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Quasi-periodic eruptions (QPEs) are luminous bursts of soft X-rays from the nuclei of galaxies, repeating on timescales of hours to weeks1-5. The mechanism behind these rare systems is uncertain, but most theories involve accretion disks around supermassive black holes (SMBHs) undergoing instabilities6-8 or interacting with a stellar object in a close orbit9-11. It has been suggested that this disk could be created when the SMBH disrupts a passing star8,11, implying that many QPEs should be preceded by observable tidal disruption events (TDEs). Two known QPE sources show long-term decays in quiescent luminosity consistent with TDEs4,12 and two observed TDEs have exhibited X-ray flares consistent with individual eruptions13,14. TDEs and QPEs also occur preferentially in similar galaxies15. However, no confirmed repeating QPEs have been associated with a spectroscopically confirmed TDE or an optical TDE observed at peak brightness. Here we report the detection of nine X-ray QPEs with a mean recurrence time of approximately 48 h from AT2019qiz, a nearby and extensively studied optically selected TDE16. We detect and model the X-ray, ultraviolet (UV) and optical emission from the accretion disk and show that an orbiting body colliding with this disk provides a plausible explanation for the QPEs.

Critical thinking ability and character education seem to be interesting educational topics that are being discussed in the digital era of 21st century. It is necessary to optimize the character education in the learning process earlier using various learning media. The aim of this study is to investigate the influence learning process of legend story the theme of "obligation and right me" using the a character-based media of "wayang beber" (the legend of "Wasis Joyokusumo") on the students' critical thinking ability. This study is quasi experimental research using post-test only non-equivalent. The samples or participants are two classes in Pati city, namely SD Ngepungrejo 01 Pati as the control class with 36 students and SD Payang 2 Pati as the experimental class with 38 students. Cluster sampling is a technique used to determine the research subject. The data then collected using several techniques, namely observations, interviews, tests, and document analysis. In analyzing the data, descriptive and inferential statistical analysis methods are implemented. In this case, the content validity and construct validity are utilized to test the internal validity. The external validity is tested using try out test of instruments on the sample of study. The validity and reliability tests are implemented. After that, the questions are eligible to be used to obtain the data. The conclusion of study is that the implementation of "wayang beber" as a character-based learning media influences the students' critical thinking ability because the significance value is less than 0,01.

Short stories have the advantage of teaching materials. Because of its short form, it is flexible to be used as teaching materials that do not take long to read. This study aims to describe the teachers' perception of the urgency of integrating tolerance education in the short story appreciation, the content of tolerance values in the short story appreciation learning instruments in high school, and the content of tolerance values in the short story appreciation teaching materials in textbooks. In order to achieve that, a descriptive qualitative method was employed in this study. The results are as follows: (1) All Indonesian teachers in senior high schools in Surakarta have the perception that the value of tolerance education is important to be integrated into learning, including in the short story appreciation learning. (2) The character of tolerance is always listed in the Syllabus document and the Core Competency component of the lesson plan. Apart from that component, the character of tolerance is implicitly included in the character of "caring" and "open to others' opinions" in 86% of the syllabus and lesson plans. (3) There are 9% of short story appreciation teaching materials that have tolerance education content. The potential for this tolerance content is found in a lot of teaching material topics in the form of learning activities and short stories.

Samin is an Indonesian tribe at Mount Kendeng, exactly in the cities of Blora and Bojonegoro. Samin people reject school, fez, polygamy, long trousers, and trade. Although they look like out of date, they have 7 good characters i.e discipline, honesty, responsibility, cooperation, tolerance, social care, and environmental care. This research aimed at investigating the strategies for implementing local wisdom-based character education among Indonesian higher education students by focusing on the values sated in Jamuskalimasada book of Samin Community. The data of this phenomenological research were collected by observation, interview, questionnaire, and documentation. The findings demonstrated that teaching character education in the higher education based on local wisdom could be conducted by integrating values and aesthetics in the course, internalizing positive values to students, habituation and training, providing example and model, creating characterized-situation based on local wisdom, and civilizing. Value-based vision of study program or campus can be achieved through educational strategy formulation including value habituation, value role model, value internalization, value integration in learning, and cultural value. Teaching character education was related to both character actualization programmed in the lesson plan and good example provision in the classroom and daily campus activities.

