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Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and C- reactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p

ATP-binding cassette (ABC) transport systems are crucial for bacteria to ensure sufficient uptake of nutrients that are not produced de novo or improve the energy balance. The cell surface of the pathobiont Streptococcus pneumoniae (pneumococcus) is decorated with a substantial array of ABC transporters, critically influencing nasopharyngeal colonization and invasive infections. Given the auxotrophic nature of pneumococci for certain amino acids, the Ami ABC transporter system, orchestrating oligopeptide uptake, becomes indispensable in host compartments lacking amino acids. The system comprises five exposed Oligopeptide Binding Proteins (OBPs) and four proteins building the ABC transporter channel. Here, we present a structural analysis of all the OBPs in this system. Multiple crystallographic structures, capturing both open and closed conformations along with complexes involving chemically synthesized peptides, have been solved at high resolution providing insights into the molecular basis of their diverse peptide specificities. Mass spectrometry analysis of oligopeptides demonstrates the unexpected remarkable promiscuity of some of these proteins when expressed in Escherichia coli, displaying affinity for a wide range of peptides. Finally, a model is proposed for the complete Ami transport system in complex with its various OBPs. We further disclosed, through in silico modelling, some essential structural changes facilitating oligopeptide transport into the cellular cytoplasm. Thus, the structural analysis of the Ami system provides valuable insights into the mechanism and specificity of oligopeptide binding by the different OBPs, shedding light on the intricacies of the uptake mechanism and the in vivo implications for this human pathogen., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Alcorlo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Co-curricular activities equip students with essential skills and knowledge for personal and professional growth. Despite their importance, many students exert minimal effort to complete the assigned tasks. Instructors perceive that the lack of emphasis on final exams in co-curricular subjects reduces student effort and commitment. Moreover, poor time management and lack of effort in completing tasks have increased across various subjects in recent years. Therefore, it is important to investigate the factors that contribute to student commitment towards co-curricular subjects. In this study, the submission status of 339 tasks was retrieved from the student learning system to measure student commitment based on whether tasks were submitted on time, delayed, or not submitted. A chi-square test f was used to investigate the relationship between students' demographic characteristics and their commitment. The findings revealed a significant association between student commitment and the type of task given (p < 0.001). Students were more likely to submit presentations on time compared to written assignments. Projects were more likely to be delayed, while written assignments had a high frequency of no submission. Age was a significant predictor of commitment (p < 0.05), with students over 20 more likely to submit on time and students under 20 more likely to ignore submission. Gender was also a significant predictor of commitment (p < 0.001), with female students having a higher percentage and frequency of on-time submissions while male students having a higher number of no submissions. However, no significant association was found between the study year and commitment (p > 0.05), indicating that the year of the study could not determine the level of commitment to the course. Overall, these findings could be used to guide the preparation of tasks and assignments in co-curricular subjects to enhance student commitment and holistic development., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The identification and prediction of athletic talent are pivotal in the development of successful sporting careers. Traditional subjective assessment methods have proven unreliable due to their inherent subjectivity, prompting the rise of data-driven techniques favoured for their objectivity. This evolution in statistical analysis facilitates the extraction of pertinent athlete information, enabling the recognition of their potential for excellence in their respective sporting careers. In the current study, we applied a logistic regression-based machine learning pipeline (LR) to identify potential skateboarding athletes from a combination of fitness and motor skills performance variables. Forty-five skateboarders recruited from a variety of skateboarding parks were evaluated on various skateboarding tricks while their fitness and motor skills abilities that consist of stork stance test, dynamic balance, sit ups, plank test, standing broad jump, as well as vertical jump, were evaluated. The performances of the skateboarders were clustered and the LR model was developed to classify the classes of the skateboarders. The cluster analysis identified two groups of skateboarders: high and low potential skateboarders. The LR model achieved 90% of mean accuracy specifying excellent prediction of the skateboarder classes. Further sensitivity analysis revealed that static and dynamic balance, lower body strength, and endurance were the most important factors that contributed to the model's performance. These factors are therefore essential for successful performance in skateboarding. The application of machine learning in talent prediction can greatly assist coaches and other relevant stakeholders in making informed decisions regarding athlete performance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ab Rasid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The success and enjoyment of a football match depend heavily on referees and their ability to ensure fair play and uphold the rules of the game. However, there is limited research investigating the disciplinary measures and booking activities of referees in top European football leagues. In the current investigation, we explored the disciplinary measures and booking activities of top-European football league referees. The dataset of the referee activities concerning 15 indicators containing 602 matches from five consecutive seasons across the five top European leagues, namely, the English Premier League, Spanish Laliga, Italian Serie A, French Ligue1, and German Bundesliga were utilized for this study. K-means cluster analysis was used to define the activity levels of the referees. The Mann-Whitney U test was employed to determine the differences in the levels of the referees' activity with respect to the disciplinary measures, while binary regression analysis was applied to examine the association between the disciplinary measures and the activity levels of the referees. Two groups of activities were defined by k-means, that is, high and low activity. The Mann-Whitney U test revealed statistically significant differences in all 15 indicators examined between high and low activity. However, the regression model demonstrated that only fouls, yellow cards, and air challenges could significantly describe referees' activity levels. These indicators appear to be predictors of high referee activity in elite European Football. Specific training on dealing with increased aggression and foul behaviour coupled with improved game organisational management could be further incorporated into referees' training programmes amongst other measures., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Nuclear Magnetic Resonance (NMR) spectra of human serum and plasma show, besides metabolites and lipoproteins, two characteristic signals termed GlycA and B arising from the acetyl groups of glycoprotein glycans from acute phase proteins, which constitute good markers for inflammatory processes. Here, we report a comprehensive assignment of glycoprotein glycan NMR signals observed in human serum, showing that GlycA and GlycB signals originate from Neu5Ac and GlcNAc moieties from N-glycans, respectively. Diffusion-edited NMR experiments demonstrate that signal components can be associated with specific acute phase proteins. Conventionally determined concentrations of acute phase glycoproteins correlate well with distinct features in NMR spectra (R 2 up to 0.9422, p-value <0.001), allowing the simultaneous quantification of several acute phase inflammation proteins. Overall, a proteo-metabolomics NMR signature of significant diagnostic potential is obtained within 10-20 min acquisition time. This is exemplified in serum samples from COVID-19 and cardiogenic shock patients showing significant changes in several acute phase proteins compared to healthy controls., (© 2023 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)

