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Purpose: Vocational education and training is important to produce skilled and innovative labor to drive the country's development in the 4th industrial revolution (IR 4.0). The employability of vocational college students is crucial to meet the country's demand for 21st-century workers. This study aims to identify the influences of innovative characteristics, work readiness, and vocational self-concept on the employability of vocational college students. The study also examined the moderating role of gender. Methods: A quantitative correlational design was carried out to achieve the objectives of the study. The samples consisted of 395 vocational college students from five vocational colleges located in the states of Kedah and Penang, Malaysia. Data were collected through online questionnaire survey, which is made up of four instruments: Youth Innovation Skills Measurement Tool, the Work Readiness Scale, the Vocational Rational Scale and the Perceived Future Employability Scale. The validity and reliability of these instruments were well established. Descriptive and structural equation modelling (SEM) analyses were carried out. Findings: Innovative characteristics ([beta] = 0.252, t = 5.041, p < 0.001), vocational self-concept ([beta] = 0.386, t = 7.131, p < 0.001) and work readiness ([beta] = 0.219, t = 3.787, p < 0.001) had significant effects on employability of vocational college students. The model explained 53% of the variance in employability. Gender, however, did not moderate any of the three direct significant relationships. Conclusion: This study found that innovative characteristics, work readiness, and vocational self-concept are factors that should be taken into consideration when developing education and career programs, interventions, and support services for vocational students. The graduate employment issues faced by vocational college students can be overcome if factors identified in this study can be enhanced. Similar approaches can be applied for both male and female students since gender is not a significant moderator. Overall, this study sheds light on the employability of vocational graduates and contributes towards improving career guidance and counseling practices for vocational students.

Online learning is on the rise, and it is becoming an important mode of learning in higher education. However, there are limited models that explain the link between learners' characteristics, learning processes, and outcomes in an online learning environment. This study aims to examine the influence of online self-regulation on the experiences and engagement of students during online learning processes and their outcomes in terms of satisfaction and academic performance. A quantitative correlational design was used to achieve the objective of this study. Data collection was carried out using an online survey. A total of 609 undergraduates from four public and private universities in Malaysia were sampled. The partial least squares structural equation modeling (PLS-SEM) was run to analyze the obtained data. The results showed that online self-regulation is a presage factor affecting online learning processes. It significantly and positively affects students' experiences and engagement in an online environment. These three factors explained more than two thirds of the variance in satisfaction, a key learning outcome of online learning. However, its predictive value for academic performance was weaker. The developed model can be used as a framework to promote positive online learning outcomes among undergraduate students. The implications of the study and recommendations for future research are discussed in this paper.

Postgraduate students need to be equipped with self-determined learning skills in order to meet the demands of higher degree and employment in the fourth industrial revolution (IR 4.0) environment. However, the lack of analysis conducted on item level for validating the measurement of postgraduate students' self-determined learning skills prompted the development of The Postgraduate Self-determined Learning Questionnaire (PSLQ) to fill in the research gaps. This paper aimed to assess the psychometric properties of the newly developed 42-item instrument through a mixed method approach as no study has evaluated the psychometric properties of PSLQ at the item level through Rasch model analysis. Quantitatively, 440 postgraduate students were sampled from a higher education institution in Malaysia to answer the questionnaire. Qualitatively, 10 respondents from science and non-science disciplines were interviewed. The paper reports findings on the psychometric properties of PSLQ through Rasch Rating Analysis and participants' perspectives on the item validity. The results revealed that the items in PSLQ demonstrated good psychometric properties for the measurement of self-determined learning skills of postgraduate students. Implications of the study were discussed in this paper. Future studies can further investigate the psychometric properties of PSLQ according to students' discipline of study.

Effective engagement during online learning is essential for achieving successful student outcomes. This study aims to determine the level of engagement among undergraduate students and its influencing factors during the online learning process. Data were collected from a sample of 609 undergraduate students, taken from four public and private universities in Malaysia. Results showed that undergraduate students have a moderate level of engagement during online learning. Their engagement was significantly influenced by perceptions of online learning, experiences in online learning, and online self-regulation skills, as demonstrated by the results of partial least square-structural equation modeling (PLS-SEM). These factors accounted for 63.7% of the variance in students' engagement (R[superscript 2] = 0.637, p < 0.01). The implications of the study were discussed.

Introduction This analysis aimed to investigate diabetes-specific psychological outcomes among adults with type 1 diabetes (T1D) using hybrid closed-loop (HCL) versus standard therapy.Research design and methods In this multicenter, open-label, randomized, controlled, parallel-group clinical trial, adults with T1D were allocated to 26 weeks of HCL (MiniMed™ 670G) or standard therapy (insulin pump or multiple daily injections without real-time continuous glucose monitoring). Psychological outcomes (awareness and fear of hypoglycemia; and diabetes-specific positive well-being, diabetes distress, diabetes treatment satisfaction, and diabetes-specific quality of life (QoL)) were measured at enrollment, mid-trial and end-trial. Linear mixed models were conducted, using restricted maximum likelihood estimation, unadjusted and adjusted (for covariates: age, sex, diabetes duration, glycated hemoglobin, recent severe hypoglycemia, pre-trial insulin delivery modality, enrollment and mid-study scores).Results 120 participants (mean age 44±12 years) were randomized to intervention (n=61) or standard therapy (n=59). At 13 weeks, the HCL group had better diabetes-specific positive well-being than the standard therapy group (unadjusted: Δ=1.0, p=0.025; adjusted: Δ=1.1, p=0.01), which was maintained at 26 weeks (unadjusted: Δ=0.9, p=0.042; adjusted: Δ=1.0, p=0.023). At 26 weeks, the HCL group also had less diabetes distress (adjusted: Δ=−6.4, p=0.039), fear of hypoglycemia (“maintain high”: adjusted: Δ=−0.8, p=0.034; and “worry”: adjusted: Δ=−1.8, p=0.048), and perceived “unacceptably high glucose levels” (unadjusted: Δ=−1.1, p