The objectives of this research are (1) revealing the lecturers and students' perception on the use of multicultural-based short story appreciation textbook in teaching prose-fiction appreciation course; and (2) evaluating the effectiveness of multicultural-based short story appreciation textbook in teaching prose-fiction appreciation course. This study employed a mixed-method approach by combining evaluative descriptive research design and experimental design to evaluate multicultural-based short story appreciation textbook in private universities in East Java, Indonesia. The data were gathered via interview, questionnaires, documentation, and test. While choosing the experimental and control group from each university, the sampling technique used was cluster random sampling. The results reveal that both the lecturers and the students showed their positive responses and attitudes towards the use of multicultural-based short story appreciation textbook in teaching prose-fiction appreciation course. They asserted that the textbook could motivate the students in learning prose-fiction appreciation course. It is inferred that the use of multicultural-based short story appreciation textbook is more effective than the use of previously common textbook used by the lecturers to teach prose-fiction appreciation.

John Lachs considers his major philosophical contributions to be his work on mediation, the love of life, and his explication of George Santayana's philosophical and literary outlooks. All three are undergirded by Lachs's effort to make philosophy relevant to people's lives. This article examines these three contributions with both a critical eye and an admiration for Lachs's efforts. The conclusion provides an assessment often missed in critiques of Lachs's work. Keywords: John Lachs, George Santayana, Wallace Stevens, Consciousness, Education, Immediacy, Living Well, Love of Life, Mediation, Naturalism, Neuroscience, Non-reductive Materialism, Preface John Lachs considers his major philosophical contributions to be his work on mediation, the love of life, and his explication of George Santayana's outlook. He notes that the foundation [...]

The study aims to find out the effectiveness of poetry appreciation textbook for the implementation of character education values at the Higher Education institution. It was set in four universities, two of which are located in Central Java, including University of Sebelas Maret Surakarta and University of Muhammadiyah Purworejo meanwhile, the other two are in Special Region of Yogyakarta, including University of Ahmad Dahlan, and University of Sarjanawiyata Taman Siswa. It utilized an experimental method with Independent Sample T-Test based on the mean difference of pre-test and post-test results from the control and experimental group. The finding confirms that the experimental group obtained the average score that equals 15.68, meanwhile the control group obtained 10.86. The T-Test shows tcalc = 5.087 (p = 0.000<0.05), that rejects the Null Hypothesis. It concludes that there is a significant difference between the experimental and control group in the use poetry appreciation textbook for character education implementation at the Higher Education institution. The study expects further exploration concerning character education implementation through literature works in a wider range for the sake of research and development. The uniqueness of the textbook in combining the values of personal development and literature is recommended as the dominant feature to introduce a complex gradual learning system for the innovation of teaching and learning method.

Teaching and learning speaking skills should be able to engage students in a creative process. Students have to be able to speak in front of the class, create a dialogue, tell a story, and produce the language creatively. The teaching and learning of the speaking skill focusing on story telling ability can work well when supported by the appropriate choice of teaching method. This study attempts to: 1) identify the list of things needed by teachers of primary schools to teach Bahasa Indonesia in fun and creative ways, 2) design a prototype of suggestopedia based storytelling learning model to teach Bahasa Indonesia in primary schools, 3) develop the prototype into a suggestopedia based storytelling learning model to teach Bahasa Indonesia in primary schools, 4) determine the effectiveness of the application of suggestopedia based storytelling learning model to teach Bahasa Indonesia in primary schools. This research is a model development study based on the procedures by Borg and Gall. This study demonstrated that a teaching model is created through the following steps: 1) identifying and analyzing the needs of the students and teachers, 2) designing and evaluating the model, 3) developing and testing the model. The effectiveness test showed a significant increase of 3.03 or 8.11% in the experimental group's mean score, from 18.94 in the pretest to 21.97 in the posttest. Meanwhile, the control group only experienced a 2.51 or 6.36% in the mean score, from 18.50 in the pretest to 21.05 in the posttest. Hence, it can be concluded that the students' story telling skill in the experiment class using the teaching method developed in this study was higher than in the control class. The result implied that the teaching model prototype can be further developed to increase the primary students' story telling skill in Salatiga.

