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ABSTRACTThis scoping review examines the role of digital solutions in active, participant-centered surveillance of adverse events following initial release of COVID-19 vaccines. The goals of this paper were to examine the existing literature surrounding digital solutions and technology used for active, participant centered, AEFI surveillance of novel COVID-19 vaccines approved by WHO. This paper also aimed to identify gaps in literature surrounding digital, active, participant centered AEFI surveillance systems and to identify and describe the core components of active, participant centered, digital surveillance systems being used for post-market AEFI surveillance of WHO approved COVID-19 vaccines, with a focus on the digital solutions and technology being used, the type of AEFI detected, and the populations under surveillance. The findings highlight the need for customized surveillance systems based on local contexts and the lessons learned to improve future vaccine monitoring and pandemic preparedness.

Abstract Background Globally, COVID-19 vaccines have proven to be instrumental for promoting population health by reducing illness from SARS-CoV-2. Vaccine certificates emerged as a potentially promising solution for encouraging vaccination and facilitating the safe reopening of society, however, they were controversial due to criticisms of infringing upon individual rights. While there is extensive literature describing the ethical, legal, and public health implications of vaccine certificates, there is currently a gap in knowledge about the association of vaccine certificates on vaccine uptake during the COVID-19 pandemic and barriers and facilitators to their use. Objectives The objectives of this scoping review are to (i) describe the existing literature on the association of vaccine certificates on the rates of COVID-19 vaccine uptake across several countries and (ii) describe the intrinsic and extrinsic barriers or facilitators that moderate this relationship. Methods We conducted a scoping review based on PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guidelines. We searched three bibliographic databases (APA PsychInfo, Embase Classic + Embase, OVID-Medline) and preprint severs during the first week of July 2023. Three reviewers independently screened the studies based on pre-specified eligibility criteria and performed quality assessments of the primary literature and data extraction. Results Sixteen studies met the inclusion criteria. 14 or these were surveys and 2 were modelling studies. The majority documented that vaccine certificates were significantly associated with increased rates of COVID-19 vaccine uptake (n = 12), motivated by factors such as travel/employer requirements, influence from the government/peers, and trust in the safety, efficacy, and science behind COVID-19 vaccines. Three studies had non-significant or mixed findings. Only one study found a significant decrease in COVID-19 vaccine uptake, motivated by pervasive distrust in the QR code-based system of digital vaccine certificates in Russia. Quality of survey studies was generally high. Conclusion Our findings provide insights into the existing literature on vaccine certificates association with vaccine uptake in several different jurisdictions and barriers and facilitators to their uptake. This information can be used to guide future examinations of the implementation of vaccine certificates and more effective implementations.

Siti Salima,1 Mulyohadi Hadi Wibowo,1 Birgitta M Dewayani,2 Aisyah Shofiatun Nisa,1 Firas Farisi Alkaff3,4 1Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia; 2Department of Pathology of Anatomy, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia; 3Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia; 4Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the NetherlandsCorrespondence: Siti Salima, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62811223830, Email s.salima@unpad.ac.id Firas Farisi Alkaff, Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia, Tel +6281330101993, Email f.f.alkaff@umcg.nl; firasfarisialkaff@fk.unair.ac.idAbstract: Hydatidiform mole (HM) is an aberrant pregnancy characterized by atypical trophoblastic hyperplasia, hydropic chorionic villi, and deprived fetal development. There are two types of HM, ie, complete (CHM) and partial (PHM). Both CHM and PHM can recur; however, the recurrence of PHM is very scarce compared to CHM. In this report, we present a case of a 33-year-old woman with recurrent PHM for 7 times without any normal pregnancy in-between. PHM was determined by histology examination. The patient underwent suction curettage and was followed up with serial β-hCG levels. Recurrent PHM, although rare, is associated with an increased incidence of malignancy. A series of clinical and β-hCG evaluation should be warranted because of the possibility of gestational trophoblastic neoplasia development.Keywords: hydatidiform mole, pregnancy, partial hydatidiform mole, case report

