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Learning loss pertains to the decline or regression in knowledge and abilities, as well as setbacks in academic advancement. This phenomenon typically arises from prolonged interruptions or gaps in the pupil's educational journey. Learning loss can be observed in diverse manifestations due to many factors. One example that can be illustrated is the disruption of formal education due to the COVID-19 pandemic that struck the world in 2019. As a result, this phenomenon has impacted students' academics, whether at the school level or higher education institutions, especially primary school students, thus causing learning poverty. This scoping review aims to identify the degree of reading literacy among primary school students and to investigate the factors that contribute to the learning losses of primary school students from the reading aspect. Four databases, including Scopus, Education Resources Information Center (ERIC), Bielefeld Academic Search Engine (BASE), and Directory of Open Access Journals (DOAJ), were used in this research, which found 40 articles for eligibility. Only 20 articles are eligible for analysis and reference after the exclusion and inclusion process for data collection. The findings show that learning losses have impacted the education sector, leading to poverty, especially among primary school children.

The existence of Civic Education(PKn) Course in the Higher Education curriculum is a compulsory subject that must be taken and passed by every student, so it is known as the General Compulsory Course (MKWU). Moreover, due to its mission on developing students' personalities, Civic Education is also known as the Personality Development Course (MKPK). However, the problem that still arises is the attitude and behavior of some students who violate moral values and character, such as cheating during exams, plagiarizing other people's work in doing assignments, drinking alcohol, doing immoral actions or promiscuity, brawling among students or groups of students, skipping lectures beyond the tolerance. In addition, another problem commonly faced is the non-optimal learning process for Civic Education which is known from the lack of students' involvement in the learning process. The implementation of the Citizen Project Model as an effort to solve problems in Civic Education learning could make students understand and behave in accordance with moral values and character as citizens. Furthermore, this model could also make students active, creative, collaborative, disciplined, and build good relations with the community and government officials. This study aims to examine the Project Citizen model in building students' moral values and character at the Universitas Muhammadiyah Purwokerto (UMP). This research was carried out with a qualitative approach using a Participatory Action Research (PAR) design. The students were involved in each stage of Project Citizen in three participatory action cycles. The data collection technique used interviews, observations, video recordings, and documents. The data analysis used theme analysis. The study results prove that the stages of the project citizen model can build UMP students' moral values and character. UMP students' moral values and character are described in 8 themes, including rationality, justice, honesty, kindness, prosocial behavior/doing good to others, the character of citizens, braveness, and motivation to be an open and independent person

Aim: The aim of this study was to determine the prevalence of various Salmonella serotypes in chickens, carcass contact surfaces as well as environmental samples collected from wet markets and small scale processing plant. Materials and Methods: A total of 182 poultry and environmental samples were collected at random on separate occasions from wet markets and small scale processing plant, during the period of October 2014 to July 2015 in Penang and Perlis, Malaysia. The samples were analyzed for the presence of Salmonella using ISO 6579:2002 conventional culture-based method. Presumptive Salmonella colonies were subjected to various biochemical tests (such as triple sugar iron and lysine iron test), serologically confirmed using polyvalent O and H antisera and further serotyped at Public Health Laboratory, Ministry of Health, Perak, Malaysia. Results: Salmonella serotypes were isolated from 161 out of 182 samples (88.46%) with 100% prevalence in the whole chicken carcass and chicken cuts - as well as transport crate, cage, drum, knife, chopping board, display table, floor, bench wash water, wash water, and drain water. Salmonella was isolated from 91.67%, 83.33%, and 66.67% of defeathering machines, drain swabs, and apron, respectively. 17 serotypes were isolated in this study with Salmonella Albany (57/161), Salmonella Corvallis (42/161), and Salmonella Brancaster (37/161) being the predominant serovars. Conclusion: The most carcass contact and environmental samples collected along the wet market chicken processing line were consistently contaminated with Salmonella. This indicates that Salmonella has established itself in poultry processing environments by colonizing the surfaces of the equipment and survives in these environments by establishing biofilms. Our results highlight the need of implementing strict hygiene and sanitation standards to reduce the incidence of Salmonella. The prevalence of Salmonella in poultry can be reduced effectively by identifying and eliminating the sources and contamination sites during slaughter and processing of poultry.