Calcium oxalate (CaOx) crystallization under laminar flow conditions, relevant for kidney stone formation, was studied in a microfluidic device simulating the geometry of kidney collecting ducts. In a typical microfluidic experiment, two reactive solutions with designated concentrations of calcium (Ca) and oxalate (Ox) ions were brought into contact in a microfluidic channel to create a laminar co-current flow of the two streams. As the streams flow co-currently in the channel, diffusion takes place between the two streams across the channel width, resulting in reactive crystallization leading to CaOx nucleation and growth of CaOx crystals along the mixing front. We studied the growth of these crystals in artificial urine as a function of the fluid flow rate in the channel, the molar ratio of Ca : Ox in the medium and the presence of an organic protein, osteopontin (OPN), known to inhibit the growth of CaOx crystals. Three different flow velocities at a fixed molar ratio of Ca : Ox = 7.5 and four molar ratios of Ca : Ox at a fixed mean flow velocity of 0.035 m s−1 were tested. Lastly, three additive OPN concentrations were evaluated: 2.4 × 10−8 mol m−3, 6 × 10−8 mol m−3 and 8.4 × 10−8 mol m−3. The mean flow velocity did not alter the crystal growth of CaOx in the studied range, whereas altering the molar ratio of Ca : Ox had a high impact on the growth rate. In addition, the type of pseudopolymorph which nucleated appears to depend strongly on the molar ratio. At a low Ca : Ox ratio, both calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD) nucleated simultaneously and the growth of the two pseudopolymorphic forms of CaOx crystals was observed. The lowest applied OPN concentration decreased the growth rate of COD, while higher concentrations of OPN slowed down the nucleation kinetics to a point that it completely inhibited the formation of any CaOx crystal in artificial urine within the investigated timeframe. COD was seen under all the conditions investigated, whilst COM was seen in experiments for Ca : Ox molar ratio values between 5 and 6. Our results were rationalized using finite element simulations supported by solution chemistry modelling. [ABSTRACT FROM AUTHOR]

Objectives: Parenteral drug products manufactured under GMP conditions should be visually inspected for defects and particulate contamination by trained and qualified personnel. Although personnel qualification is required, no practical protocols or formal guidelines are available for the development of qualification test sets (QTSs) used for qualification procedures. The current practice is to either procure a standardized QTS from a commercial supplier or amass sufficient manufacturing rejects during visual inspection procedures to compile in-house QTSs. However, both strategies inherently possess disadvantages and limitations. The objective of this study was to develop a manufacturing protocol for an optimal and adaptable QTS for training and qualification procedures. Methods: We combined the results of a literature search, survey of five Dutch hospital pharmacy compounding facilities, semi-structured personnel interviews, and extensive pre-GMP formulation studies to develop an optimal and adaptable QTS manufacturing protocol. Results: The literature search did not identify a manufacturing protocol for an optimal and adaptable QTS, but did identify specifications and requirements for optimal QTSs. The survey among hospital pharmacy compounding facilities revealed considerable variability in the qualification procedures and used QTSs. Semi-structured personnel interviews and pre-GMP formulation studies demonstrated that defects encountered during routine productions could be realistically simulated with pharmaceutical-grade excipients. As a proof-of-concept, we manufactured two different QTSs under GMP conditions and assessed these for formal GMP training and qualification purposes, which were considered a significant improvement compared to using manufacturing rejects. Conclusions: To the best of our knowledge, this is the first study presenting these data and our adaptable protocol, which is provided in the Supplemental Materials, may aid compounding facilities in the standardization, training, and qualification of personnel involved in visual inspection procedures. [ABSTRACT FROM AUTHOR]