Andi Kurniadi,1 Dani Setiawan,1 Jessica Kireina,1 Dodi Suardi,1 Siti Salima,1 Febia Erfiandi,1 Mia Yasmina Andarini2 1Department of Obstetrics and Gynecology, Universitas Padjadjaran, Bandung, Indonesia; 2Faculty of Medicine, Universitas Islam Bandung, Bandung, IndonesiaCorrespondence: Andi Kurniadi, Department of Obstetrics and Gynecology, Universitas Padjadjaran, Bandung, Indonesia, Tel +62 812 2028 6197, Email andi.kurniadi@unpad.ac.idBackground: Cervical cancer in pregnancy is rare and its management remains a formidable challenge. Clinical upstaging is a serious concern. Presentation may mimic pregnancy-related conditions, thus delaying diagnosis and leading to an advanced stage at presentation. In addition, concerns regarding chemotherapy safety in pregnancy may hinder its administration. Definitive therapy may also be delayed due to pregnancy.Case Report: A 37-year-old G3P2A0 10– 11 weeks pregnant woman was diagnosed with stage IB2 cervical cancer. We originally planned to perform neoadjuvant chemotherapy with paclitaxel 175mg/m2 and carboplatin 6 AUC every 21 days followed by caesarean section and radical hysterectomy. However, preoperatively, the tumor had grown further and progressed to stage IIB. Postpartum radiotherapy was thus indicated. Lower segmental caesarean section along with bilateral salpingectomy and ovarian transposition were performed. Radiotherapy was administered through external beam radiation therapy and brachytherapy. The patient delivered a small for gestational age male baby with no abnormalities. At 2-month follow-up, the infant appeared generally healthy.Conclusion: Cancer diagnosis during pregnancy adversely impacts women’s physical and psychological states. Symptoms may mimic pregnancy-related conditions, thus delaying diagnosis. Its management involves a multidisciplinary team to protect both maternal and fetal health.Keywords: cervical cancer, pregnancy, cancer in pregnancy, neoadjuvant chemotherapy

Vaccine certificates have been implemented worldwide, aiming to promote vaccination rates and to reduce the spread of COVID-19. However, their use during the COVID-19 pandemic was controversial and has been criticized for infringing upon medical autonomy and individual rights. We administered a national online survey exploring social and demographic factors predicting the degree of public approval of vaccine certificates in Canada. We conducted a multivariate linear regression which revealed which factors were predictive of vaccine certificate acceptance in Canada. Self-reported minority status (p

Globally, measures, such as lockdown, quarantining, and physical distancing, have been implemented to curb the spread of COVID-19. As the vaccines are now available and reintegration into society is beginning, measures such as vaccine certificates are being implemented around the world. We conducted a scoping review to identify the initial digital solutions for COVID-19 vaccine certificates and evaluate them on the basis of purpose and use case, technological architecture, and ethical and legal implications. Articles identified from a Google search and a search of MEDLINE, Ovid and preprint servers were reviewed in duplicate, and data were extracted using a data extraction form. Data were extracted for date, location, type of article, source, companies identified for creating vaccine certificates, technology used, type of evidence provided (article quoting research study or an expert opinion), digital architecture, security and privacy measures, and use cases. Technology emerged as the most dominant theme followed by ethics, travel, legal concerns, public policy, and scientific concerns. Our review identified eight solutions that are working toward COVID-19 vaccine certificates world-wide, all optimizing blockchain technology. COVID-19 vaccine certificates are being considered in 11 countries and are in place in 5 others. Many issues concerning the themes we identified remain to be addressed to facilitate successful implementation.

Background: The Dietary Guidelines for Americans (DGA) 2015-2020 supports that healthy eating patterns should include a variety of vegetables from all five of the following vegetable subgroups: dark green, red and orange, legumes, starchy, and others. Aims and Objective: To determine the approximate composition and nutritive values of edible portions of different varieties of popular seeds and to identify the heavy metals contents of these seeds. Materials and Methods: Five different seeds were collected from traditional supermarkets in Benghazi. Moisture and Ash contents in the samples were determined by A.O.A.C method. Total fat and the crude protein content in the seed sample were measured by using soxhlet extraction, and the Kjeldahl method of AOAC, respectively. The mineral content in seeds also determined by Atomic Absorption, spectrophotometer. Result: Five different seeds (pumpkin, sunflower, watermelon seeds, corn and chickpea) were analyzed for determination their protein, fat, energy and moister contents. The highest and signifi cant protein contents found in sunflower seeds 27.5% (p=0.001) whilst the lowest content was observed in corn. The highest fat and carbohydrate contents found in sunflower seeds and in the corn, 50%; 50% (P= 0.014) and (72.4%) (P=0.0005) respectively. In compared to other seeds, the moisture contents of pumpkin seeds presented the highest amount with signifi cant values (p=0.0001). The energy contents of sunflower seeds were the predominant value 626.28 kcal/100 g followed by both pumpkin seeds and watermelon seeds 591.2 and 585.89 kcal/100g respectively. The ash content of pumpkin seeds was approximately 5.87%. Furthermore, Pumpkin seeds had higher amounts of potassium 871 mg/100g, and watermelon seed was the highest sources of calcium (86 mg/100g) than other seeds. Magnesium, Iron and copper signifi cantly found higher in sunflower seeds. Conclusion: Overall seeds could be one of the good sources of food staple for macro and micronutrients, and may have health and economic benefi cial. Consumption of such seeds should be at recommended levels due to presences some quantities of lead and cadmium,which could have detrimental health effect.