Bone morphogenetic protein (BMP)-9 is considered a member of the transforming growth factor (TGF)β superfamily. It was first found as an inducer of bone and cartilage formation and then discovered that this factor mediates several physiologic functions and hemostasis. Besides physiological conditions, BMP9 has also been elucidated that it is involved in several pathological situations, especially cancer. In various cancers, dysregulation of BMP9 has raised the issue that BMP9 might play a conflicting role in tumour development. BMP9 binding to its receptors (BMPRs), including ALKs and BMPRII, induces canonical SMAD-dependent and non-canonical PI3K/AKT and MAPK signalling pathways in tumour cells. BMP9, via inducing apoptosis, inhibiting tumour-promoting cell signalling pathways, suppressing epithelial-mesenchymal transition (EMT) process, blocking angiogenesis, and preventing cross-talk in the tumour microenvironment, mainly exerts tumour-suppressive functions. In contrast, BMP9 triggers tumour-supportive signalling pathways, promotes EMT, and enhances angiogenesis, suggesting that BMP9 is also involved in tumour development. It has been demonstrated that modulating BMP9 expression and functions might be a promising approach to cancer treatment. It has also been indicated that evaluating BMP9 expression in cancers might be a biomarker for predicting cancer prognosis. Overall, BMP9 would provide a promising target in cancer management.

In the present work, a WC particle-reinforced CoCrFeMnNi high-entropy alloy (HEA) was fabricated by laser melting deposition (LMDed). The LMDed CoCrFeMnNi high-entropy alloy (CoCrFeMnNi) composite is primarily comprised of a face-centered cubic (FCC) crystal structure. However, in the case of CoCrFeMnNi with 2.5 wt.% WC, it exhibits a combination of an FCC matrix and a ceramic phase known as M 23 C 6 . The corrosion behavior of CoCrFeMnNi and CoCrFeMnNi with 2.5 wt.% WC particle in 0.5 M H 2 SO 4 was comparatively investigated. Compared with CoCrFeMnNi, the passive film formed on the CoCrFeMnNi with 2.5 wt.% WC had a more stable and stronger protective property. The corrosion current density of the CoCrFeMnNi with 2.5 wt.% WC dropped by 149.1% compared to that of the CoCrFeMnNi, indicating that the CoCrFeMnNi with 2.5 wt.% WC had better corrosion resistance than that of the CoCrFeMnNi.

Introduction: The objective of this study was to investigate the effect of convalescent plasma (CP) transfusion on clinical and serial laboratory parameters in severe COVID-19 patients. The Coronavirus Disease 2019 (COVID-19) pandemic presents a challenge to the healthcare system worldwide due to the limited treatment options available. The body of evidence reported that CP containing anti- COVID-19 antibodies could be effective against the infection., Materials and Methods: This was a cross-sectional study that involved retrospective data collection of severe COVID-19 adult patients who received CP transfusion along with the best-of-care (CP group, n: 53) and best-of-care only (control group, n: 53). An age, gender, and comorbidity were manually matched approximately at a 1:1 ratio., Results: The prevalence of adverse transfusion reactions was 5.7%. A shorter duration of oxygen support (median: 12 days vs 14 days, P=0.030) and a shorter duration of mechanical ventilation (median: 6 days vs 10 days, P=0.048) were found in the CP group. The laboratory parameters were also improved. However, there was no significant difference in the mechanical ventilation rate, length of hospital stay, length of intensive care unit (ICU) stay, and mortality rate across both groups (P = 0.492, 0.614, 0.793, 0.374)., Conclusion: CP transfusion is safe and effective in the treatment of severe COVID-19 patients. However, a revision of our approaches such as early CP transfusion and use of a high-titre anti-COVID-19 neutralising antibody (nAb) unit is necessary to unlock the full potential benefits of CP transfusion among COVID-19 patients.

Artemisia is a perennial wild shrub with large branches and compound leaves. Artemisia contains about 400 types, and its medical importance is due to the presence of many active substances and compounds such as volatile oils, alkaloids and flavonoids, glycosides, saponins, tannins, and coumarins. This study was designed to study the effect of the aqueous extract of the fruit of the Artemisia plant on the organs of the body, as well as to know its ability to activate the hepatic enzyme alanine transaminase (ALT/GPT). The fruit of this shrub was extracted using the measurement technique gas chromatography-mass spectrometry (GC/MASS) and organic solvent hexane and ethyl acetate in one to one ratio. It contained 21 compounds, a high percentage of their terpenes, essential aromatic oils, alkaloids, and phenolic compounds. The results showed a significant improvement in the enzyme (ALT/GPT) level after adding different concentrations of hot aqueous extract to the fruit of the Artemisia plant. The fruit of the Artemisia plant can be used to treat many diseases and improve the activity of liver enzymes., Competing Interests: The authors declare that they have no conflict of interest.