Background/Objectives: Products from various parts of Crataegus species are traditionally applied as a cardiotonic. In Europe and the USA, mainly Crataegus monogyna Jacq. (Lindm.) and Crataegus laevigata (Poir.) DC (synonym Crataegus oxyacantha L.) are used, but worldwide, other Crataegus species are also used. Phytotherapeutic preparations with a standardised content of flavonoids and/or oligomeric procyanidins are commercially available. The products are generally considered as safe and are at most associated with minor and atypical adverse reactions. The aim of this study was to critically assess the information about the safety of Crataegus-containing products in humans. Methods: A scoping review of the literature about adverse reactions associated with Crataegus-containing products was performed. Next, individual case safety reports (ICSRs) were assessed, which were included in VigiBase (the World Health Organisation's global database of adverse event reports for medicines and vaccines) and in the database of the Netherlands Pharmacovigilance Centre Lareb. The findings are discussed in relation to the literature. Results: The scoping review yielded 23 clinical studies with single-herb and 14 with multi-herb preparations, from which only a few minor gastrointestinal and cardiac events had been reported. A total of 1527 reports from VigiBase, from 1970 to 2023, were analysed, as well as 13 reports from Lareb. The most frequently reported adverse reactions belonged to the system organ classes 'gastrointestinal disorders', 'skin and subcutaneous tissue disorders', 'general disorders and administration site conditions', 'cardiac disorders' or 'nervous system disorders'. In 277 reports of VigiBase, a single-herb product was the only suspect for causing the adverse reaction(s). Of these, 12.6% were graded as serious. Conclusions: The results of our study provide deeper insight in the adverse reaction profile of Crataegus-containing products and should contribute to their safe application in the treatment of less severe forms of cardiac failure. [ABSTRACT FROM AUTHOR]

The threat that climate change poses to water resource systems has led to a substantial and growing number of impact studies. These studies follow two approaches: (a) top‐down studies are driven by projections of future climate change provided by downscaled general circulation models (GCMs); and (b) bottom‐up studies are driven by the systematic evaluation of exploratory scenarios. Top‐down approaches produce realistic scenarios rooted in the simulation of thermodynamic and dynamic processes represented in GCMs, but the internal resolution of these processes make it difficult to link vulnerabilities to discrete components of change. Bottom‐up approaches link vulnerabilities to discrete components of change through the structured evaluation of exploratory scenarios, but the lack of insight rooted in climate change processes can lead to the development of implausible scenarios. This paper evaluates exploratory scenarios developed through thermodynamic and dynamical guided perturbations motivated by GCM‐bound insights. The result is a hybrid approach that bridges a gap between top‐down and bottom‐up approaches. This yields several advantages. First, emerging vulnerabilities are linked to distinct thermodynamic and dynamic processes that are modeled in GCMs with differential likelihoods and plausible ranges of change. Second, the structured evaluation of process‐informed exploratory scenarios link system vulnerabilities to distinct components of climate change. An illustrative case study demonstrates perturbations linked to thermodynamic and dynamical processes have a large impact on stakeholder‐defined flood and drought performance, and the structured evaluation of process‐informed exploratory scenarios find nuanced infrastructure‐specific vulnerabilities that would be difficult to identify using an alternative approach. Plain Language Summary: This paper addresses the threat climate change poses to water resource systems. Existing studies mainly use top‐down and bottom‐up methods. Top‐down studies rely upon climate models but struggle to assess local concerns. Bottom‐up studies assess local concerns but struggle to link those concerns to ways the climate is changing. This paper introduces a hybrid approach that combines the strengths of both methods. It evaluates local vulnerabilities using variables that drive impacts and are represented in climate models. A case study shows that this hybrid approach identifies local flood and drought vulnerabilities that would be difficult to find with traditional top‐down and bottom‐up methods. This paper aims to enhance our understanding of how climate change impacts water resource systems. Key Points: Exploratory scenarios rooted in processes represented in climate model simulations enhance bottom‐up climate vulnerability assessmentsSystematic exploration of climate drivers with uncertain futures enhance top‐down climate impact assessmentsExploratory scenarios linked to specific climate change insights identify nuanced system‐centric vulnerabilities [ABSTRACT FROM AUTHOR]