Abstract Background The media play a critical role in informing the public about the COVID-19 pandemic. Throughout the pandemic, international travel has been a highly contested subject at both the international and national levels. We examined Canadian media reporting on international travel restrictions during the pandemic, how these restrictions aligned with the International Health Regulations (IHR 2005), and how the narrative around international travel evolved over time. Methods We analysed articles from Canada’s top three national newspapers by circulation – The Globe and Mail, The National Post and The Toronto Star - published between Jan 1, 2020 - May 31, 2020. Our search yielded a total of 378 articles across the three newspapers. After removing duplicates and screening the remaining articles, we included a total of 62 articles for the analysis. We conducted a qualitative media content analysis by using an inductive coding approach. Results Three major themes were identified within the articles. These included: 1) The role of scientific and expert evidence in implementing travel restrictions; 2) Federal legislation, regulation and enforcement of international travel measures; and 3) Compliance with World Health Organization (WHO) guidelines in travel restriction policy- and decision-making. The federal government relied primarily on scientific evidence for implementing international travel restrictions and fully exercised its powers under the Quarantine Act to enforce travel regulations and comply with the IHR 2005. The government embraced a rules-based international order by following WHO recommendations on international travel, contributing to a delay in border closure and travel restrictions until mid-March. Conclusion The media focussed significantly on international travel-related issues during the early phase of the pandemic. The dominant media narrative surrounded the need for earlier travel restrictions against international travel.

Abstract Background The 2005 International Health Regulations (IHR (2005)) require States Parties to establish National Focal Points (NFPs) responsible for notifying the World Health Organization (WHO) of potential events that might constitute public health emergencies of international concern (PHEICs), such as outbreaks of novel infectious diseases. Given the critical role of NFPs in the global surveillance and response system supported by the IHR, we sought to assess their experiences in carrying out their functions. Methods In collaboration with WHO officials, we administered a voluntary online survey to all 196 States Parties to the IHR (2005) in Africa, Asia, Europe, and South and North America, from October to November 2019. The survey was available in six languages via a secure internet-based system. Results In total, 121 NFP representatives answered the 56-question survey; 105 in full, and an additional 16 in part, resulting in a response rate of 62% (121 responses to 196 invitations to participate). The majority of NFPs knew how to notify the WHO of a potential PHEIC, and believed they have the content expertise to carry out their functions. Respondents found training workshops organized by WHO Regional Offices helpful on how to report PHEICs. NFPs experienced challenges in four critical areas: 1) insufficient intersectoral collaboration within their countries, including limited access to, or a lack of cooperation from, key relevant ministries; 2) inadequate communications, such as deficient information technology systems in place to carry out their functions in a timely fashion; 3) lack of authority to report potential PHEICs; and 4) inadequacies in some resources made available by the WHO, including a key tool – the NFP Guide. Finally, many NFP representatives expressed concern about how WHO uses the information they receive from NFPs. Conclusion Our study, conducted just prior to the COVID-19 pandemic, illustrates key challenges experienced by NFPs that can affect States Parties and WHO performance when outbreaks occur. In order for NFPs to be able to rapidly and successfully communicate potential PHEICs such as COVID-19 in the future, continued measures need to be taken by both WHO and States Parties to ensure NFPs have the necessary authority, capacity, training, and resources to effectively carry out their functions as described in the IHR.

Abstract Background Human Papillomavirus (HPV) is the most common sexually transmitted infection in Canada and around the world. Vaccination is an effective prevention strategy, but uptake is low, especially among newcomers to Canada. We sought to understand newcomers’ knowledge, attitudes, and beliefs (KAB) on HPV and HPV vaccination and their role in HPV vaccine acceptance. Methods Newcomers were defined as individuals born outside Canada, (i.e., individuals born in a different country, the majority of whom are immigrants or refugees, but also includes students and undocumented migrants). Eligible participants were newcomers, aged 16 or older and who could read or write in English, French or Arabic. Surveys were administered in two community health centres in Ottawa, Canada that primarily engage with newcomer populations. Follow-up interviews were conducted either at the community health centre or over the phone, depending on participants’ preferences. Results Fifty participants completed the survey, the majority of whom were women (74%) and spoke Arabic as their first language (54%). Seven participants completed supplemental interviews to complement their survey responses. The majority (70%) of participants had not previously heard of HPV. Less than half (46%) knew that the vaccine is effective in preventing certain types of cancer; nearly 40% incorrectly believed the vaccine could cure HPV. Qualitative interviews supported the survey findings. Conclusions Despite a lack of HPV knowledge due to cultural and language barriers, there is still a strong desire among newcomers to receive the vaccine, especially when accompanied by a physician recommendation. Cultural and language-appropriate resources are needed to help newcomers make informed vaccination decisions and promote HPV vaccine uptake.