We performed this cohort study to test whether further analysis of intrathecal inflammation can be omitted if the free light chain kappa (FLCκ) quotient is within the reference range in the corresponding quotient diagram. FLCκ concentrations were measured in serum and cerebrospinal fluid (CSF) samples. The intrathecal fraction (IF) of FLCκ was calculated in relation to the hyperbolic reference range. 679 patient samples were used as a discovery cohort (DC). The sensitivity and negative predictive value (NPV) of the FLCκ-IF for the detection of an intrathecal humoral immune response (CSF-specific OCB and/or IF IgG/A/M > 0%) was determined. Based on these data, a diagnostic algorithm was developed and prospectively validated in an independent validation cohort (VC, n = 278). The sensitivity of the FLCκ-IF was 98% in the DC and 97% in the VC with a corresponding NPV of 99%. The use of the FLCκ-IF as a first line analysis would have reduced the Ig and OCB analysis by 62% in the DC and 74% in the VC. The absence of a FLCκ-IF predicts the absence of a humoral intrathecal immune response with a very high NPV of 99%. Thus, integration of our proposed algorithm into routine CSF laboratory analysis could help to reduce analytical efforts.

Preventive strategies involving the use of pneumococcal conjugate vaccines (PCVs) are known to drastically reduce pneumococcal disease. However, PCV vaccination has been plagued with serotype replacement by non-PCV serotypes. In this study, we describe the prevalence and molecular characteristics of non-PCV13 serotypes (non-vaccine serotypes, NVTs) from pneumococcal carriage isolates obtained from children < 5 years old in Cape Coast, Ghana, after PCV introduction. The isolates were subjected to antibiotic susceptibility testing and multilocus sequence typing (MLST), and molecular techniques were used to detect the presence of virulence genes. Serotypes 11A, 13, 15B, 23B, and 34 formed the top five of the 93 NVT isolates. As such, 20 (21.5%), 49 (48.4%), and 70 (74.3%) isolates were non-susceptible to penicillin, tetracycline, and cotrimoxazole, respectively. Sixteen (17.2%) multidrug-resistant isolates were identified. However, non-susceptibility to ceftriaxone and erythromycin was low and all isolates were fully susceptible to levofloxacin, linezolid, and vancomycin. Whereas pcpA, pavB, lytA, and psrP genes were detected in nearly all serotypes, pilus islet genes were limited to serotypes 11A, 13, and 23B. MLST for predominant serotype 23B isolates revealed three known and seven novel sequence types (STs). ST172 and novel ST15111 were the most dominant and both STs were related to PMEN clone Columbia23F-26 (ST338). In conclusion, non-PCV13 serotype 23B was the most prevalent, with characteristics of rapid clonal expansion of ST172 and ST15111, which are related to international clones of the pneumococcus. Continuous monitoring of NVTs in Ghana is, therefore, essential, as they have the potential to cause invasive disease, show high antibiotic resistance, and attenuate the effects of PCV vaccination.

The study aims to examine the moderating effect of self-efficacy on supervisory support and organizational citizenship behavior (OCB). An individual's self-efficacy is defined as their belief in their own ability to successfully complete a goal or task, which influences their motivation, persistence, and decision-making. This study is based on the Conservation of Resource Theory, which holds that personal resources such as self-efficacy can influence employees' perceived support and extra-role behavior (OCB). The data were collected from 618 employees in four public sector organizations in Putrajaya, Malaysia through a questionnaire survey and analyzed using the partial least squares structural equation modeling (PLS-SEM) technique. Resultantly, supervisory support demonstrated a significant positive relationship with OCB. The results suggested that personal resources, such as self-efficacy increase the level of OCB with lower or higher perceived supervisory support. The results highlighted that self-efficacy strengthens supervisory support relations with OCB when supported by employees' self-belief and confidence. It is critical to investigate the role of self-efficacy because industries must constantly change, and employees must have self-efficacy resources to continuously improve and sustain their performance level. The findings can contribute to the literature and open new avenues for future research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abdullah and Wider.)

The non-complexity of tennis, coupled with its health benefits, renders it appealing and encourages varying competitions at different levels of age, gender, and expertise. However, the rapid increase in the participation rates witnesses a surge in injury occurrences, prompting the need for in-depth analysis to facilitate immediate intervention. We employed a media content analysis technique in which tennis-associated articles published in the last 5 years were examined. A total of 207 news reports were gathered and screened for analysis. Subsequently, 71 articles were excluded from the study due to content duplications or summary updates of existing news articles, while 23 news articles were also excluded from the study due to inappropriateness. Finally, 113 news reports directly related to injury in tennis were coded and analyzed. We examined various types of injuries reported from the screened articles with respect to their status (fresh, recurrent, and recovery) across expertise levels i.e., elite, or amateur. Similarly, the incidence of injury occurrences based on the types of tournaments the players engage in was also investigated. A chi-square analysis was employed to achieve the objectives of the study. Occurrences of tennis-associated injuries are disseminated across expertise levels [ χ ( 18 ) 2 = 16.542; p = 0.555], with knee, hip, elbow, and shoulder injuries being highly prevalent in both elite and amateur players. Nevertheless, it was noted that elite players suffered a staggering 72.60% of injury-related problems, while amateur players sustained 27.40% of injuries. Moreover, the status of injury spreads based on types of tournaments [ χ ( 4 ) 2 = 3.374; p = 0.497], with higher occurrences of fresh and recurrent injuries, while low recovery rates were observed. The findings further demonstrated that injuries are sustained regardless of tournament types [ χ ( 36 ) 2 = 39.393; p = 0.321]. However, most of the injuries occurred at international tournaments (85%). Whereas, only 5.30% of the injuries occurred at national/regional tournaments while 9.70% were unidentified. It could be deduced from the findings of this investigation that elite players are more prone to injuries compared with amateur players. Furthermore, the most common tennis-related injuries affect the lower, trunk, and upper regions of the body, respectively. A large number of the reported tennis injuries are fresh and recurrent, with a few recoveries. The international tennis tournaments are highly attributed to injury occurrences as opposed to the national/regional tournaments. The application of the media-based data mining technique is non-trivial in projecting injury-related problems that could be used to facilitate the development of an injury index peculiar to the tennis sport for prompt intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Musa, Hassan, Abdullah, Latiff Azmi, Abdul Majeed and Abu Osman.)