Purpose: The study explored the barriers and enablers faced by language teachers in teaching 21st century skills at Chinese vernacular schools. It aimed to determine the effects of teachers' attitudes, barriers, and enablers in teaching the skills during language lessons. Method: A mixed-method design was used to achieve the two objectives of this study. Quantitative data were collected from 400 language teachers from Chinese vernacular schools, and semistructured interviews were carried out with nine of the teachers. Barriers and enablers faced by teachers were identified through literature review, semi-structured interviews, and questionnaire surveys. Triangulation was carried out for analysis purposes. The effects among the variables were analysed through partial least squares structural equation modelling via Smart PLS 3.0. Findings: The major barriers and enablers faced by language teachers in teaching 21st century skills at Chinese vernacular schools were uncovered. Direct effects of teachers' attitudes, barriers, and enablers on the teaching of 21st century skills were found. However, there were no significant moderating effects of barriers and enablers on their teaching. Both of these variables had stronger effects on teachers' attitudes. Significance: With the identifications of barriers and enablers faced by language teachers at Chinese vernacular schools, more effective support and interventions can be provided to these teachers. Teacher training and professional development programmes on 21st century language teaching can also be improved by incorporating the influencing factors identified in this study.

Postgraduate students have to play active roles in self-determined learning, as major agent in their own learning and research activities. There is a lack of validated research instruments to measure self-determined learning among postgraduate students. The Postgraduate Self-Determined Learning Questionnaire (PSLQ) was specifically developed to fill in the gaps. This study aims to examine the validity and reliability of the PSLQ through exploratory factor analysis (EFA). The original version of PSLQ has 59 items and it was administered to a sample of 201 postgraduate students from a research-intensive university in Malaysia. The results of EFA revealed that PSLQ measures four distinct factors; learner-centered learning, interactive non-linear learning, double-loop reflection, and capacity development, which accounted for 54.22% of the variance in self-determined learning. The total number of items in PSLQ has been reduced to 42, after 17 items were removed. The instrument demonstrated excellent internal consistency, with a Cronbach's alpha value of [alpha]=0.959. The findings-suggest that PSLQ is a valid and reliable instrument that can be used to measure self-determined learning among postgraduate students. Implications of the research findings are discussed in this paper.

Abstract Background International longitudinal studies have indicated an increasing incidence of diabetic ketoacidosis (DKA). We aim to examine the incident trends, demographic differences, length of stay and mortality for DKA in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) in Victoria, Australia from 2002 to 2016. Methods Age and sex adjusted incident trends, length of stay and mortality for DKA was retrospectively obtained using the Victorian Admitted Episode Dataset between 2002 and 2016. Data for adults with T1D and T2D was obtained from the National Diabetes Services Scheme (NDSS). Joinpoint regression analysis was used to identify changes in linear trends that were described as average annual percentage change (AAPC). Results There were 23,628 DKA presentations in Victoria between 2002 and 2016. For T1D there was an increase in DKA presentations (AAPC + 6.8%) from 2003 to 2016 and for T2D there was a decline from 2003 to 2011 (APC − 3.5%), increase from 2011 to 2014 (APC + 38.5%), and a decrease from 2014 to 2016 (APC − 20.9%). Length of stay was longer for people with T2D than T1D (P

The use of self-correction strategy helps students to detect their own mistakes and self-correct them, thereby students self-regulate their own learning processes. It is still a strategy that is rarely researched in mathematics learning, particularly at the primary level. This study attempts to fill in the gaps by determining the effectiveness self-correction strategy on primary school students' mathematics achievement. It also aims to determine the mediating roles of problem-solving self-efficacy on the relationships between the two variables. To assess the effects of self-correction strategy empirically, a Pretest-Posttest Nonequivalent Control Group design was employed. The study involved 62 primary school students. The experimental group (n=32) applied self-correction strategy during 12 mathematics lessons while the control group (n=30) did not. Achievement of both groups was measured by the mathematics test. Students' problem-solving self-efficacy was measured by the Problem-Solving Self-Efficacy Questionnaire. Results of Analysis of Covariance (ANCOVA) found that self-correction strategy was effective in improving the experimental group's mathematics achievement [F(1, 59) = 11.00, p < 0.05, eta square = 0.157]. The results of regression analysis showed that self-efficacy was a significant mediator between the use of self-correction strategy and their mathematics achievement [F(1, 61) = 27.60, p = 0.046, [beta] = -0.201]. Implications of the findings from the educational and research standpoints were discussed and suggestions for future research were provided in this paper.

Coarctation of the aorta (CoA) is one of the most common types of congenital heart disease. Unfortunately, there is a high prevalence of hypertension and late cardiovascular mortality in patients with CoA despite successful repair. The growing impact of acquired cardiovascular disease remains a significant concern as the adult congenital heart disease population continues to rapidly expand and age. This review aims to explore (1) the determinants of vascular health and atherosclerosis including endothelial dysfunction and vascular wall abnormalities, (2) the prevalence of atherosclerosis and associated sequelae in repaired CoA including coronary artery disease, coronary artery calcium, aortic calcium, stroke, and peripheral artery disease, and (3) the contributing factors specific to CoA. This review aims to guide optimization of long-term cardiovascular health to ultimately reduce mortality and morbidity in this young high-risk population.

