression with fluorescence-based multiplex immunohistochemistry (mIHC). Validation cohorts: we analyzed bulk RNAseq GC datasets from TCGA, the “3G” chemotherapy trial and an immunotherapy phase 2 trial. The cox proportional hazards model was used to identify factors that influenced overall survival (OS). To study the TME, we analyzed single-cell RNAseq performed on GCs. Results In the discovery cohort of 350 GCs, increased PD-1 expression of CD8 T-cells was prognostic for OS (HR 0.822, p = 0.042). PD-1 expression in CD8 T-cells highly correlated with cytolytic [Granzyme-B+] (r = 0.714, p +] (r = 0.798, p PD-1 and CD8A expression levels had improved OS when treated with immunotherapy (HR 0.117, p = 0.036) and chemotherapy (HR 0.475, p = 0.017). Analysis of an scRNAseq dataset of 152,423 cells from 40 GCs revealed that T-cell and NK-cell proportions were higher (24% vs 18% and 19% vs 15%, p p high compared to CD8PD-1low tumors. Conclusion This is one of the largest GC cohorts of mIHC combined with analysis of multiple datasets providing orthogonal validation of the clinical relevance of PD-1+CD8+ T-cells being associated with improved OS. CD8PD-1high tumors have distinct features of an immunologically active, T-cell inflamed TME.

ObjectiveClinical Information System (CIS) usage can reduce healthcare costs over time, improve the quality of medical care and safety, and enhance clinical efficiency. However, CIS implementation in developing countries poses additional, different challenges from the developed countries. Therefore, this research aimed to systematically review the literature, gathering and integrating research findings on Success Factors (SFs) in CIS implementation for developing countries. This helps to integrate past knowledge and develop a set of recommendations, presented as a framework, for implementing CIS in developing countries.Materials and MethodsA systematic literature review was conducted, followed by qualitative data analysis on the published articles related to requirements and SF for CIS implementation. Eighty-three articles met the inclusion criteria and were included in the data analysis. Thematic analysis and cross-case analysis were applied to identify and categorize the requirements and SF for CIS implementation in developing countries.ResultsSix major requirement categories were identified including project management, financial resources, government involvement and support, human resources, organizational, and technical requirements. Subcategories related to SF are classified under each major requirement. A set of recommendations is provided, presented in a framework, based on the project management lifecycle approach.ConclusionThe proposed framework could support CIS implementations in developing countries while enhancing their rate of success. Future studies should focus on identifying barriers to CIS implementation in developing countries. The country-specific empirical studies should also be conducted based on this research’s findings to match the local context.

Background: Multi-arm multi-stage trials are an efficient, adaptive approach for testing many treatments simultaneously within one protocol. In settings where numbers of patients available to be entered into trials and resources might be limited, such as primary postpartum haemorrhage, it may be necessary to select a pre-specified subset of arms at interim stages even if they are all showing some promise against the control arm. This will put a limit on the maximum number of patients required and reduce the associated costs. Motivated by the World Health Organization Refractory HaEmorrhage Devices trial in postpartum haemorrhage, we explored the properties of such a selection design in a randomised phase III setting and compared it with other alternatives. The objectives are: (1) to investigate how the timing of treatment selection affects the operating characteristics; (2) to explore the use of an information-rich (continuous) intermediate outcome to select the best-performing arm, out of four treatment arms, compared with using the primary (binary) outcome for selection at the interim stage; and (3) to identify factors that can affect the efficiency of the design. Methods: We conducted simulations based on the refractory haemorrhage devices multi-arm multi-stage selection trial to investigate the impact of the timing of treatment selection and applying an adaptive allocation ratio on the probability of correct selection, overall power and familywise type I error rate. Simulations were also conducted to explore how other design parameters will affect both the maximum sample size and trial timelines. Results: The results indicate that the overall power of the trial is bounded by the probability of ‘correct’ selection at the selection stage. The results showed that good operating characteristics are achieved if the treatment selection is conducted at around 17% of information time. Our results also showed that although randomising more patients to research arms before selection will increase the probability of selecting correctly, this will not increase the overall efficiency of the (selection) design compared with the fixed allocation ratio of 1:1 to all arms throughout. Conclusions: Multi-arm multi-stage selection designs are efficient and flexible with desirable operating characteristics. We give guidance on many aspects of these designs including selecting the intermediate outcome measure, the timing of treatment selection, and choosing the operating characteristics.