Learners’ engagement is shown to be a major predictor of learning, performance, and course completion as well as course satisfaction. It is easier to engage learners in a face-to-face teaching and learning format since the teacher can observe and interpret the learner’s facial expression and body language. However, in a virtual setting with the students sitting behind cameras, it is difficult to ascertain engagement as the students might be absent-mindedly attending the class. Henceforth, with the rapid transition to online learning, designing course content that could actively engage the students towards achieving the said elements is, therefore, necessary. We applied a data-driven approach in designing a virtual physical education and sport science−related course via a learner engagement model. A fully online course catering to 132 students that runs for a total of 14 weeks was used as a case study to develop the course. The study was conducted during the 2020/2021 academic year, which was the period of the peak COVID-19 pandemic in Malaysia. The delivery of the course content was implemented in stages to achieve three essential educational outcomes namely, skill and knowledge acquisition, and personal development as well as course satisfaction. We hypothesised that the developed learners’ engagement approach will promote the students’ acquisition of skills and knowledge and foster the personal development of the students through fitness improvement. It is also hypothesised that the students will be satisfied with the course developed upon successful completion. A chi-square analysis projected a statistically significant difference in the skill and knowledge acquisition before and after the programme (p < 0.001). A Wilcoxon rank-sum test demonstrated personal improvement in the overall fitness of the student upon completing the prescribed activity of the course content. Moreover, a total of 96.2%, 95.5% and 93.2% of students expressed their satisfaction with the clarity of the learning objectives, good organisational and course content plan, and appropriate workload of the course designed, respectively. There is sufficient evidence to accept all hypotheses formulated, and hence, we postulated that, since students spend more time outside the classroom, out-of-class learners’ engagement activity should be considered when designing a virtual course to promote lifelong learning, experience, and higher-order thinking. The techniques presented herein could be useful to academics, professionals, and other relevant stakeholders in developing virtual course content within a specific domain of interest.

Anthropometric variables (AV) are shown to be essential in assessing health status and to serve as markers for evaluating health-related risks in different populations. Studying the impact of physical activity (PA) on AV and its relationship with smoking is a non-trivial task from a public health perspective. In this study, a total of 107 healthy male smokers (37 ± 9.42 years) were recruited from different states in Malaysia. Standard procedures of measurement of several anthropometric indexes were carried out, and the International Physical Activity Questionnaire (IPPQ) was used to ascertain the PA levels of the participants. A principal component analysis was employed to examine the AV associated with physical activity, k-means clustering was used to group the participants with respect to the PA levels, and discriminant analysis models were utilized to determine the differential variables between the groups. A logistic regression (LR) model was further employed to ascertain the efficacy of the discriminant models in classifying the two smoking groups. Six AV out of twelve were associated with smoking behaviour. Two groups were obtained from the k-means analysis, based on the IPPQ and termed partially physically active smokers (PPAS) or physically nonactive smokers (PNAS). The PNAS were found to be at high risk of contracting cardiovascular problems, as compared with the PPAS. The PPAS cluster was characterized by a desirable AV, as well as a lower level of nicotine compared with the PNAS cluster. The LR model revealed that certain AV are vital for maintaining good health, and a partially active lifestyle could be effective in mitigating the effect of tobacco on health in healthy male smokers.

Antibiotic resistance in pneumococci contributes to the high pneumococcal deaths in children. We assessed the molecular characteristics of multidrug-resistant (MDR) pneumococci isolated from healthy vaccinated children under five years of age in Cape Coast, Ghana. A total of 43 MDR isolates were selected from 151 pneumococcal strains obtained from nasopharyngeal carriage. All isolates were previously serotyped by multiplex PCR and Quellung reaction. Susceptibility testing was performed using either the E-test or disk diffusion method. Virulence and antibiotic resistance genes were identified by PCR. Molecular epidemiology was analyzed using multilocus sequence typing (MLST). Vaccine-serotypes 23F and 19F were predominant. The lytA and pavB virulence genes were present in all isolates, whiles 14-86% of the isolates carried pilus-islets 1 and 2, pcpA , and psrP genes. Penicillin, tetracycline, and cotrimoxazole resistance were evident in >90% of the isolates. The ermB , mefA , and tetM genes were detected in (n = 7, 16.3%), (n = 4, 9.3%) and (n = 43, 100%) of the isolates, respectively. However, >60% showed alteration in the pbp2b gene. MLST revealed five novel and six known sequence types (STs). ST156 (Spain 9V -3) and ST802 were identified as international antibiotic-resistant clones. The emergence of international-MDR clones in Ghana requires continuous monitoring of the pneumococcus through a robust surveillance system.

The popularity of modern tennis has contributed to the increasing number of participants at both recreational and competitive levels. The influx of numerous tennis participants has resulted in a wave of injury occurrences of different types and magnitudes across both male and female players. Since tennis injury harms both players' economic and career development, a better understanding of its epidemiology could potentially curtail its prevalence and occurrences. We used online-based tennis-related injury reports to study the prevalence, location types, and injury intensities in both male and female tennis players for the past five years. It is demonstrated from the chi-square analysis that injury occurrences are significantly associated with a specific gender (χ2(18) = 50.773; p = 0.001), with male players having a higher risk of injury manifestation (68.10%) as compared with female players (31.90%). Nonetheless, knee, hip, ankle, and shoulder injuries are highly prevalent in both male and female players. Moreover, the injury intensities are distributed across gender (χ2(2) = 0.398; p = 0.820), with major injuries being dominant, followed by minor injuries, whilst a few cases of career-threatening injuries were also reported. It was similarly observed that male players recorded a higher degree of both major, minor, and career-threatening injuries than female players. In addition, male players sustained more elbow, hip, knee, shoulder, and thigh injuries than female players. Whereas, female players mostly suffered from Achilles and back injuries, ankle and hamstring injuries affected both genders. The usage of online newspaper reports is pivotal in characterizing the epidemiology of tennis-related injuries based on locations and gender to better understand the pattern and localization of injuries, which could be used to address the problem of modern tennis-related injuries.