The purpose of this study is to examine the effect of social and emotional learning approach on student social-emotional competence. A quasi-experimental pre-test post-test non-equivalent design conducted with 207 Junior Secondary School students enrolled in form 3. The students divided into two groups: an experimental and a control group. The experimental group was taught through social-emotional learning approach, while the control group taught via traditional teaching approach. The development of social-emotional competence measured through a questionnaire at the beginning and the end of the classes. The results obtained from the analysis of covariance revealed that students in social and emotional learning approach classroom had positively demonstrated significant social-emotional competence compared to students in the traditional teaching approach group. Therefore, the utilized (social and emotional learning- RULER) has provided substantial procedures on how students can integrate and apply RULER's strategies in enhancing their social emotional competence. The implication for introducing social and emotional learning approach into teaching and learning was discussed.

Purpose: This quantitative study explored willingness to communicate (WTC) across two settings, ESL in Malaysia, and EFL in Indonesia and Thailand. Participants' WTC levels were measured and communicative situations in which participants were almost always willing and almost never willing to communicate in English were identified. Method: Convenience sampling was used to select the three countries, four secondary schools and 42 intact classes from Years 7 to 10. Two schools were in Malaysia, while one school each was in Indonesia and Thailand. A total of 1038 participants, consisting of 291 Malaysians, 325 Indonesians and 422 Thais took part in the study. The instrument used was an adapted questionnaire measuring WTC inside and outside the English classroom. Findings: The major findings were: (1) Situations in which students were almost never willing to communicate in English were mainly found outside the classroom; (2) Students were almost always willing to communicate in English in brief, predictable situations requiring the use of set phrases; (3) ESL students had a higher level of WTC than EFL students; and (4) WTC inside the classroom was significantly higher than WTC outside the classroom. Significance: The findings have implications for ESL/EFL classroom instruction. English teachers remain the main interlocutors in increasing WTC in the classroom. They also need to bridge the gap between the classroom and the outside world by preparing students for real social situations. This is consistent with the situation-specific aspect of WTC in the heuristic model proposed by MacIntyre, Clément, Dörnyei, & Noels (1998).

This study provides an insight into using personalized weekly e-Learning Journals to improve self-regulated learning (SRL) of university students. Quasi-experimental method with time series data analysis was used. Pre and post-tests together with time series data over an intervention period on SRL were collected. 54 students in an undergraduate course wrote personalized weekly e-Learning Journals (e-LJs) in the Learning Management System (LMS) over a 10-week period. The e-LJs contained selfreflection prompts designed according to the course curriculum activities and assessments to scaffold students' SRL. It was found that students' SRL improved significantly over the intervention period. The time series data on SRL shows that students' SRL varied according to the timing of assessments. Academic staff can help university students improve their SRL by providing personalized weekly e-LJs that contained self-reflection prompts. These prompts need to be personalized according to the course curriculum activities and assessments.

Throughout the last decade in Malaysia, participation of students with disabilities in higher education has seen minimal growth. This paper investigates the policies and practices regulating disability in Malaysia's higher education. Three aspects -- legislation, funding, and governance -- are analysed. To reveal the gaps in policy and practice, comparison is carried out with the cases of England and Australia. The research involved examining government documents such as disability acts, action plans, and research and statistics reports, combined with interviewing university administrators. It was found that Malaysian legislation requires more supporting details and that disability funding for universities should be considered. For governance, systematic legislation review and specific university monitoring are recommended. Establishing an independent national entity to conciliate grievances is proposed to address the inadequate redress mechanism available for students with disabilities. Overall, the government and universities could ensure that disability information is available in the public domain, especially online. Such practice would enhance disability awareness and knowledge for all. Although this paper mainly takes on the perspective of a developing nation, it attains an international orientation as it also depicts the workings of the developed world in governing disability in higher education.

We describe an unusual case of multi-vessel giant coronary artery aneurysms complicated by acute coronary syndrome despite escalation of therapy. A 65-year-old man with hypertension and hypercholesterolemia presented to clinic with atypical chest pain over 4 months. Outpatient computed tomography coronary angiography (CTCA) demonstrated giant coronary aneurysms involving all 3 major coronary arteries. Outpatient coronary angiogram findings were in concordance with the CTCA with no definite obstructive coronary disease. Myocardial perfusion imaging was normal. He was commenced on dual antiplatelet therapy (DAPT). At 6 months, he presented with chest pain and non-ST-elevation myocardial infarction. Repeat coronary angiogram demonstrated occluded first septal LAD branch which previously had aneurysmal dilatation. DAPT was changed to long-term oral anticoagulation. He remains well at 18 months. This case highlights the importance of multi-modality imaging in the diagnosis and workup of coronary artery aneurysms and challenges in management; an individualized approach is required.

Multicultural education is crucial in promoting cross-cultural understanding, recognition, and celebration of diversity in Malaysia-one of the most culturally diverse countries in the world. Preschool teachers play central roles in laying the foundation for cultural acceptance and positive racial interaction during early childhood. This study aims to explore Malaysian preschool teachers' training and attitudes towards multicultural education. A quantitative questionnaire survey approach was used to gather the required data. The participants consisted of 1,067 preschool teachers from 267 private and government preschools providers in the country. Two validated instruments were employed to measure the variables in this study. The trainings received by the preschool teachers were measured by the Teachers' Training Multicultural Education Scale (TTMES) while their attitudes towards multicultural education were gauged by the Multicultural Teaching Scale (MTS). Findings showed that preschool teachers were positive about the trainings that they received in relation to multicultural education. However, the extent to which they actually understood the concept of multiculturalism was doubtful in view that two thirds of the teachers demonstrated misconception about the fundamental principles of multicultural education when their attitudes towards multicultural education were examined. Significant differences were found in teachers' training and attitudes according to the categories of preschools; teachers from mono-cultural preschools displayed the least positive attitudes towards multicultural education. Implications of the study were discussed in the paper.