Indigenous fire stewardship enhances ecosystem diversity, assists with the management of complex resources, and reduces wildfire risk by lessening fuel loads. Although Indigenous Peoples have maintained fire stewardship practices for millennia and continue to be keepers of fire knowledge, significant barriers exist for re-engaging in cultural burning. Indigenous communities in Canada have unique vulnerabilities to large and high-intensity wildfires as they are predominately located in remote, forested regions and lack financial support at federal and provincial levels to mitigate wildfire risk. Therefore, it is critical to uphold Indigenous expertise in leading effective and socially just fire stewardship. In this perspective, we demonstrate the benefits of cultural burning and identify five key barriers to advancing Indigenous fire stewardship in Canada. We also provide calls to action to assist with reducing preconceptions and misinformation and focus on creating space and respect for different knowledges and experiences. Despite growing concerns over wildfire risk and agency-stated intentions to establish Indigenous Peoples as partners in wildfire management, power imbalances still exist. The future and coexistence with fire in Canada needs to be a shared responsibility and led by Indigenous Peoples within their territories.

The feruloyl esterase B gene (faeB) is specifically induced by hydroxycinnamic acids (e.g. ferulic acid, caffeic acid and coumaric acid) but the transcriptional regulation network involved in faeB induction and ferulic acid metabolism has only been partially addressed. To identify transcription factors involved in ferulic acid metabolism we constructed and screened a transcription factor knockout library of 239 Aspergillus niger strains for mutants unable to utilize ferulic acid as a carbon source. The ΔfarA transcription factor mutant, already known to be involved in fatty acid metabolism, could not utilize ferulic acid and other hydroxycinnamic acids. In addition to screening the transcription factor mutant collection, a forward genetic screen was performed to isolate mutants unable to express faeB. For this screen a PfaeB-amdS and PfaeB-lux613 dual reporter strain was engineered. The rationale of the screen is that in this reporter strain ferulic acid induces amdS (acetamidase) expression via the faeB promoter resulting in lethality on fluoro-acetamide. Conidia of this reporter strain were UV-mutagenized and plated on fluoro-acetamide medium in the presence of ferulic acid. Mutants unable to induce faeB are expected to be fluoro-acetamide resistant and can be positively selected for. Using this screen, six fluoro-acetamide resistant mutants were obtained and phenotypically characterized. Three mutants had a phenotype identical to the farA mutant and sequencing the farA gene in these mutants indeed showed mutations in FarA which resulted in inability to growth on ferulic acid as well as on short and long chain fatty acids. The growth phenotype of the other three mutants was similar to the farA mutants in terms of the inability to grow on ferulic acid, but these mutants grew normally on short and long chain fatty acids. The genomes of these three mutants were sequenced and allelic mutations in one particular gene (NRRL3_09145) were found. The protein encoded by NRRL3_09145 shows similarity to the FarA and FarB transcription factors. However, whereas FarA and FarB contain both the Zn(II)2Cys6 domain and a fungal-specific transcription factor domain, the protein encoded by NRRL3_09145 (FarD) lacks the canonical Zn(II)2Cys6 domain and possesses only the fungal specific transcription factor domain.

Introduction: Although the Baha 5SP has been commercially available for six years, very few studies have been performed on the device's efficacy. The current study aims to evaluate the characteristics and audiological results in patients with severe‐to‐profound mixed hearing loss fitted with this superpower sound processor. Methods: This retrospective evaluation was conducted at a tertiary referral centre where a series of 82 adult patients with severe‐to‐profound mixed hearing loss were implanted with a percutaneous bone‐anchored hearing system and fitted with a superpower sound processor between 2016 and 2019. Patients with incomplete or unreliable audiological data (n = 24) were excluded, resulting in 58 data sets for analysis. The main outcome measures were unaided and aided pure‐tone thresholds and aided free‐field speech perception in quiet. Results: The median unaided air conduction (AC) threshold averaged across 0.5, 1 and 2 kHz (PTA0.5–2kHz) of all patients was 75 dB hearing loss (HL); the median unaided AC averaged across 1, 2 and 4 kHz (PTA1–4kHz) was 84 dB HL. For bone conduction and direct bone conduction, the median PTA0.5–2kHz was 52 and 47 dB HL, respectively. With the superpower device, the median free‐field speech reception threshold was 54 dB sound pressure level (SPL), and the median speech perception score at 65 dB SPL was 80%. Conclusions: At least 75% of the patients reached a maximum phoneme score of 70%. For patients with lower scores, the superpower device still provides a substantial hearing benefit. This makes the superpower device particularly suitable for patients with severe‐to‐profound mixed hearing loss with a contraindication for conventional hearing aids and/or cochlear implants. [ABSTRACT FROM AUTHOR]