Background: It is of great importance for archers to have a stable posture for successful shooting. In studies conducted on this subject, attention is drawn to the necessity of postural stability in archers for a successful shooting performance. Balanced posture, which is an important parameter, includes the preservation of the center of mass on the support base. In this study, it is aimed to examine the correlation between dynamic and static balance and achievement score in archers. Methods: This study is a cross-sectional and correlational research and is conducted with 18 archery athletes. Flamingo balance test was used to measure static balance and Y-Balance test was used to measure dynamic balance. For statistical analysis, since the distribution was normal, Pearson correlation coefficient was used for observing the correlation between parameters. Results: It has been observed that archery mean scores and right leg absolute reach distance have a moderate (r = 0.592, p = 0.010) positive correlation and a moderate (r = 0.670, p < 0.05) positive correlation with the left leg. As the dynamic balance success increases, the archery score also increases. Similarly, the dynamic balance success increases with the higher static balance success. Conclusion: This study represents that a linear relationship was observed between dynamic balance ability and shooting on target and emphasizes the importance of dynamic balance for successful shooting in archers. These findings support that archer will contribute positively to their success score with balance training in addition to their routine training. [ABSTRACT FROM AUTHOR]

Background: Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students' caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective: This study aimed to examine the mediating effect of moral sensitivity and the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design: A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context: This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations: This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results: The clinical internship environment (B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity (B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students' caring behaviours via moral sensitivity (B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours (B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity (B = 0.006, 95% CI = [0.003, 0.010]). Conclusion: Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. [ABSTRACT FROM AUTHOR]

Background: Obesity is a complex, diverse and multifactorial disease that has become a major public health concern in the last decades. The current classification systems relies on anthropometric measurements, such as BMI, that are unable to capture the physiopathological diversity of this disease. The aim of this study was to redefine the classification of obesity based on the different H-NMR metabolomics profiles found in individuals with obesity to better assess the risk of future development of cardiometabolic disease. Materials and methods: Serum samples of a subset of the Di@bet.es cohort consisting of 1387 individuals with obesity were analyzed by H-NMR. A K-means algorithm was deployed to define different H-NMR metabolomics-based clusters. Then, the association of these clusters with future development of cardiometabolic disease was evaluated using different univariate and multivariate statistical approaches. Moreover, machine learning-based models were built to predict the development of future cardiometabolic disease using BMI and waist-to-hip circumference ratio measures in combination with H-NMR metabolomics. Results: Three clusters with no differences in BMI nor in waist-to-hip circumference ratio but with very different metabolomics profiles were obtained. The first cluster showed a metabolically healthy profile, whereas atherogenic dyslipidemia and hypercholesterolemia were predominant in the second and third clusters, respectively. Individuals within the cluster of atherogenic dyslipidemia were found to be at a higher risk of developing type 2 DM in a 8 years follow-up. On the other hand, individuals within the cluster of hypercholesterolemia showed a higher risk of suffering a cardiovascular event in the follow-up. The individuals with a metabolically healthy profile displayed a lower association with future cardiometabolic disease, even though some association with future development of type 2 DM was still observed. In addition, H-NMR metabolomics improved the prediction of future cardiometabolic disease in comparison with models relying on just anthropometric measures. Conclusions: This study demonstrated the benefits of using precision techniques like H-NMR to better assess the risk of obesity-derived cardiometabolic disease. [ABSTRACT FROM AUTHOR]

This study focuses on analyzing the damages and ballistic limit for the fiber metal laminate (FML) and nano-silica reinforced FML. FML materials are hybrid sandwich composite materials used in lightweight structural applications. FML is constructed as a sandwich structure by bonding an aluminum alloy and a glass fiber reinforced composite. To enhance the impact strength of the FML composite, it was reinforced with nano-silica particles within the epoxy resin at various concentrations ranging from 1 wt% to 7 wt%. The laminates are then subjected to high-velocity impact tests using a single-stage gas gun setup, to assess the failure modes of the FML in an aluminum sheet and nanocomposite layers. The influence of nano-silica on natural frequency and damping factor is also examined by using a shock sensor and DAQ (Data Acquisition system). Results indicate that the FML laminate containing 5 wt% nano-silica demonstrates superior impact resistance compared to other filler percentages, as demonstrated by the ballistic limit and damage assessment. The ballistic limit for the pure FML laminate without nano-silica is 98 m/s, whereas the FML laminate containing 5 wt% nano-silica exhibits a peak value of 112 m/s, presenting a notable 14.3% increase in ballistic limit compared to the pure FML. Additionally, the dynamic response analysis reveals changes in the natural frequency values of the laminates before and after impact, indicating permanent damage to the laminate structure. [ABSTRACT FROM AUTHOR]

Objective: To establish the reference standard of the median nerve conduction study (NCS) in Korea. Methods: A total of 648 median motor and 602 median sensory NCSs from 349 Korean healthy volunteers were tested and analyzed prospectively. Equipment calibration, assessment of intra- and inter-rater reliability, and the NCSs per se were conducted according to a predetermined protocol. A reference standard was established from uncertainty components for the following parameters: the onset and peak latencies; the baseline-to-peak and peak-to-peak amplitudes; the area and duration of the negative wave; and the nerve conduction velocity. The effects of sex, age and stimulation intensity were analyzed. Results: Each measured value of 648 median motor and 602 median sensory nerves were obtained and presented with both mean and expanded uncertainties, as well as mean and standard deviations. The cut-off values with expanded uncertainty were determined for different age and sex groups. After adjusting for anthropometric covariates, all parameters except duration were affected by age, and sex appeared to influence both duration and area. While stimulation intensity significantly affected some parameters including latencies, the effect sizes were negligible. Conclusion: We propose the median NCS reference standard using the largest Korean dataset ever available. The use of the traceable and reliable reference standard is anticipated to promote more accurate and dependable diagnosis and appropriate management of median neuropathies in Korea. [ABSTRACT FROM AUTHOR]