The continuing mutability of the SARS-CoV-2 virus can result in failures of diagnostic assays. To address this, we describe a generalizable bioinformatics-to-biology pipeline developed for the calibration and quality assurance of inactivated SARS-CoV-2 variant panels provided to Radical Acceleration of Diagnostics programs (RADx)-radical program awardees. A heuristic genetic analysis based on variant-defining mutations demonstrated the lowest genetic variance in the Nucleocapsid protein (Np)-C-terminal domain (CTD) across all SARS-CoV-2 variants. We then employed the Shannon entropy method on (Np) sequences collected from the major variants, verifying the CTD with lower entropy (less prone to mutations) than other Np regions. Polyclonal and monoclonal antibodies were raised against this target CTD antigen and used to develop an Enzyme-linked immunoassay (ELISA) test for SARS-CoV-2. Blinded Viral Quality Assurance (VQA) panels comprised of UV-inactivated SARS-CoV-2 variants (XBB.1.5, BF.7, BA.1, B.1.617.2, and WA1) and distractor respiratory viruses (CoV 229E, CoV OC43, RSV A2, RSV B, IAV H1N1, and IBV) were assembled by the RADx-rad Diagnostics core and tested using the ELISA described here. The assay tested positive for all variants with high sensitivity (limit of detection: 1.72–8.78 ng/mL) and negative for the distractor virus panel. Epitope mapping for the monoclonal antibodies identified a 20 amino acid antigenic peptide on the Np-CTD that an in-silico program also predicted for the highest antigenicity. This work provides a template for a bioinformatics pipeline to select genetic regions with a low propensity for mutation (low Shannon entropy) to develop robust ‘pan-variant’ antigen-based assays for viruses prone to high mutational rates.

Background: Patients with single ventricle (SV) without Fontan palliation are uncommon, and their long-term outcomes remain unclear. Methods: Retrospective study of 35 adult patients with SV without Fontan from two tertiary centers. Primary outcome was mortality. Results: Median age at first follow-up was 31 years (IQR: 20–40). Most common defect was double inlet left ventricle (34%), and 69% had left ventricular morphology. Patients were unoperated (46%), had systemic-to-pulmonary artery shunt (31%) or bidirectional cavopulmonary shunt (23%) as final palliation. Most common reasons for not progressing to Fontan palliation were pulmonary vascular disease (54%), patient refusal (17%), Fontan takedown (14%), and hypoplastic pulmonary arteries (11%). Baseline mean hemoglobin was 195 ± 29 g/L, mean O2 saturation 83 ± 6.9%, and 4 patients in NYHA Class III‒IV. After a mean follow-up of 10 ± 8.3 years, there were 9 deaths with heart failure being the leading cause (n = 6). Age-adjusted survival of these adult SV survivors was 73% and 53% at 40 and 50 years of age, respectively. Deceased patients more frequently had renal impairment (50% vs 0%) and QRS prolongation (75% vs 16%) at baseline (all p

The barriers that indigenous students face in pursuing higher education are substantial and far-reaching. This study seeks to understand the impact of institutional support on engagement of "Orang Asli" students and its effects on their learning outcomes and academic achievement. Quantitative data were collected from 160 "Orang Asli" students from three tribal groups through an online survey. Indigenous students from 11 selected public universities in Malaysia have responded to the survey, with a response rate of 89%. The partial least squares (PLS) approach was used to analyse the data. Results of the structural model showed that despite the absence of dedicated indigenous support centres at public universities in Malaysia, institutional support still have significant impact on engagement of "Orang Asli" students, which in turn affects their learning outcomes and academic achievement positively. The implications of the research findings and recommendations for future research are discussed in this paper.

Purpose: This study aimed to examine the interaction effects of gender and motivational beliefs on students' self-regulated learning. Specifically, three types of motivational beliefs under the Expectancy-Value Model were examined, namely self-efficacy, control beliefs and anxiety. Methodology: A quantitative correlational research design was used to achieve the research objectives. Data were collected through the questionnaire survey method from 322 secondary school students (166 males; 156 females). The samples were taken from two ICT-integrated schools located in Peninsular Malaysia. The learning environment in these schools was conducive for self-regulated learning. The Learning Strategies Scale and the Motivation Scale, taken from the Motivated Strategies for Learning Questionnaire (MSLQ) were used to measure the variables of the study. Findings: The findings showed that self-efficacy and control beliefs were positively related to students' self-regulated learning. Anxiety, however, was found to be negatively related to self-regulated learning. The interactions between gender and levels of motivational beliefs on self-regulated learning were also explored in this study. The relationships between self-efficacy and self-regulated learning differed according to gender. However, there were no significant interaction effects between gender and internal control beliefs on self-regulated learning. This implies that gender differences in self-regulated learning were not due to the differences in control beliefs and anxiety. Significance: This study offers insights on the interaction effects between motivational beliefs, and gender and self-regulated learning. It may help to develop effective instructional strategies to enhance students' self-regulated learning skill in ICT-related learning environments.

A virtual learning environment (VLE) is a web-based platform that allows students to learn at a personally defined place, time and pace. However, most students are lacking in the self-regulation skills and metacognitive abilities to take advantage of the flexibility and high learners' control available in VLEs. The purpose of the study was to investigate the influence of self-regulation processes on secondary school students' metacognition within a partial least square (PLS) framework. The sample consisted of 506 secondary school students. The data analysis was run using Smart PLS Version 3.0. The results revealed that self-efficacy and procrastination were significantly related to strategy use, which in turn influenced students' metacognition. Self-efficacy was found to be the primary motivational belief that drives students' help-seeking behaviour as well as the application of task strategies and time management. The findings may help to design more effective pedagogical practices to increase metacognitive abilities among secondary school students in technologically enhanced learning environments.