Background As Canada continues to address challenges related to the opioid crisis, individuals suffering from opioid use disorder (OUD) can be especially vulnerable to physical and psychological destabilization after surgery. Adopting a harm reduction approach postoperatively can be a success factor for safe recovery and satisfactory analgesia. Purpose We present the case of a 40-year-old patient (referred to as DC) with OUD using illicit fentanyl, heroin, and oxycodone preoperatively and admitted for an elective liver resection for steroid-induced hepatoma. Despite a preoperative anesthesia assessment and the initiation of a standard balanced multimodal analgesic regimen, suboptimal analgesia was evident in the first 24 h postoperatively. This lack of analgesic efficacy precipitated DC’s use of illicit self-injected intravenous (IV) opioid and significant emotional distress. To address this, a nurse practitioner and anesthesiologist within the Toronto General Hospital acute and transitional pain program and the surgical team quickly met and adopted a harm reduction approach to manage DC’s postoperative pain and emotional distress. The ultimate goal was to eliminate self-administration of illicit IV opioids and prevent DC from attempting to leave hospital against medical advice. Following an interprofessional team discussion that included DC, IV fentanyl was offered via a patient-controlled analgesia pump to DC’s satisfaction (exceeding standard settings), providing acceptable pain relief. To our knowledge, DC did not self-administer additional illicit drugs during the remainder of hospitalization. Outcome This harm reduction approach resulted in DC’s safe recovery, achievement of postoperative functional milestones, and continued engagement with outpatient pain treatment.

Abstract Background We aim to describe the general characteristics of how the Canadian newspaper The Globe and Mail reports on opioid-related news, the opioid crisis and its victims, and explore how Canadians’ perceptions of the opioid crisis could have developed over time from this reporting. The Globe and Mail has the highest circulation among Canadian newspapers and is Canada’s newspaper of record. Methods Reviewers performed independent, blinded bibliometric searches of all The Globe and Mail articles archived in the Canadian Periodicals Index Quarterly spanning an 18-year period (1 January 2000–1 June 2018) related to the keywords “opioids” or “drugs and opioids” and “opiates”. Independently and in duplicate, reviewers manually extracted qualitative data from articles and identified emergent themes. Articles were screened independently by both reviewers based on the inclusion criteria. Conflicts were resolved by discussion and consensus. Social representation theory was used as a framework for describing how the opioid crisis is portrayed in Canada. Results Our search yielded 650 relevant opioid articles. The number of articles peaked in 2009, 2012, and in 2016, coinciding with major developments in the epidemic. The language used in this discourse has evolved over the years and has slowly shifted towards less stigmatizing language. Content analysis of the articles revealed common social representations attributing responsibility to pharmaceutical companies, physicians, and foreign countries. Conclusions The Globe and Mail’s coverage of the opioid crisis is focused on basic social representations and attributed responsibility for the crisis to a few collectives. A shift toward coverage of the root causes of the opioid epidemic could positively influence the general public’s perception of the opioid crisis and promote deeper understanding of the issue. Journalists face several obstacles to achieve greater focus and framing of the opioid crisis; a closer working relationship between the media and the research community is needed.

Yudi Mulyana Hidayat,1 Munizar,1 Ali Budi Harsono,1 Gatot Nyarumenteng Adhipurnawan Winarno,1 Hasanuddin,2 Siti Salima1 1Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Aceh, IndonesiaCorrespondence: Yudi Mulyana Hidayat Tel +62 8122024759Email yudi.mulyana@unpad.ac.idPurpose: The ultimate goal of cytoreduction surgery is the complete removal of all visible tumors (complete cytoreductive surgery) or tumor residues < 1 cm (optimal cytoreduction surgery). Following cytoreduction surgery in ovarian cancer, tumor residue is one of the most important prognostic factors. Oncologists strive to be able to predict the outcome of cytoreduction surgery during the presurgical period. The purpose of this study was to assess CCL5 as a modality for determining whether a patient could perform optimal cytoreduction surgery or not.Materials and Methods: This was an observational, analytic, and cross-sectional study of patients with ovarian cancer who underwent surgery at the Dr. Hasan Sadikin Bandung from 2019 to 2020. All of the patients had stage I–IV disease based on the International Federation of Gynecology and Obstetrics (FIGO) score.Results: In total, 72 patients were enrolled in this study, 31 of whom underwent suboptimal cytoreduction surgery and 41 underwent optimal cytoreduction surgery. The mean serum CCL5 level at suboptimal cytoreduction was 70,920.87 ± 36,362.966, while that at optimal cytoreduction was 43,244.95 ± 21,983.887. CCL5, as a predictor of suboptimal cytoreduction surgery, had a sensitivity of 61.3%, a specificity of 68.3%, and an accuracy of 65.7% (p = 0.012).Conclusion: Preoperative CCL5 serum levels can predict suboptimal cytoreduction surgery outcomes in patients with ovarian cancer.Keywords: ovarian cancer, CCL5, cytoreductive surgery