$\bf{Abstract}$: A qubit lattice algorithm (QLA), which consists of a set of interleaved unitary collision-streaming operators, is developed for electromagnetic wave propagation in tensor dielectric media. External potential operators are required to handle gradients in the refractive indices, and these operators are typically non-unitary. A similar problem arises in the QLA for the Korteweg-de Vries equation, as the potential operator that models the KdV nonlinear term is also non-unitary. Several QLAs are presented here that avoid the need of this non-unitary potential operator by perturbing the collision operator. These QLAs are fully unitary., 10 pages, 0 figures

Learning English is not an easy feat. We used to travel long distances to learn English from the best English teachers when we were younger. We may now study English without leaving our homes by using the internet; all we need is reliable internet access. As we all know, there are several advantages to studying English online, yet there are drawbacks if we do so incorrectly. I utilized a quantitative research technique to identify the advantages and disadvantages of online English learning. First, I used Google Forms to determine the most pertinent 15 questions for participants, which took approximately three months, and I obtained 95 responses out of 100 surveys on the benefits and drawbacks of online English learning. By extensively investigating the replies, we can appropriately establish the weightiness of the pros and cons of studying English on the internet. Although technology and multimedia make it easier to study English, there are advantages and problems due to poor internet usage. According to research, there are a plethora of advantages we may reap if we apply the right implications of using internet resources to learn any language, not only English. Without a doubt, if we exploited the internet in the wrong way, there would be a slew of bad consequences for our society as a whole.

In the article the results of study of the structure and micro-hardness of the surface layer of 38Cr2MoAl steel after volumetric quenching and high tempering, followed by ion-plasma nitriding, in comparison with electromechanical surface hardening (EMSH) are presented. Experimentally confirmed, that after the EMSH of 38Cr2MoAl steel, a gradient microstructure of finely dispersed martensite, bainite and austenite with a residual hardness of up to 8100 HV MPa and a depth of up to 0.8 mm is formed in the surface layer. At the same time, the maximum microhardness of the surface layer is not on the surface, but at a depth of 0.1 mm. The EMSH is formed by gradient surface layers of metal of high hardness on the surface of products. For a wide range of machine parts, EMSH can be used as a finishing treatment, since it is not accompanied by the presence of defects in the decarburization of the surface layer and deterioration of roughness. After ion-plasma nitriding for 8 hours, the microhardness of the surface layer of 38X2MYA steel was 9030 HV MPa at a depth of 0.1 mm and 8650 HV MPa at a depth of 0.2 mm. At a depth of 0.3 mm, the microhardness of the surface after nitriding and EMP are almost equal, respectively 7230 and 7170 HV MPa. The results of wear tests according to the “rubber roller — fixed sample” scheme and the American Society for Testing and Materials (ASTM G65) “Standard Method for Measuring Abrasive Abrasion using the “Dry Sand” Installation/Rubber wheel” showed high wear resistance of nitrided samples. However, with the continuation of the tests, due to the shallow depth of the nitrided layer (up to 0.3 mm), the wear resistance of the nitrided and hardened samples is leveled. The practical significance of the study is associated with the possibility of reducing the cost of manufacturing parts from nitrided steels by hardening the executive surfaces of the products of the EMSH. In addition, the EMSH allows steel 38Cr2MoAl for surface hardening and subsequent finishing by finishing turning on metal-cutting machines.

Critical thinking is one of the most demanded skills for educational goals, job security, and problem solving in the lifelong process of 21st - century learners. Thus, various specialised courses in education have adopted approaches that integrate critical thinking throughout the curriculum. From the perspective of English language teaching, teachers, researchers, and syllabus writers are committed to the development of learners’ language acquisition through critical thinking as a language pedagogical approach. Empirical studies have frequently demonstrated a high positive correlation between leaners’ critical thinking skills and their language proficiency gains. However, in the Asian EFL context of higher education, the practice of critical thinking skills in language classrooms is not yet well supported widely. In order to clarify the essential place of critical thinking in EFL education, through the insightful discussion on the relevant literature background, this critical review of the literature suggests ways to improve English language teaching that incorporate critical thinking in three major areas: (1) language teaching instructional strategies that incorporate critical thinking, (2) language teaching materials that incorporate critical thinking, and (3) pedagogical content knowledge about critical thinking skills for language teachers. Therefore, this study aims to raise awareness among teachers, researchers, educational scholars, and regional and national authorities in the Asian EFL higher education context about the representation of critical thinking in language programs and teacher training in the roadmap for future English language education.