Effective engagement during online learning is essential for achieving successful student outcomes. This study aims to determine the level of engagement among undergraduate students and its influencing factors during the online learning process. Data were collected from a sample of 609 undergraduate students, taken from four public and private universities in Malaysia. Results showed that undergradaute students have a moderate level of engagement during online learning. Their engagement was significantly influenced by perceptions of online learning, experiences in online learning, and online self-regulation skills, as demonstrated by the results of partial least square-structural equation modeling (PLS-SEM). These factors accounted for 63.7% of the variance in students' engagement (R2 =.637, p < 0.01). The implications of the study were discussed. [ABSTRACT FROM AUTHOR]

Lymph nodes (LNs) are the critical sites of immunity, and the stromal cells of LNs are crucial to their function. Our understanding of the stromal compartment of the LN has deepened recently with the characterization of nontraditional stromal cells. CD41 (integrin αIIb) is known to be expressed by platelets and hematolymphoid cells. We identified two distinct populations of CD41+Lyve1+ and CD41+Lyve1- cells in the LNs. CD41+Lyve1- cells appear in the LN mostly at the later stages of the lives of mice. We identified CD41+ cells in human LNs as well. We demonstrated that murine CD41+ cells express mesodermal markers, such as Sca-1, CD105 and CD29, but lack platelet markers. We did not observe the presence of platelets around the HEVs or within proximity to fibroblastic reticular cells of the LN. Examination of thoracic duct lymph fluid showed the presence of CD41+Lyve1- cells, suggesting that these cells recirculate throughout the body. FTY720 reduced their trafficking to lymph fluid, suggesting that their egress is controlled by the S1P1 pathway. CD41+Lyve1- cells of the LNs were sensitive to radiation, suggestive of their replicative nature. Single cell RNA sequencing data showed that the CD41+ cell population in naïve mouse LNs expressed largely stromal cell markers. Further studies are required to examine more deeply the role of CD41+ cells in the function of LNs.

Dnm2fl/fl Pf4-Cre (Dnm2Plt–/–) mice lacking the endocytic GTPase dynamin 2 (DNM2) in platelets and megakaryocytes (MKs) develop hallmarks of myelofibrosis. At the cellular level, the tyrosine kinase JAK2 is constitutively active but decreased in expression in Dnm2Plt–/– platelets. Additionally, Dnm2Plt–/– platelets cannot endocytose the thrombopoietin (TPO) receptor Mpl, leading to elevated circulating TPO levels. Here, we assessed whether the hyperproliferative phenotype of Dnm2Plt–/– mice was due to JAK2 constitutive activation or to elevated circulating TPO levels. In unstimulated Dnm2Plt–/– platelets, STAT3 and, to a lower extent, STAT5 were phosphorylated, but their phosphorylation was slowed and diminished upon TPO stimulation. We further crossed Dnm2Plt–/– mice in the Mpl–/– background to generate Mpl–/–Dnm2Plt–/– mice lacking Mpl ubiquitously and DNM2 in platelets and MKs. Mpl–/– Dnm2Plt–/– platelets had severely reduced JAK2 and STAT3 but normal STAT5 expression. Mpl–/– Dnm2Plt–/– mice had severely reduced bone marrow MK and hematopoietic stem and progenitor cell numbers. Additionally, Mpl–/– Dnm2Plt–/– mice had severe erythroblast (EB) maturation defects, decreased expression of hemoglobin and heme homeostasis genes and increased expression of ribosome biogenesis and protein translation genes in spleen EBs, and developed anemia with grossly elevated plasma erythropoietin (EPO) levels, leading to early fatality by postnatal day 25. Mpl–/– Dnm2Plt+/+ mice had impaired EB development at three weeks of age, which normalized with adulthood. Together, the data shows that DNM2-dependent Mpl-mediated endocytosis in platelets and MKs is required for steady-state hematopoiesis and provides novel insights into a developmentally controlled role for Mpl in normal erythropoiesis, regulating hemoglobin and heme production.

Research universities in Malaysia are striving to transform into world-class institutions. These universities have the capacity to attract the best students to achieve excellence in education and research. It is important to monitor the psychological well-being of students during the transformation process so that proactive intervention can help students cope with the learning and research demands. This study profiled and monitored the personality traits of postgraduate and undergraduate students in a selected Malaysian research university using a quantitative research method. The researchers profiled personality traits using an online assessment, the Behavioral Management Information System (BeMIS), and tracked real and preferred personality traits and positive changes during rapid institutional transition.

Elementary Students experienced poor self-management and a lower level of school readiness. The purpose of the study is to identify the level of school readiness among elementary students with behavioral problems. It also aimed to identify the influences of self-regulation skills, parenting style, and transition support programs on school readiness and behavioral problems. The study involved 113 of 519 Year One student from six schools in the State of Perak, Malaysia, categorized as students with behavioral problems. The Year One Pupil's Readiness Instrument (IKMTS), Behavioral Problems Scale, Self-Regulation Scale, Parents Authority Scale, and Transition Activities Scale were utilized to collect the data for this study. Descriptive results showed that the level of school readiness among students with behavioral problems was moderate. Self-regulation skills and parenting style were revealed to be two major variables that impact school preparation and behavioral difficulties in the Partial Least Squares Structural Equation Modeling (PLS-SEM) study.