Abstract Background The hand, foot and mouth disease (HFMD) is a febrile and exanthematous childhood disease mainly caused by Enterovirus 71 (EV-A71). In severe HFMD, virulent EV-A71 strains can cause acute flaccid paralysis and cardiopulmonary edema leading to death. Currently, no FDA approved antiviral treatment or vaccine is available for EV-A71. Flavonoids such as silymarin and baicalein are known to possess in vitro antiviral properties against viruses. In this study, the cytotoxicity and antiviral activity of silymarin, baicalein and baicalin were investigated. Methods The cytotoxic effects of three flavonoids towards rhabdomyosarcoma (RD) cells were first examined using cell proliferation MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] assay. Compounds found to be non-cytotoxic in RD cells were evaluated for their in vitro antiviral properties against the EV-A71 subgenotype B4 strain 41 (5865/SIN/000009) using antiviral assays. Viral infectivity was determined by reduction of the formation of plaques in RD cells. For the measurement of RNA copy number, the real time quantitative reverse transcription PCR (qRT-PCR) was used. The most potent compound was further evaluated to determine the mode of action of inhibition by time course, virus attachment and entry assays in Vero cells. Results Silymarin was shown to exert direct extracellular virucidal effects against EV-A71 at 50% inhibitory concentration (IC50) of 15.2 ± 3.53 μg/mL with SI of 10.53. Similarly, baicalein exhibited direct extracellular virucidal effects against EV-A71 at a higher IC50 value of 30.88 ± 5.50 μg/mL with SI of 13.64. Besides virucidal activity, silymarin was shown to block both viral attachment and entry of EV-A71 to inhibit infection in Vero cells. Conclusions Silymarin has a stronger inhibition activity against EV-A71 in comparison to baicalein. It could serve as a promising antiviral drug to treat EV-A71 infections.

This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence.

To manage stem canker disease on royal poinciana, actinobacterial isolates were used as biological control agents (BCAs) based on their strong in vitro inhibitory effects against Neoscytalidiumdimidiatum. Streptomyces griseorubens UAE2 and Streptomyces wuyuanensis UAE1 had the ability to produce antifungal compounds and cell-wall-degrading enzymes (CWDEs). Only S. griseorubens, however, restored the activity of 1-aminocyclopropane-1-carboxylate (ACC) deaminase (ACCD). In vivo apple fruit bioassay showed that lesion development was successfully constrained by either isolates on fruits inoculated with N. dimidiatum. In our greenhouse and container nursery experiments, S. griseorubens showed almost complete suppression of disease symptoms. This was evident when the preventive treatment of S. griseorubens significantly (p < 0.05) reduced the numbers of conidia of N. dimidiatum and defoliated leaves of royal poinciana seedlings to lesser levels than when S. wuyuanensis was applied, but comparable to control treatments (no pathogen). The disease management of stem canker was also associated with significant (p < 0.05) decreases in ACC levels in royal poinciana stems when S. griseorubens was applied compared to the non-ACCD-producing S. wuyuanensis. This study is the first to report the superiority of antagonistic actinobacteria to enhance their effectiveness as BCAs not only for producing antifungal metabolites and CWDEs but also for secreting ACCD.

Atypical lymphocytosis due to infections is classically seen in viral and chronic bacterial infections. A four year old boy with acute streptococcal infection presented at Al-Nahdha Hospital, Muscat, Oman, with follicular tonsillitis and bilateral cervical lymphadenitis. The blood film showed 33% atypical lymphocytes. Serologically, immunoglobulin M (IgM) antibodies were positive for cytomegalovirus, herpes simplex virus, and Epstein Barr virus, but the patient responded dramatically to antibiotics.

The purpose of the study is to analyze theoretically and simulate the formation of management skills in junior schoolchildren. The authors classified junior schoolchildren's management skills, defined psychological and pedagogical principles of their formation. Empirically obtained results of questionnaires for teachers and parents (n=550) determined how well they understood the importance and relevance of forming management skills at primary school. In order to examine the organization of the pedagogical process at schools the pedagogical documents were analyzed. Obtained data were used to develop indices and criteria of formed management skills, as well as a structural and functional scheme of forming management skills in junior schoolchildren. The suggested model of the content of learning-activity management preserves the substantial distinctness of management actions and operations and creates possibilities for comprehending the structure of learning-activity management to apply knowledge thereof consciously when organizing the educational process in elementary schools.

The educational system of Kazakhstan is now characterized by certain gradual changes of an educational paradigm. The educational paradigm is understood as framework of key provisions and the ideas which are acknowledged by the pedagogical public during the concrete time period and are the cornerstone of scientific research. Change of an educational paradigm includes transition from the education aligned on teaching to the education aligned on training. The criterions for the change of this paradigm are: the education which is more aligned on the student; change of teacher's role; the further definition of the main goal; transition from potential to result; change of the training process The competence-based approach in education also objectively meets both social expectations in education, and interests of participants of educational process. At the same time this approach conflicts too many stereotypes which developed in an education system, the existing criteria for evaluation of students' educational activity, pedagogical activity of teachers, work of administration. Practice of teaching at the higher school showed that the existing crisis in the field of education for a long time is not only overcome, but still is not even fully realized by most of participants of educational process. Explanatory and illustrative didactic approach still remains the leading model in educational process where activity is transferred as the unique content of training. Certainly, it does not meet requirements of time, moreover, contradicts new laws of practice. Now there is an urgent need to train students in the real ways of thinking (the theoretical, dialectic, logical analysis, synthesis, system approach). Developing their creative abilities (ability to apply the acquired knowledge in any situations, including also independent problem definition, and also search of new ways of tasks solution), increasing professional skills of teachers when they can freely carry out pedagogical activity in standard and unusual situations.