Evaluating remote sensing techniques (RST)-based water quality monitoring systems in hydrological applications is a complex multi-attribute decision-making (MADM) problem due to several integrated issues. These issues include the need to consider 15 evaluation criteria, the importance of these criteria in relation to their application and network infrastructure, data variation, and trade-offs and conflicts between them. Therefore, this study proposes an MADM integrated modelling approach to weight these criteria and rank the selected RSTs using the "Fuzzy Weighted with Zero Inconsistency" (FWZIC) method coupled with the "Vlse-kriterijumska Optimizcija I Kaompromisno Resenje" (VIKOR) method. First, a decision matrix was developed for the evaluation criteria and their intersection with various RSTs in different network categories. Next, the assessment criteria were weighted using FWZIC, followed by ranking the RSTs for each category using VIKOR. The findings reveal that the criteria weighting varied across categories, as assigned by specialists-based FWZIC. For example, the "data acquisition system complexity" criterion received the maximum weight (w = 0.081) for mesh-based sensing and the lowest (w = 0.057) for cellular-based sensing. Using the obtained weights and based on the ascending order of the performance score value (Q), various RSTs were benchmarked using VIKOR. This includes (n = 22) RSTs in fixed star, (n = 8) RSTs in mesh sensing, (n = 6) RSTs in cellular sensing, (n = 3) RSTs in fixed cable sensing, and (n = 2) RSTs in movable sensing. Finally, the evaluation process for the benchmarked RSTs involved systematic ranking, sensitivity analysis, and comparison analysis, which confirmed the robustness of the proposed approach across all RST categories. [ABSTRACT FROM AUTHOR]

Background: Students' approaches to learning are of essence in nursing education. This is because nursing is a profession where classroom learning leads to clinical performance. Although the literature recognizes student's approaches to learning as a significant aspect affecting the quality of students' learning, studies suggest that quality of learning has not been highly achieved in Malawian nursing colleges. Currently, there is a scarcity of empirical data on the learning approaches that Malawian nursing and midwifery students in nursing colleges employ. This study assessed the different approaches to learning among nursing and midwifery students in selected Malawian nursing colleges. Methods: This was a cross- sectional study that employed quantitative methods. The target population was nursing and midwifery students pursuing nursing diplomas from Nkhoma College of Nursing, Ekwendeni College of Health Sciences and Malawi College of Health Sciences. A total of 251 students were sampled randomly from the three nursing colleges. Data was collected through a self-administered questionnaire (R-SPQ-2 F) by Biggs. The data was analyzed using chi-square and binary logistic regression. In this study Cronbach's alpha was 0.6. Results: Most students had used a deep approach to learning (M = 3.201, SD = 0.623) than the surface approach (M = 2.757, SD = 0.732). Being in the age category of 16–20 had more likelihood of adopting a surface approach to learning compared to other age categories (X2 = 7.669, DF 2, P =.02). Students from Malawi College of Health Sciences were more likely to adopt a surface approach to learning compared to students from Nkhoma Nursing College and Ekwendeni College of Health Sciences (X2 = 12.388, df = 2, P =.002). Conclusion: A deep approach to learning emerged as the most preferred approach to learning which indirectly implies that most students attain meaningful learning. Age and environment are some of the key determinants associated with different learning approaches. More attention should be given to younger students during teaching and learning to promote deep learning. [ABSTRACT FROM AUTHOR]

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In this work, a unique fiber-metal laminate for steam turbine applications was created utilizing natural fiber (Abelmoschus esculentus) and nanosilica particles. This study evaluated how surface treatment affected attributes related to load bearing and impact resistance. Prior to creating the composite, the metal foil was shot-blasted, and fiber and particles were silane-treated. The vacuum bag technique was used to create the composites, and oven drying was used. The results showed that adding biosilica enhanced the thermo-mechanical characteristics. In the silane-treated form of the composite designator EON3, a maximum storage modulus of 7.14 GPa with a loss factor of 0.44 was reported. Similar to this, the composite designation EON3 has the maximum fracture toughness at 29.26 MPa/m and the lowest energy release rate at 0.74 MJ/m2. Last but not the least, the composite designation EON2 at 50% of maximal UTS was determined to have the greatest fatigue life counts of 32,811. The treated metal-fiber interface showed enhanced bonding in the SEM morphological and macroscopic pictures. When both the qualities of metal and fiber are required, steam turbine, aerospace, and energy industries may employ these properties-improved composites. [ABSTRACT FROM AUTHOR]

This study aims to examine, for each head coach (HC) replaced, the association between training intensity and physical performances obtained in games. Furthermore, the study investigated how contextual factors influence locomotor and mechanical performance association. External load variables were collected using Global Positioning System (GPS) devices across the 4 weeks and 4 games before and after the replacement in a professional adult male soccer team. Six different HC records were analysed (48.8 ± 7.4 years of age; 11.2 ± 3.9 years as an HC) during a three-season span (2020/21-2022/2023). There were marked differences within player variability across the two coaching regimes. Game loads didn't reflect training-related performance, with differences ranging from -71.4% to -9.9%. Players under the outgoing coaches have greater coverage of meters per minute. Meters per minute, distance covered over 18 km/h and high-speed running (all in training) are found to be significant variables influenced by contextual factors. Withinsubject and time, training loads did not reflect game-related loads/performances, with starters showing higher deficits (ranging from -79.0 to -14.5). The study suggests that changes in soccer HC can affect players' training intensity and game performance, influenced by various contextual factors and not directly correlated. This type of information might be very suitable to improve training load periodization and programming. For further research avenues, could be the study of the variation of the psychological states of the players at the time of the dismissal and hiring of the HCs, associating them with the physiological performance at the same moments. [ABSTRACT FROM AUTHOR]