Abstract Platelets are blood components that survive in circulation for 7 to 10 days in humans. Thus, platelet production by bone marrow (BM) megakaryocytes (MKs), and their removal from the blood circulation is precisely orchestrated to maintain an average platelet count. Abnormalities in both processes can result in thrombocytopenia (low platelet count) or thrombocytosis (high platelet count), often associated with the risk of bleeding or overt thrombus formation, respectively. Platelet glycans, particularly sialic acids, are indicators of platelet count. Loss of platelet sialic acids leads to platelet clearance. A State‐of‐the‐Art lecture titled “Platelet and Megakaryocyte Glycobiology” was presented at the ISTH virtual congress 2021 to discuss (i) the loss of O‐glycan sialic acid on BM MKs, revealing the Thomsen‐Friedenreich (TF) antigen as a new concept of thrombocytopenia; herein, impaired thrombopoiesis is attributed to activation of immune cells with a plasmacytoid dendritic cell signature; and (ii) upregulation of antibodies against the TF antigen in pediatric patients with immune thrombocytopenia (ITP), positing that glycan alterations such as MK asialylation can lead to immune cell responses. Here, we discuss our findings alongside new data presented at the 2020 and 2021 ISTH congresses on the role of sialic acids and glycans in regulating platelet count. Desialylation is a prominent feature in thrombocytopenia, notably in ITP presentation. We compare similarities between ITP mediated with shear‐stress and with storage‐related asialylation. We also discuss genes involved in sialic acid synthesis leading to thrombocytopenia. Increased awareness in gene‐regulating MK and platelet glycans is a giant leap to understanding the underpinning mechanisms of ITP and other forms of thrombocytopenia.

This study identified the fundamental lifestyles adopted by a university community in Malaysia. Rapid growth and expansion of higher education in Malaysia is inevitable as the country moves from a production-based economy to one that is innovative and knowledge-based, requiring the development of a highly skilled and knowledgeable workforce. Research universities in Malaysia are leading the way in the generation of intellectual property and wealth for the country, as well as enhancing the quality of life of its people. A case study approach found that the university community's lifestyle is focused on recognitions. Implications for university personnel are discussed.

Purpose – The study explored the barriers and enablers faced by language teachers in teaching 21st century skills at Chinese vernacular schools. It aimed to determine the effects of teachers’ attitudes, barriers, and enablers in teaching the skills during language lessons. Method – A mixed-method design was used to achieve the two objectives of this study. Quantitative data were collected from 400 language teachers from Chinese vernacular schools, and semi-structured interviews were carried out with nine of the teachers. Barriers and enablers faced by teachers were identified through literature review, semi-structured interviews, and questionnaire surveys. Triangulation was carried out for analysis purposes. The effects among the variables were analysed through partial least squares structural equation modelling via Smart PLS 3.0. Findings – The major barriers and enablers faced by language teachers in teaching 21st century skills at Chinese vernacular schools were uncovered. Direct effects of teachers’ attitudes, barriers, and enablers on the teaching of 21st century skills were found. However, there were no significant moderating effects of barriers and enablers on their teaching. Both of these variables had stronger effects on teachers’ attitudes. Significance – With the identifications of barriers and enablers faced by language teachers at Chinese vernacular schools, more effective support and interventions can be provided to these teachers. Teacher training and professional development programmes on 21st century language teaching can also be improved by incorporating the influencing factors identified in this study.

The recent development and mass administration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines allowed for disease control, reducing hospitalizations and mortality. Most of these vaccines target the SARS-CoV-2 Spike (S) protein antigens, culminating with the production of neutralizing antibodies (NAbs) that disrupt the attachment of the virus to ACE2 receptors on the host cells. However, several studies demonstrated that the NAbs typically rise within a few weeks after vaccination but quickly reduce months later. Thus, multiple booster administration is recommended, leading to vaccination hesitancy in many populations. Detecting serum anti-SARS-CoV-2 NAbs can instruct patients and healthcare providers on correct booster strategies. Several in vitro diagnostics kits are available; however, their high cost impairs the mass NAbs diagnostic testing. Recently, we engineered an ACE2 mimetic that interacts with the Receptor Binding Domain (RBD) of the SARS-2 S protein. Here we present the use of this engineered mini-protein (p-deface2 mut) to develop a detection assay to measure NAbs in patient sera using a competitive ELISA assay. Serum samples from twenty-one patients were tested. Nine samples (42.8%) tested positive, and twelve (57.1%) tested negative for neutralizing sera. The data correlated with the result from the standard commercial assay that uses human ACE2 protein. This confirmed that p-deface2 mut could replace human ACE2 in ELISA assays. Using bacterially expressed p-deface2 mut protein is cost-effective and may allow mass SARS-CoV-2 NAbs detection, especially in low-income countries where economical diagnostic testing is crucial. Such information will help providers decide when a booster is required, reducing risks of reinfection and preventing the administration before it is medically necessary.

Mutations affecting sialylation and galactosylation affect megakaryocyte function and thrombopoiesis. Here the authors show that the enzyme β4GalT1 regulates thrombopoiesis and hematopoietic stem cell homeostasis by controlling beta-1 integrin function.