Background: The provision of dental care in Pakistan is limited, with less than 5% of the population having access to qualified dental practitioners. The lack of contextually relevant local dental guidelines further adds to the problem. We developed clinical practice guidelines (CPGs) and referral pathways to improve primary care for common oral diseases. Methods: Using the GRADE-ADOLOPMENT approach, recommendations from source guidelines (developed in Europe and the United States) were adopted (retained as is or with minor changes), adapted (modified according to the local context), or excluded (omitted due to lack of local relevance). The guidelines included diseases such as periodontitis, dental pain, intraoral swelling, and oral cavity malignancies. The end result was a set of locally relevant CPGs, which were then used to formulate referral pathways, with the incorporated suggestions being based on a thorough evidence review process. Results: We included four recommendations, three of which were adopted with minor modifications to the referral pathway. These changes focused on assessing potentially malignant oral conditions and counseling for risk factors. No content changes were needed for the CPGs of the other two disorders. We developed referral pathways for three specific oral conditions, detailing primary care physicians’ roles in diagnosis, initial treatment, and timely referral. Conclusion: Contextually relevant dental CPGs and referral pathways can improve patient outcomes in Pakistan. Our study produced four additional recommendations focused on risk factor counselling and mitigation, which could potentially reduce the burden of oral malignancies in our local population.

Abstract Background Structured Problem Solving (SPS) is a patient-centered approach to promoting behavior change that relies on productive collaboration between coaches and participants and reinforces participant autonomy. We aimed to describe the design, implementation, and assessment of SPS in the multicenter Prevention of Urinary Stones with Hydration (PUSH) randomized trial. Methods In the PUSH trial, individuals with a history of urinary stone disease and low urine output were randomized to control versus a multicomponent intervention including SPS that was designed to promote fluid consumption and thereby prevent recurrent stones. We provide details specifically about training and fidelity assessment of the SPS coaches. We report on implementation experiences related to SPS during the initial conduct of the trial. Results With training and fidelity assessment, coaches in the PUSH trial applied SPS to help participants overcome barriers to fluid consumption. In some cases, coaches faced implementation barriers such as variable participant engagement that required tailoring their work with specific participants. The coaches also faced challenges including balancing rapport with problem solving, and role clarity for the coaches. Conclusions We adapted SPS to the setting of kidney stone prevention and overcame challenges in implementation, such as variable patient engagement. Tools from the PUSH trial may be useful to apply to other health behavior change settings in nephrology and other areas of clinical care. Trial registration ClinicalTrials.gov Identifier NCT03244189.

The purpose of this manuscript is to summarize key aspects of care for patients with advanced oral cancer, metastatic to the head and neck region. Patients with advanced oral cancer are treated with multimodal treatment. Surgical intervention leads to limitation in speech and swallowing abilities while adverse effects of chemotherapy and radiation treatment can include nausea, vomiting, diarrhea, mucositis, cystitis, dehydration, nephrotoxicity, skin dermatitis, myelosuppression, and nutritional deficiencies leading to weight loss. These toxicities could be overcome through self-care measures practiced by the patient. Oncology nurses could impart knowledge about self-care measures via patient and family counseling.

L’objectif du présent article est de résumer les aspects centraux des soins aux patients atteints d’un cancer avancé de la bouche avec métastases dans la région de la tête et du cou. Ces patients sont traités par approche multimodale. L’intervention chirurgicale limite leur capacité de parler et d’avaler, tandis que la chimiothérapie et la radiothérapie peuvent entraîner nausées et vomissements, diarrhée, mucite, cystite, déshydratation, néphrotoxicité, dermatite, dépression médullaire et carences alimentaires entraînant une perte de poids. Il est possible de contrer ces effets toxiques à l’aide de mesures d’autosoins. Dans le cadre de leurs interventions d’enseignement, les infirmières en oncologie pourraient transmettre aux patients et aux familles les connaissances nécessaires à l’application de ces mesures d’autosoins.

Abstract Introduction The prevalence of hyperthyroidism in Pakistan is 2.9%, which is two times higher than in the United States. Most high-quality hyperthyroidism clinical practice guidelines (CPGs) used internationally originate from high-income countries in the West. Local CPGs in Pakistan are not backed by transparent methodologies. We aimed to produce comprehensive, high-quality CPGs for the management of hyperthyroidism in Pakistan. Methods We employed the GRADE-ADOLOPMENT approach utilizing the 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis as the source CPG. Recommendations from the source guideline were either adopted as is, excluded, or adapted according to our local context. Results The source guideline included a total of 124 recommendations, out of which 71 were adopted and 49 were excluded. 4 recommendations were carried forward for adaptation via the ETD process, with modifications being made to 2 of these. The first addressed the need for liver function tests (LFTs) amongst patients experiencing symptoms of hepatotoxicity while being treated with anti-thyroid drugs (ATDs). The second pertained to thyroid status testing post-treatment by radioactive iodine (RAI) therapy for Graves’ Disease (GD). Both adaptations centered around the judicious use of laboratory investigations to reduce costs of hyperthyroidism management. Conclusion Our newly developed hyperthyroidism CPGs for Pakistan contain two context-specific modifications that prioritize patients’ finances during the course of hyperthyroidism management and to limit the overuse of laboratory testing in a resource-constrained setting. Future research must investigate the cost-effectiveness and risk-benefit ratio of these modified recommendations.