The demands of professional tennis, including physical and psychological aspects, contribute to the frequency of retirements at elite levels of the sport. The aim of this study was to analyze epidemiological patterns and risk factors associated with retirements in previous ATP and WTA Tour tournaments. A retrospective cohort study was conducted. This study focused on previous ATP and WTA Tour tournaments. The ATP database encompassed 584,806 matches, while the WTA database included 267,380 matches. To assess retirements, potential risk factors such as playing surface, tournament category, match round, and player age were analyzed. Incidence rates were calculated for the period between 1978–2019 for men and 1994–2018 for women. The overall incidence rate was 1.56 (95%CI: 1.54, 1.59) and 1.36 (95%CI: 1.33, 1.39) retirements per 1000 games played in male and female competitions, respectively. Retirements increased over the years. Higher incidence rates were observed on hard (1.59 [95%CI: 1.56, 1.63] and 1.39 [95%CI: 1.34, 1.44]) and clay (1.60 [95%CI: 1.57, 1.63] and 1.36 [95%CI: 1.32, 1.41]) compared to grass courts (0.79 [95%CI: 0.65, 0.94] and 1.06 [95%CI: 0.88, 1.27]). Risk factors differed by gender, with tournament category significant in males (IRR: 1.23 [95%CI: 1.19, 1.28] in ITF vs ATP) and match round in females (IRR: 0.92 [95%CI: 0.88, 0.98] in preliminary vs final). This study provides valuable insights for coaches, players, support teams, and epidemiologists regarding retirements and associated risk factors in previous ATP and WTA Tour tournaments, contributing to injury prevention strategies. [ABSTRACT FROM AUTHOR]

Polyetheretherketone (PEEK) is considered as an excellent biomaterial for bone grafting and connective tissue replacement. The clinical potential is, however, limited by its bioinertness, poor osteoconduction, and weak antibacterial activity. These disadvantages can be overcome by introducing suitable additives to produce mineral-polymer composites or coatings. In this work, a PEEK-based bioactive composite has been obtained by blending the polymer with magnesium phosphate (Mg3(PO4)2) particles in amounts ranging from 1 to 10 wt.% using the hot press technique. The obtained composite exhibited improved mechanical and physical properties, above the lower limits set for bone engineering applications. The tested grafts were found to not induce cytotoxicity. The presence of magnesium phosphate induced the mineralisation process with no adverse effects on the expression of the marker crucial for osteoblastic differentiation. The most promising results were observed in the grafts containing 1 wt.% of magnesium phosphate embedded within the PEEK matrix. The improved bioactivity of grafts, together with suitable physical–chemical and mechanical properties, indicate this composite as a promising orthopaedic implant material. [ABSTRACT FROM AUTHOR]

Based on conservation of resources theory and the work–home resources model, this study examines how and when narcissistic leadership influences employees' change-oriented organizational citizenship behavior. A total of 363 employees from 61 teams across numerous enterprises based in central China were surveyed using a questionnaire. The study hypotheses were tested using structural equation modeling and Monte Carlo simulation analysis. The findings revealed that narcissistic leadership results in the development of a negative team climate, termed "team chaxu climate," which, in turn, hinders employees' change-oriented organizational citizenship behavior. Furthermore, this study explored the moderating role of leaders' family affective support in the relationship between narcissistic leadership and team chaxu climate. This study contributes to our understanding of the relationship between narcissistic leadership and employee organizational citizenship behavior and empirically validates the work–home resources model. [ABSTRACT FROM AUTHOR]

Background: In 2012, Botswana introduced 13-valent pneumococcal conjugate vaccine (PCV-13) to its childhood immunization program in a 3+0 schedule, achieving coverage rates of above 90% by 2014. In other settings, PCV introduction has been followed by an increase in carriage or disease caused by non-vaccine serotypes, including some serotypes with a high prevalence of antibiotic resistance. Methods: We characterized the serotype epidemiology and antibiotic resistance of pneumococcal isolates cultured from nasopharyngeal samples collected from infants (≤12 months) in southeastern Botswana between 2016 and 2019. Capsular serotyping was performed using the Quellung reaction. E-tests were used to determine minimum inhibitory concentrations for common antibiotics. Results: We cultured 264 pneumococcal isolates from samples collected from 150 infants. At the time of sample collection, 81% of infants had received at least one dose of PCV-13 and 53% had completed the three-dose series. PCV-13 serotypes accounted for 27% of isolates, with the most prevalent vaccine serotypes being 19F (n = 20, 8%), 19A (n = 16, 6%), and 6A (n = 10, 4%). The most frequently identified non-vaccine serotypes were 23B (n = 29, 11%), 21 (n = 12, 5%), and 16F (n = 11, 4%). Only three (1%) pneumococcal isolates were resistant to amoxicillin; however, we observed an increasing prevalence of penicillin resistance using the meningitis breakpoint (2016: 41%, 2019: 71%; Cochran-Armitage test for trend, p = 0.0003) and non-susceptibility to trimethoprim-sulfamethoxazole (2016: 55%, 2019: 79%; p = 0.04). Three (1%) isolates were multi-drug resistant. Conclusions: PCV-13 serotypes accounted for a substantial proportion of isolates colonizing infants in Botswana during a four-year period starting four years after vaccine introduction. A low prevalence of amoxicillin resistance supports its continued use as the first-line agent for non-meningeal pneumococcal infections. The observed increase in penicillin resistance at the meningitis breakpoint and the low prevalence of resistance to ceftriaxone supports use of third-generation cephalosporins for empirical treatment of suspected bacterial meningitis. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae remains a significant global threat, with existing vaccines having important limitations such as restricted serotype coverage and high manufacturing costs. Pneumococcal lipoproteins are emerging as promising vaccine candidates due to their surface exposure and conservation across various serotypes. While prior studies have explored their potential in mice, data in a human context and insights into the impact of the lipid moiety remain limited. In the present study, we examined the immunogenicity of two pneumococcal lipoproteins, DacB and MetQ, both in lipidated and non-lipidated versions, by stimulation of primary human immune cells. Immune responses were assessed by the expression of common surface markers for activation and maturation as well as cytokines released into the supernatant. Our findings indicate that in the case of MetQ lipidation was crucial for activation of human antigen-presenting cells such as dendritic cells and macrophages, while nonlipidated DacB demonstrated an intrinsic potential to induce an innate immune response. Nevertheless, immune responses to both proteins were enhanced by lipidation. Interestingly, following stimulation of dendritic cells with DacB, LipDacB and LipMetQ, cytokine levels of IL-6 and IL-23 were significantly increased, which are implicated in triggering potentially important Th17 cell responses. Furthermore, LipDacB and LipMetQ were able to induce proliferation of CD4+ T cells indicating their potential to induce an adaptive immune response. These findings contribute valuable insights into the immunogenic properties of pneumococcal lipoproteins, emphasizing their potential role in vaccine development against pneumococcal infections. [ABSTRACT FROM AUTHOR]