Environmental monitoring (EM) is the cornerstone for the assurance of sterility during aseptic manufacturing. In this study, the EM quality aspects in the radiopharmaceutical cleanrooms of the University Medical Center Groningen (UMCG), The Netherlands, were evaluated. Hereto, data obtained from EM over the period 2010–2022 were analyzed. The data were sorted according to the Good Manufacturing Practice (GMP) classification of the respective premises with their corresponding limits, and frequencies of excursions were determined per location. The frequency of conducted measurements gradually increased between the start and end of the assessed period. There was a trend of increased action limit excursions observed between 2010–2022. We found that EM in grade A areas appeared to be significantly less compliant with GMP specifications than the combined data from all sampled premises at the facility (p < 0.00001; two-sided Fisher's exact test). A trend was found for reduced action limit excursions for passive air sampling and particle counting, suggesting improved GMP compliance over time for this specific type of EM. The contamination recovery rate (CRR) found for cleanroom conditions, around 10%, was considered sufficient. From this comprehensive data analysis, we learn that, in order to be fully compliant with the requirements set in the recent revision of EU (European Union)-GMP Annex 1 'Manufacture of sterile medicinal products' (in force as of 25 August 2023), strategies to further improve product protection are justified. For example, improved cleaning and disinfection procedures, more efficient working methods as well as optimization of the conditions under which aseptic manufacturing is performed are to be considered. [ABSTRACT FROM AUTHOR]

Annually, over 300 million surgeries occur globally, requiring numerous surgical instruments. However, many instruments on the tray are returned to the central sterile supply department (CSSD) unused, creating an unsustainable pattern of unnecessary consumption. To address this, we developed a method for optimising surgical instrument trays (SITs) that is straightforward to implement in other hospitals. This optimisation aims to enhance patient safety and sustainability and to improve working conditions and reduce costs. We identified actual instrument usage (IU) in the operating room (OR) and obtained expert recommendations (ERs). Data from both methods were combined in a computer model (CM) to adjust the SITs. The performance of the adjusted SITs was assessed over a year. IU of three different SITs was collected during 16 procedures (mean = 28.4%, SD = 6.4%). Combining IU and ERs resulted in a 36.7% reduction in instruments and a 31.3% weight reduction. These measures contribute to reducing the carbon footprint and enhancing sustainability. During the evaluation of the new SIT contents (n = 7 procedures), mean IU increased from 28.4% (SD = 6.4%) to 46.5% (SD = 11.0%), with no missing instruments during surgery. A one-year follow-up showed no need for further alterations. Combining both methods yields better results than using them individually, efficiently reducing unnecessary items in SITs without compromising patient safety. [ABSTRACT FROM AUTHOR]