This study aimed to examine the effectiveness of a schema-based instruction strategy in improving mathematics word problem solving and working memory performance of third grade students with learning disabilities in schools in Oman. Students received a diagnosis of specific learning disability (SLD) based on the aptitude discrepancy model in which an achievement test and an aptitude test (Raven’s Coloured Successive Matrices) were used to determine the existence of a discrepancy. Students were then divided into two matched groups, a control group and an experimental group; each group included (20) students. Study instruments included a mathematics word problem solving test, a working memory test, and the schema-based intervention program. Results of the study showed that participants in the experimental group differed from controls in word problem solving and working memory performance following exposure to the intervention program. More specifically, performance of experimental group participants in the word problem solving varied across the pre, during the implementation, and post intervention phases in favor of the post intervention phases and in favor of the type of Assembly problems. Implications of using schema-based instruction strategy with students with SLD are discussed in the light of the study findings.

Recently, the Filter Bank Multi-Carrier with Offset-QAM modulation (FBMC-OQAM) system proved to be a strong candidate wave that can replace the conventional OFDM (Orthogonal Frequency Division Multiplexing) through several properties in future mobile generations (5G and 5G+). However, it faces a significant issue, which is high Peak-to-Average-Power-Ratio (PAPR) as all advanced waveforms. Many researchers have proposed either hybrid or non-hybrid techniques adapted to the FBMC-OQAM structure to minimize the PAPR parameter. Nevertheless, all of these techniques suffer from high complexity, which is a significant challenge in practical implementations. Therefore, in this paper, we propose two alternative low-complexity approaches, TD and TC, to effectively mitigate the PAPR problem in FBMC-OQAM systems. Both proposed hybrid schemes achieve superior PAPR performance compared to the conventional TR and very competitive results in comparison to the existing literature algorithms while requiring less computational complexity.

Injury reduction effectiveness of selecting running shoes based on plantar shape. J Strength Cond Res 23(3): 685-697, 2009-Popular running magazines and running shoe companies suggest that imprints of the bottom of the feet (plantar shape) can be used as an indication of the height of the medial longitudinal foot arch and that this can be used to select individually appropriate types of running shoes. This study examined whether or not this selection technique influenced injury risk during United States Army Basic Combat Training (BCT). After foot examinations, BCT recruits in an experimental group (E: n = 1,079 men and 451 women) selected motion control, stability, or cushioned shoes for plantar shapes judged to represent low, medium, or high foot arches, respectively. A control group (C: n = 1,068 men and 464 women) received a stability shoe regardless of plantar shape. Injuries during BCT were determined from outpatient medical records. Other previously known injury risk factors (e.g., age, fitness, and smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference in injury risk between the E and C groups among men (risk ratio (E/C) = 1.01 ; 95% confidence interval = 0.88-1.16; p = 0.87) or women (risk ratio (E/C) = 1.07; 95% confidence interval = 0.91-1.25; p = 0.44). In practical application, this prospective study demonstrated that selecting shoes based on plantar shape had little influence on injury risk in BCT. Thus, if the goal is injury prevention, this selection technique is not necessary in BCT. KEY WORDS age, physical activity, physical fitness, smoking

Summary: Psychiatric disorders are highly prevalent in Pakistan and burdens the scarce number of psychiatrists present in the country. The establishment of evidence-based clinical practice guidelines (EBCPGs) and primary-care referral pathways within the local context is imperative to make the process efficient. In this Health Policy, we aimed to develop EBCPGs and primary-care referral pathways that are specific to Pakistan's primary-care setting, with the aim of facilitating the management of psychiatric conditions. Ten EBCPGs were created through the GRADE-ADOLOPMENT process; two recommendations were adopted with minor changes, 43 were excluded, and all others were adopted without any changes. Ten primary-care referral pathways for managing ten psychiatric disorders were created and 23 recommendations were added which will help to bridge the gap in care provision. These psychiatric referral pathways and EBCPGs will bring Pakistan's healthcare system a step closer to achieving optimal health outcomes for patients.