Objective: To examine long-term outcomes after tetralogy of Fallot (TOF) repair. Methods: Single-centre retrospective study of 293 patients aged ≥16 years with previous TOF repair at a median age of 2.6 years (IQR:1.1–5.1 years). Surgical approach was trans-atrial (51% (149/293)), right ventriculotomy (34% (101/293)) and unknown (15%, 43/293). Results: After a median adult centre follow-up of 9 years (IQR:3.9–15.5 years, max 40), survival was excellent (n = 284, 97%). Age-adjusted survival was 99%, 95%, and 83% at 20, 40, and 60 years of age, respectively. Over half required ≥1 pulmonary valve (PV) intervention (166/293, 57%). Arrhythmia endpoints occurred in 24% (70/293) including atrial arrhythmia in 12% (34/293) and ventricular arrhythmia in 6% (18/293). Freedom from PV intervention and arrhythmia reduced with time (85% and 95% at 20, 46% and 82% at 40, and 16% and 31% at 60 years of age, respectively). The vast majority have excellent functional status at latest follow-up (NYHA Class I/II: 99.5%, 202/203). Independent risk factors for lower RVEF at latest cardiac magnetic resonance imaging (CMR) were male sex (p = 0.01), PV intervention (p = 0.02), increased QRS duration on ECG on latest follow-up (p

International law enforcement is an understudied but indispensable factor for maintaining the international order. We study the effectiveness of elite justifications in building coalitions supporting the enforcement of violations of the law against territorial seizures. Using survey experiments fielded in the USA and Australia, we find that the effectiveness of two common justifications for enforcement—the illegality of a country’s actions, and the consequences of those actions for international order—increase support for enforcement and do so independently of two key public values: ideology and interpersonal norm enforcement. These results imply elites can build a broad coalition of support by using multiple justifications. Our results, however, highlight the tepidness of public support, suggesting limits to elite rhetoric. This study contributes to the scholarship on international law by showing how the public, typically considered a mechanism for generating compliance within states, can impede or facilitate third-party enforcement of the law between states.

Online learning is on the rise, and it is becoming an important mode of learning in higher education. However, there are limited models that explain the link between learners' characteristics, learning processes, and outcomes in an online learning environment. This study aims to examine the influence of online self-regulation on the experiences and engagement of students during online learning processes and their outcomes in terms of satisfaction and academic performance. A quantitative correlational design was used to achieve the objective of this study. Data collection was carried out using an online survey. A total of 609 undergraduates from four public and private universities in Malaysia were sampled. The partial least squares structural equation modeling (PLS-SEM) was run to analyze the obtained data. The results showed that online self-regulation is a presage factor affecting online learning processes. It significantly and positively affects students' experiences and engagement in an online environment. These three factors explained more than two thirds of the variance in satisfaction, a key learning outcome of online learning. However, its predictive value for academic performance was weaker. The developed model can be used as a framework to promote positive online learning outcomes among undergraduate students. The implications of the study and recommendations for future research are discussed in this paper. [ABSTRACT FROM AUTHOR]

Purpose – This quantitative study explored willingness to communicate (WTC) across two settings, ESL in Malaysia, and EFL in Indonesia and Thailand. Participants’ WTC levels were measured and communicative situations in which participants were almost always willing and almost never willing to communicate in English were identified. Method – Convenience sampling was used to select the three countries, four secondary schools and 42 intact classes. Two schools were in Malaysia, while one school each was in Indonesia and Thailand. A total of 1038 participants, consisting of 291 Malaysians, 325 Indonesians and 422 Thais took part in the study. The instrument used was an adapted questionnaire measuring WTC inside and outside the English classroom. Findings – The major findings were: 1) Situations in which students were almost never willing to communicate in English were mainly found outside the classroom; 2) Students were almost always willing to communicate in English in brief, predictable situations requiring the use of set phrases; 3) ESL students had a higher level of WTC than EFL students; and 4) WTC inside the classroom was significantly higher than WTC outside the classroom. Significance – The findings have implications for ESL/EFL classroom instruction. English teachers remain the main interlocutors in increasing WTC in the classroom. They also need to bridge the gap between the classroom and the outside world by preparing students for real social situations. This is consistent with the situation-specific aspect of WTC in the heuristic model proposed by MacIntyre, Clément, Dörnyei, & Noels (1998).

During infection neuraminidase desialylates platelets and induces their rapid clearance from circulation. The underlying molecular basis, particularly the role of platelet glycoprotein (GP)Ibα therein, is not clear. Utilizing genetically altered mice we report that the extracellular domain of GPIbα, but neither von Willebrand factor nor ADAM17 (a disintegrin and metalloprotease 17), is required for platelet clearance induced by intravenous injection of neuraminidase. Lectin binding to platelets following neuraminidase injection over time revealed that the extent of desialylation of O-glycans correlates with the decrease of platelet count in mice. Injection of α2,3-neuraminidase reduces platelet counts in wild-type but not in transgenic mice expressing only a chimeric GPIbα that misses most of its extracellular domain. Neuraminidase treatment induces unfolding of the O-glycosylated mechanosensory domain in GPIbα as monitored by single-molecule force spectroscopy, increases the exposure of the ADAM17 shedding cleavage site in the mechanosensory domain on the platelet surface, and induces ligand-independent GPIb-IX signaling in human and murine platelets. These results suggest that desialylation of O-glycans of GPIbα induces unfolding of the mechanosensory domain, subsequent GPIb-IX signaling including amplified desialylation of N-glycans, and eventually rapid platelet clearance. This new molecular mechanism of GPIbα-facilitated clearance could potentially resolve many puzzling and seemingly contradicting observations associated with clearance of desialylated or hyposialylated platelets.

The immune response relies on the integration of cell-intrinsic processes with cell-extrinsic cues. During infection, B cells vacate the marrow during emergency granulopoiesis but return upon restoration of homeostasis. Here we report a novel glycosylation-mediated crosstalk between marrow B cells and hematopoietic progenitors. Human B cells secrete active ST6GAL1 sialyltransferase that remodels progenitor cell surface glycans to suppress granulopoiesis. In mouse models, ST6GAL1 from B cells alters the sialylation profile of bone marrow populations, and mature IgD+ B cells were enriched in sialylated bone marrow niches. In clinical multiple myeloma, ST6GAL1 abundance in the multiple myeloma cells negatively correlated with neutrophil abundance. These observations highlight not only the ability of medullary B cells to influence blood cell production, but also the disruption to normal granulopoiesis by excessive ST6GAL1 in malignancy.