The Tanintharyi Region in southern Myanmar is rich in biodiversity yet is facing threats from varying degrees of anthropogenic pressure. In this research we examine how anthropogenic pressures are influencing large carnivores (tiger Panthera tigris, leopard Panthera pardus and dhole Cuon alpinus) and their major prey species (wild pig Sus scrofa, muntjac Muntiacus spp., sambar Rusa unicolor, gaur Bos gaurus and banteng Bos javanicus) in the Lenya Reserved Forest and adjacent areas of Sundaic forest. We used data from camera-trap surveys during May 2016–March 2018 and logistic regression to analyse the relationships between the presence of large carnivores and explanatory variables such as human disturbance, landscape variability and changes in prey distribution. Tiger presence was positively associated with the occurrence of gaur and distance to villages. The occurrence of prey did not explain the detection of leopards in the study area. We suspect this was because leopards have a broad diet, including arboreal primates, and their prey was not fully recorded in our camera-trap survey. Dholes were positively associated with wild pigs and the total number of prey but not associated with forest type and landscape variables. To restore the carnivore population and conserve the biodiversity of this area, effective protection of predators and habitat management for large ungulates are crucial.

Introduction: The intangible nature of soft skills makes it difficult for nursing academics to evaluate nursing students' attainment of these skills. Most of the time, academics focus more on assessing nursing students' knowledge and performance (hard skills) in clinical skill assessments. In focusing primarily on assessing nursing students' hard skill competencies, the nursing profession has given inadequate attention to developing their soft skill competencies. Thus, this study aimed to explore the nursing academic's view on soft skills elements in structured clinical skill assessment for the undergraduate nursing program. Method: This study was conducted using a qualitative approach. A total of 10 nursing academics were involved, and they were recruited through a purposive sampling method. Data was collected through in-depth interviews using open-ended questions to gain insight into nursing academics' perception of soft skills elements in structured clinical skill assessment for the undergraduate nursing program. Data analysis was conducted by using an inductive content analysis method. Results: Four themes emerge from this study. These are 1) awareness and involvement, 2) Factors influencing on implementation of soft skills in the structured clinical skills assessment, 3) academic responsibility, and 4) suggestions to overcome barriers. Conclusion: Findings from this study provide new insights into the nursing academic perception of soft skills elements in structured clinical skill assessments of undergraduate nursing program needs improvement and proper structure on how/what are the soft skills elements that want to measure for nursing students. These findings would assist in developing a more strategic framework for soft skills elements in structured clinical skill assessments to produce quality nursing graduates.

Water-driven percussion drilling techniques, such as that used by the RoXplorer(R) coiled tubing drill rig, return a rock sample as cuttings that are carried to the surface by the circulating drilling fluid. This drilling technique does not deliver a core sample. In order for the RoXplorer(R) to be effective as a mineral-exploration drill rig, it is critical to develop robust, representative and repeatable sampling techniques for the rock cuttings and to establish with confidence the depth interval from which the sample was derived. The RoXplorer(R) produces more than 7 kg/m of cuttings every few minutes (rate of penetration dependent) that are carried to the surface by the drilling fluid with a fluid return rate of 80-150 L/min. The cuttings, which range in size from

The spread of multidrug-resistant and virulent Staphylococcus aureus among children is a public health concern, but the actual conditions in Myanmar have not been characterized. In this study, a to...

Targeted mass primaquine treatment (TPT) might be an effective intervention to facilitate elimination of vivax malaria in Myanmar by 2030. In this study, we explored the factors hindering coverage of a TPT campaign conducted in a malarious township of northern Myanmar. From August 2019 to July 2020, a cross-sectional exploratory design including quantitative and qualitative data was conducted in five villages with high P. vivax prevalence following a TPT campaign. Among a targeted population of 2322; 1973 (85.0%) participated in the baseline mass blood survey (MBS) and only 52.0% of the total targeted population (1208, 91.9% of total eligible population) completed the TPT. G6PD deficiency was found among 13.5% of total MBS participants and those were excluded from TPT. Of 1315 eligible samples, farmers and gold miners, males, and those aged 15 to 45 years had higher percentages of non-participation in TPT. Qualitative findings showed that most of the non-participation groups were outside the villages during TPT because of time-sensitive agricultural and other occupational or education-related purposes. In addition to mitigating of some inclusion criteria (i.e. including young children or offering weekly PQ treatment to G6PD deficient individuals), strengthening community awareness and increasing engagement should be pursued to increase community participation.