Colorectal cancer (CRC) is the third most common cancer globally and presents a significant challenge owing to its high mortality rate and the limitations of traditional treatment options such as surgery, radiotherapy, and chemotherapy. While these treatments are foundational, they are often poorly effective owing to tumor resistance. Immunotherapy is a groundbreaking alternative that has recently emerged and offers new hope for success by exploiting the body’s own immune system. This article aims to provide an extensive review of clinical trials evaluating the efficacy of various immunotherapies, including CRC vaccines, chimeric antigen receptor T-cell therapies, and immune checkpoint inhibitors. We also discuss combining CRC vaccines with monoclonal antibodies, delve into preclinical studies of novel cancer vaccines, and assess the impact of these treatment methods on patient outcomes. This review seeks to provide a deeper understanding of the current state of CRC treatment by evaluating innovative treatments and their potential to redefine the prognosis of patients with CRC.

Tomanage stemcanker disease on royal poinciana, actinobacterial isolateswere used as biological control agents (BCAs) based on their strong in vitro inhibitory effects against Neoscytalidium dimidiatum. Streptomyces griseorubens UAE2 and Streptomyces wuyuanensis UAE1 had the ability to produce antifungal compounds and cell-wall-degrading enzymes (CWDEs). Only S. griseorubens, however, restored the activity of 1-aminocyclopropane-1-carboxylate (ACC) deaminase (ACCD). In vivo apple fruit bioassay showed that lesion development was successfully constrained by either isolates on fruits inoculated with N. dimidiatum. In our greenhouse and container nursery experiments, S. griseorubens showed almost complete suppression of disease symptoms. This was evident when the preventive treatment of S. griseorubens significantly (p < 0.05) reduced the numbers of conidia of N. dimidiatum and defoliated leaves of royal poinciana seedlings to lesser levels than when S. wuyuanensis was applied, but comparable to control treatments (no pathogen). The disease management of stem canker was also associated with significant (p < 0.05) decreases in ACC levels in royal poinciana stems when S. griseorubens was applied compared to the non-ACCD-producing S. wuyuanensis. This study is the first to report the superiority of antagonistic actinobacteria to enhance their effectiveness as BCAs not only for producing antifungal metabolites and CWDEs but also for secreting ACCD. [ABSTRACT FROM AUTHOR]

Cet article traite les obstacles d'accès aux soins de santé dans la province d'Al Haouz au Maroc, les défis qui en découlent et comment répondre aux exigences d'équité territoriale. L’approche utilisée est géographique, en adoptant des méthodes quantitatives et une représentation cartographique des données pour analyser la situation. Il ressort des résultats que des facteurs géographiques et socio-économiques, entravent l'accès aux soins notamment le relief difficile, la répartition inégale des services de santé, l'insuffisance des ressources et la pauvreté persistante. Ces problèmes demeurent un défi majeur dans la province d'Al Haouz malgré les efforts du gouvernement marocain pour l’amélioration d'accès aux soins de santé. Une redéfinition donc de politiques du système de santé publique est à prévoir, à travers une stratégie élaborée sur la base des spécificités locales, y compris le développement de programmes de santé mobiles, la formation du professionnel de santé, la sensibilisation à la santé et l'investissement dans de nouvelles installations de santé. Ils nécessitent également la réduction des dépenses directes des ménages pour les soins de santé et la généralisation des programmes d'assurance maladie

Background: The Dietary Guidelines for Americans (DGA) 2015-2020 supports that healthy eating patterns should include a variety of vegetables from all five of the following vegetable subgroups: dark green, red and orange, legumes, starchy, and others. Aims and Objective: To determine the approximate composition and nutritive values of edible portions of different varieties of popular seeds and to identify the heavy metals contents of these seeds. Materials and Methods: Five different seeds were collected from traditional supermarkets in Benghazi. Moisture and Ash contents in the samples were determined by A.O.A.C method. Total fat and the crude protein content in the seed sample were measured by using soxhlet extraction, and the Kjeldahl method of AOAC, respectively. The mineral content in seeds also determined by Atomic Absorption, spectrophotometer. Result: Five different seeds (pumpkin, sunflower, watermelon seeds, corn and chickpea) were analyzed for determination their protein, fat, energy and moister contents. The highest and significant protein contents found in sunflower seeds 27.5% (p=0.001) whilst the lowest content was observed in corn. The highest fat and carbohydrate contents found in sunflower seeds and in the corn, 50%; 50% (P= 0.014) and (72.4%) (P=0.0005) respectively. In compared to other seeds, the moisture contents of pumpkin seeds presented the highest amount with significant values (p=0.0001). The energy contents of sunflower seeds were the predominant value 626.28 kcal/100 g followed by both pumpkin seeds and watermelon seeds 591.2 and 585.89 kcal/100g respectively. The ash content of pumpkin seeds was approximately 5.87%. Furthermore, Pumpkin seeds had higher amounts of potassium 871 mg/100g, and watermelon seed was the highest sources of calcium (86 mg/100g) than other seeds. Magnesium, Iron and copper significantly found higher in sunflower seeds. Conclusion: Overall seeds could be one of the good sources of food staple for macro and micronutrients, and may have health and economic beneficial. Consumption of such seeds should be at recommended levels due to presences some quantities of lead and cadmium, which could have detrimental health effect. [ABSTRACT FROM AUTHOR]