Background: Habit Reversal Therapy (HRT) has long been used in the treatment of Tourette Syndrome and Tic Disorders. It has more recently been used to treat Trichotillomania and skin picking behaviors, both considered as Obsessive Compulsive Related Disorders (OCRD).Objectives: This literature review sought to establish and quality assess the existing randomized controlled trial evidence supporting the use of HRT in the DSM-5 family of OCRDs.Search Methods: EMBASE, PsycINFO, PubMed, and Cochrane databases were searched for key terms relating to each OCRD (as classified in the DSM-5), and HRT.Selection Criteria: Titles and abstracts were screened, and any literature matching pre-specified criteria were then selected to be reviewed further. Of these, 8 Randomized Controlled Trials (RCT) relating to Trichotillomania, and 2 RCTs relating to Excoriation Disorder, were extracted and reviewed against the 2010 Consolidating Standards of Reporting Trials (CONSORT) statement.Results: The review identified 10 RCTs of HRT, but these were limited to patients with a primary diagnosis of Trichotillomania or “excoriation behavior,” only. There were some reports of the use of HRT in Tourette Syndrome or Tic Disorder with secondary OCD, but the OCD symptoms were not reliably reported on.Conclusion: There is a gap in the current literature regarding the use of HRT in the DSM-5 OCRDs. In those RCTs that have been reported, the quality of study methodology was questionable as evaluated by CONSORT criteria. The implications of these findings are discussed, and suggestions are made for future research.

Background. This is an excerpt from chapter 4 of the annual registry report from the Australia and New Zealand islet and pancreas transplant registry. The full report is available at http://anziptr.org/reports/. Methods. We report data for all allogeneic islet isolation and transplant activity from 2002 to end 2017. Solid organ pancreas transplantation activity is reported separately. New Zealand does not have an islet transplant program. Data analysis was performed using Stata software version 14 (StataCorp, College Station, TX). Results. From 2002 to 2017, a total of 104 allogeneic islet transplants were performed in 62 recipients. Conclusions. The number of islet transplants performed in Australia was slightly lower in 2017 but continues to increase over time.

Multicultural early childhood education is necessary in a culturally diverse country like Malaysia. Preschool teachers play an important role in implementing multicultural education in the classroom. This paper reports the findings of a self-report questionnaire involving 854 preschool teachers in Malaysia. The preschool teachers disclosed their current multicultural education practices as well as the challenges they encountered when implementing multicultural education. While the majority of teachers claimed that they implemented multicultural education, a closer examination revealed that most of them used the tourist or contribution approach which focuses on only the outward manifestations of a culture when dealing with multicultural education. The transformation or anti-bias approach was used by only a small number of teachers. The teachers identified some challenges in multicultural education implementation, such as lack of instructional resources and the lack of stakeholder support. Thus, it is important to ensure teachers develop more critical understandings of multicultural education through teacher education training and programs. Other efforts to help teachers overcome challenges in implementing multicultural education include producing and developing more instructional materials and learning aids, which are suitable for young children and appropriate for the local context. Preschool teachers also need stakeholders to give more support and to acknowledge the importance of implementing multicultural early childhood education.

Multicultural education is important in multicultural societies. Multicultural education should be introduced in the early years as the preschool years are a critical time when young children develop the moral values and ethical standards of their society. Therefore, it is crucial for preschool teachers to be equipped with the appropriate knowledge, skills and attitudes to promote multicultural education. This paper reports the findings of a survey involving 854 preschool teachers who were serving in both public and private preschools in Malaysia. The preschool teachers completed a questionnaire to demonstrate their understandings of multicultural education, their perceptions of its importance in early childhood education and their opinions about other preschool teachers' attitudes towards multicultural education. The findings indicated that the Malaysian preschool teachers had a limited understanding of multicultural education. Although most of them acknowledged the importance of introducing multicultural education at preschool level, the extent to which they actually understood the concept was still doubtful. Even though a majority of the preschool teachers believed that other preschool teachers had favourable attitudes towards multicultural education, there were a considerably high percentage of preschool teachers who actually possessed unfavourable or condition-dependent attitudes. Thus, it is critical to focus on supporting teachers in developing more critical and deeper understandings of multicultural education. Efforts such as reviewing teacher training programmes as well as enhancing teachers' openness, self-reflective abilities, commitment to social justice and positive intercultural experiences are needed to promote teachers' positive beliefs and attitudes towards diversity.

Transition services are required by law for students with disabilities in many developed countries. In Malaysia, however, there is still no specific legislation mandating that school-to-work transition planning and services be provided to students with disabilities. This study investigated the state of the transition services provided by educational organisations to students with disabilities in Malaysia. A mixed method research design, which utilises both quantitative and qualitative research techniques, was employed to obtain information from 23 government organisations and NGOs involved in the education and training of students with disabilities. This study found that the organisations surveyed were aware of the lack of transition support and call attention to the importance of instituting a national policy on school-to-work transition services and supported employment systems for students with disabilities. The legislative and educational implications for Malaysia are discussed.

The literacy practices of many communities today show new ways of meaning making in the contemporary, technological and digital culture. A number of Malaysian adolescents belong to this culture. This pilot study reports the preliminary findings of a larger study aimed at describing the online activities of Malaysian adolescents. Fifty-four participants from an urban secondary school in Penang took part in this study. One finding showed that the percentages of language use on the Internet were: 80.6 per cent in English, 10.6 per cent in Bahasa Malaysia and 8.8 per cent in Chinese. In addition, the study also revealed some common websites that these adolescents frequented. The findings point to the need to investigate the extent of these online literacy practices beyond school among the adolescent population in Malaysia and to look into the implications for ESL education. (Contains 4 tables and 2 figures.)