Many underutilized edible fruit species (UEFS) are found in the Indo-Gangetic Plains (IGP), which support food security (FS) for both indigenous people and other dependent communities. Unfortunately, there is little study and fragmented information available about these naturally edible products. The UEFS of the IGP was the subject of a systematic review utilizing the PRISMA protocol, which produced implications for FS and land degradation neutrality (LDN). This review aims to survey, summarize, and annotate the published information about the angiosperms native and naturalized UEFS of IGP to identify and make use of this species, particularly for the sustainable development of this region. A systematic review confirmed that 371 species of UEFS, of which 62 species were threatened and near threatened (TNT)-UEFS. Among the TNT-UEFS, 41 species were threatened, while 21 species were NT. The threatened species were further categorized as per the International Union for Conservation of Nature (IUCN) Red List in the IGP as vulnerable (21 species), endangered (16 species), and critically endangered (four species). This systematic review suggests integration of the native and naturalized UEFS in afforestation and reforestation programs to aid in various ecosystem services. Calamus inermis, Corypha taliera, Licuala peltata, and Saurauia punduana are examples of multipurpose species that require immediate sustainable conservation and cultivation initiatives to save them from extinction in the near future. Multipurpose species such as Aegle marmelos, Buchanania lanzan, Manilkara hexandra, Syzygium cuminii, Tamarindus indica are immensely constructive and climate-smart by surviving in harsh agroclimatic conditions and have great potential for establishment on marginal and wastelands throughout the IGP region. These resilient fruit species enhance biodiversity, ecosystems, and landscapes in addition to providing food for humans. It progressively advances India’s commitment to LDN, combating climate change, and achieving the UN-SDGs, which call for reducing hunger and raising FS by 2030. As a result, the study will offer baseline data for the next investigations and be helpful to policymakers in creating sustainable and scientific policies for the IGP. [ABSTRACT FROM AUTHOR]

Intestinal protozoan parasitic infections are considered one of the most frequent types of infection caused by these parasites and remain a major health problem for communities. This study aims to detect the frequency of intestinal protozoan infections infection among Zakho general population from October 2018 to June 2022. This cross-sectional study was performed on 2,118 patients referring to private medical diagnostic laboratories in Zakho, Kurdistan Region, Iraq. Samples of fecal matter were collected and subjected to analysis using two different techniques: direct observation under the microscope (wet mount) and formalin-ether concentration methods. Morphological characteristics of trophozoites and cysts were used to identify E. histolytica using microscopical examination. Out of 2,118 recruited samples, 1,155 (54.53%) were male, and 963 (45.47%) were female. The mean age of participants was 20.41 (±19.12), with ages ranging from 1 to 63 years. The overall prevalence of protozoan infections was 395/2118 (18.65%). Out of these, Entamoeba histolytica was the predominant pathogenic protozoa infection 271 (68.61%), followed by Giardia lamblia 100 (25.31%). A significant association was seen between Entamoeba histolytica and age groups (P=0.003) and gender (P=0.004). The highest infection rate was reported among the age group <15 years (55.72%). We also found a higher rate of Giardia infection among age group < 15 years (46%) with significant differences (P=0.002) and a higher rate of Giardia seen in females (55%) with significant association (P=0.014). The frequency of Giardia lamblia and E. histolytica infections in our study was higher than other studies reported in Iraq and other countries, and these infections continue to pose a difficult public health issue and necessitate the implementation of stronger and more effective preventative measures. [ABSTRACT FROM AUTHOR]

Background: In Singapore, where drug use is a highly stigmatized and criminalized issue, there is limited understanding of the challenges faced by individuals, particularly sexual minority men, in their journey towards recovery from substance dependence or addiction. This qualitative study aimed to investigate the driving forces behind drug use, the factors contributing to drug cessation, and the elements influencing the recovery process. Methods: Data were extracted from clinical records provided by The Greenhouse Community Services Limited between January 2020 to May 2022. These records encompassed information from four distinct forms: the intake assessment, progress notes, case closing summary, and the care plan review. Thematic analysis was employed to identify and categorize recurring themes within the data. Results: Data from beneficiaries (n = 125) were analyzed and yielded a series of themes related to facilitators of drug use, motivations to cease drug use, and managing one's ongoing recovery. Within the facilitators of drug use, two sub-themes were identified: (a) addressing trauma and triggers and (b) managing emotions. Additionally, managing one's recovery was marked by four significant sub-themes: (a) uncovering personal identities, (b) losing motivation and drive, (c) overcoming obstacles, and (d) preparing for aftercare. Conclusions: The study contributes valuable insights into the dynamics of ongoing recovery management, offering potential avenues for interventions that could enhance support for individuals in their journey to overcome substance dependence. Enhancing psychoeducation and fostering peer support have the potential to facilitate the recovery process. Clearly, a holistic approach is needed to address these complex issues that cuts across our societies. [ABSTRACT FROM AUTHOR]