This study investigated whether and how medication reviews (MRs) conducted by pharmacists and general practitioners (GPs) with patient involvement can be performed on the island of Aruba (Dutch Caribbean). In this mixed-methods pilot study (both qualitative and quantitative), constructive and observational methodologies were combined. Healthcare providers' and patients' views on MRs and aspects of Aruban healthcare and culture relevant to MRs were examined. These insights were used to develop a protocol for conducting and implementing MRs in Aruba. Surveys were distributed and semi-structured interviews were held among Aruban community pharmacists and GPs, and a pilot program was created in which MRs were carried out with four Aruban patients and their GPs. According to the included healthcare providers, the main purpose of MRs is to optimize the patient experience and achieve concordance. Even though pharmacists and GPs consider their partnership equal, they have different views as to who should bear which responsibility in the MR process in matters regarding patient selection and follow-up. Common Aruban themes that were mentioned by the healthcare providers and deemed relevant for conducting MRs included behaviour/culture, healthcare, lifestyle, and therapy compliance. Anamnesis should be concise during the MR, and questions about medication storage, concerns, beliefs, and practical problems, as well as checks for limited health literacy, were considered important. In the pilot, at least three to, maximally, eight pharmacotherapy-related problems (PRPs) were detected per MR consultation, such as an incorrect dosage of acetylsalicylic acid, an inappropriate combination tablet for blood pressure regulation, and the absence of important laboratory values. All patients considered their consultation to be positive and of added value. In addition, it was observed that an MR can potentially generate cost savings. The information obtained from the healthcare providers and patients, together with the basic principles for MRs, as applied in the Netherlands, led to a definitive and promising MR format with practical recommendations for community pharmacists in Aruba: in comparison with the Dutch MR approach, GPs and pharmacists in Aruba could collaborate more on patient selection for MRs and their follow-up, because of their specific knowledge regarding the medications patients are taking chronically (pharmacists), and possible low levels of health literacy (GPs). Taking into account the Aruban culture, pharmacists could ask extra questions during MRs, referring to lifestyle (high prevalence of obesity), readability of medication labels (limited literacy), and herbal product use (Latin American culture). GPs and medical specialists sometimes experience miscommunication regarding the prescription of medication, which means that pharmacists must carefully take into account possible duplicate medications or interactions. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study is to describe the values of character education for Drama course. It is a qualitative descriptive study. The data were obtained from the play entitled Opera Kecoa¸ written by N.Riantiarno. by looking at the settings, the characters, the plots and some relevant documents. The technique used to collect the data was by document analysis technique. As one form of literary work, Opera Kecoa drama script contains character education values. The values of character education in this drama script are shown through characterizations and events in each chapter. Based on the results of the analysis found ten character education values contained in the drama Opera Kecoa, these values include: social care, tolerance, hard work, discipline, peace,patriotism, friendly, independent, creative, and responsibility. By reason of the values of these characters, the Opera Kecoa drama script can be used as a medium of learning in the college literature. Abstrak: Penelitian ini bertujuan mendeskripsikan nilai-nilai pendidikan karakter yang terdapat pada sebuah naskah drama. Penelitian ini menggunakan metode deskriptif kualitatif dengan subjek penelitiannya adalah naskah drama Opera Kecoa karya N.Riantiarno. Sumber data diperoleh dari tempat dan peristiwa, informan, naskah drama, dan dokumen. Pengumpulan data menggunakan teknik analisis dokumen. Sebagai salah satu bentuk karya sastra, naskah drama Opera Kecoa memuat nilai-nilai pendidikan karakter. Nilai-nilai pendidikan karakter dalam naskah drama ini ditampilkan melalui penokohan dan alur peristiwa pada setiap babaknya. Berdasarkan hasil analisis maka ditemukan sepuluh nilai pendidikan karakter yang terdapat dalam naskah drama Opera Kecoa, nilai-nilai tersebut antara lain: peduli sosial, toleransi, kerja keras, disiplin, cinta damai, cinta tanah air, bersahabat, mandiri, kreatif, dan tanggung jawab. Dengan alasan adanya nilai-nilai karakter tersebut maka naskah drama Opera Kecoa dapat digunakan sebagai salah satu media pembelajaran sastra di perguruan tinggi.

Objective: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is standard of care in the Netherlands in patients with stage III epithelial ovarian cancer following interval cytoreductive surgery (CRS). Differences in patient selection, technical aspects, and perioperative management exist between centers performing HIPEC. Standardization aims to reduce unwanted variation in clinical practice. As part of an implementation process, we aimed to standardize perioperative care for patients treated with CRS and HIPEC using a Delphi-based consensus approach. Methods: We performed a two-phase modified Delphi method involving a multidisciplinary panel of 40 experts who completed a survey on CRS and HIPEC. During a consensus meeting, survey outcomes and available scientific evidence was discussed. Items without consensus (