Glycosmis pentaphylla (Retz.) DC., locally known as nerapan, has long been used in Asian countries as a traditional remedy for ailments attributed to microbial infections. This study aims to isolate antimicrobial alkaloids from G. pentaphylla, to determine their combination effects with selected antimicrobial agents and to screen for their photoactivated enzymatic restriction inhibitory activity. Bioautography-guided isolation of antimicrobial alkaloids was performed by using column chromatography with Staphylococcus aureus, Escherichia coli, and Candida albicans as the indicator microbes. The antimicrobial effects of the alkaloids combined with selected antimicrobial agents, namely, ciprofloxacin, erythromycin, vancomycin, and ketoconazole, were determined by using a checkerboard assay. Photoactivated enzymatic restriction inhibitory activity was assessed by using agarose gel electrophoresis. Two antimicrobial active alkaloids were isolated and identified as arborinine and arborine. The antimicrobial activity of arborinine and arborine was determined to be in the range of 250 µg/ml and 1000 µg/ml. Partial synergy was observed for all arborine-antibiotics and arborinine-ketoconazole interactions against S. aureus and C. albicans, respectively. Arborine was relatively the strongest photoactivated enzymatic restriction inhibitor, particularly against EcoRI, PstI, and SalI. The results obtained are promising and encourage further research on alkaloids as potential antimicrobial-enhancing agents.

Background Adults previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop short-term immunity and may have increased reactogenicity to coronavirus disease 2019 (COVID-19) vaccines. This prospective, multicenter, active-surveillance cohort study examined the short-term safety of COVID-19 vaccines in adults with a prior history of SARS-CoV-2. Methods Canadian adults vaccinated between 22 December 2020 and 27 November 2021 were sent an electronic questionnaire 7 days post–dose 1, dose 2, and dose 3 vaccination. The main outcome was health events occurring in the first 7 days after each vaccination that prevented daily activities, resulted in work absenteeism, or required a medical consultation, including hospitalization. Results Among 684 998 vaccinated individuals, 2.6% (18 127/684 998) reported a prior history of SARS-CoV-2 infection a median of 4 (interquartile range: 2–6) months previously. After dose 1, individuals with moderate (bedridden) to severe (hospitalized) COVID-19 who received BNT162b2, mRNA-1273, or ChAdox1-S vaccines had higher odds of a health event preventing daily activities, resulting in work absenteeism or requiring medical consultation (adjusted odds ratio [95% confidence interval]: 3.96 [3.67–4.28] for BNT162b2, 5.01 [4.57–5.50] for mRNA-1273, and 1.84 [1.54–2.20] for ChAdox1-S compared with no infection). Following dose 2 and 3, the greater risk associated with previous infection was also present but was attenuated compared with dose 1. For all doses, the association was lower or absent after mild or asymptomatic infection. Conclusions Adults with moderate or severe previous SARS-CoV-2 infection were more likely to have a health event sufficient to impact routine activities or require medical assessment in the week following each vaccine dose.

In the course of malaria elimination in the Greater Mekong Subregion (GMS), malaria epidemiology has experienced drastic spatiotemporal changes with residual transmission concentrated along international borders and the rising predominance of Plasmodium vivax. The emergence of Plasmodium falciparum parasites resistant to artemisinin and partner drugs renders artemisinin-based combination therapies less effective while the potential spread of multidrug-resistant parasites elicits concern. Vector behavioral changes and insecticide resistance have reduced the effectiveness of core vector control measures. In recognition of these problems, the Southeast Asian International Center of Excellence for Malaria Research (ICEMR) has been conducting multidisciplinary research to determine how human migration, antimalarial drug resistance, vector behavior, and insecticide resistance sustain malaria transmission at international borders. These efforts allow us to comprehensively understand the ecology of border malaria transmission and develop population genomics tools to identify and track parasite introduction. In addition to employing in vivo, in vitro, and molecular approaches to monitor the emergence and spread of drug-resistant parasites, we also use genomic and genetic methods to reveal novel mechanisms of antimalarial drug resistance of parasites. We also use omics and population genetics approaches to study insecticide resistance in malaria vectors and identify changes in mosquito community structure, vectorial potential, and seasonal dynamics. Collectively, the scientific findings from the ICEMR research activities offer a systematic view of the factors sustaining residual malaria transmission and identify potential solutions to these problems to accelerate malaria elimination in the GMS.