In this study, four different kinds of perovskite powders (LaMnO3, LaFeO3, LaCrO3, and LaNiO3) were prepared and investigated as anode materials for supercapacitor. The as-prepared powders were blended with active carbon and subsequently coated on the nickel plates as the collector layer of the supercapacitors. Three different types of the aqueous solutions (3 M KCl, 1 M LiOH, and 3 M LiOH) were respectively served as the electrolytes for the supercapacitor. The morphology and crystalline phase were characterized by transmission electron microscopy and XRD. The electrical capacity and impedance were measured by the electrochemical capacitance voltage analyzer and impedance spectroscopy. The profiles of specific capacitance of the four different anodic electrodes and three different electrolytes were implemented. The impedance results indicated that four asymmetric pseudocapacitors didn’t show any Warburg-type line and semi-circle line in the low-frequency region. According to the CV profiles, the intrinsic LaNiO3 exhibits the highest specific capacitance of 106.58 F/g in 3 M LiOH. Furthermore, the 98% of the initial capacitance of LaNiO3 was retained after 500 charge-discharge life cycles at the maximum current density of 1 A/g. The efficient charge storage of LaNiO3 was attributed by the anion intercalated redox reactions along with the suitability of electrode-electrolyte interactions. Keywords: Perovskite, Lanthanum nickel oxide, Pseudocapacitance, Asymmetric supercapacitor, Oxygen de-intercalation

Abstract Background Unplanned reattendances (UR) are an important quality indicator in the emergency department (ED). Understanding the risk factors associated with UR can aid clinicians in optimizing the allocation of time and resources, as well as targeted counselling for this specific group of patients. In this study, we aimed to compare patient characteristics between children who attended a pediatric emergency department (ED) with unplanned reattendances (UR) and those without UR. We also aimed to study the association between healthcare delivery factors such as timing of the attendance, patient load, changeover months for rotating junior doctors, presence of supervision, and rate of UR. Study design We performed a retrospective, single-center cohort study of patients

Abstract Background Medical students in Singapore engage in short term medical missions, locally known as Overseas Community Involvement Projects (OCIPs). Little is known about the learning outcomes of an OCIP and how this complements their medical education back home. Understanding this can help the medical educators structure the OCIP to optimise its learning value. Objectives This study aims to gain an in-depth understanding of the experiences and learning outcomes of the medical students who participated in the OCIP. Methods This was a qualitative study involving Singaporean students from one medical school travelling to Nepal. Data was collected from reflective journals, overall group reflections and two focus group discussions. The data was thematically analysed using the Accreditation Council for Graduate Medical (ACGME) core competencies for medical professionals. Results The data could be classified under various themes within the six domains of the ACGME framework. The study revealed themes of: humanism, socioeconomic and cultural determinants of health under the domain of patient care, application of medical knowledge, investigating and evaluating the needs of a population and feedback to drive improvement under the domain of practice-based learning and improvement, use of non-verbal cues and communicating across language barriers under the domain of interpersonal and communication skills, healthcare systems and delivery, resourcefulness and adaptability, health equity and accessibility under the domain of systems-based practice, ethics, role-modelling, teamwork and leadership skills, interprofessional skills and resilience under the domain of professionalism. Understanding the students’ motivations, utilising reflections, and following the patients’ journey facilitated attainment of these outcomes. Conclusions This OCIP experience translated to learning outcomes aligned with the ACGME framework. There is great potential for the experiential learning from a well-structured OCIP to help with personal and professional development and global health education.

Airway macrophages (AM) are the predominant immune cell in the lung and play a crucial role in preventing infection, making them a target for host directed therapy. Macrophage effector functions are associated with cellular metabolism. A knowledge gap remains in understanding metabolic reprogramming and functional plasticity of distinct human macrophage subpopulations, especially in lung resident AM. We examined tissue-resident AM and monocyte-derived macrophages (MDM; as a model of blood derived macrophages) in their resting state and after priming with IFN-γ or IL-4 to model the Th1/Th2 axis in the lung. Human macrophages, regardless of origin, had a strong induction of glycolysis in response to IFN-γ or upon stimulation. IFN-γ significantly enhanced cellular energetics in both AM and MDM by upregulating both glycolysis and oxidative phosphorylation. Upon stimulation, AM do not decrease oxidative phosphorylation unlike MDM which shift to ‘Warburg’-like metabolism. IFN-γ priming promoted cytokine secretion in AM. Blocking glycolysis with 2-deoxyglucose significantly reduced IFN-γ driven cytokine production in AM, indicating that IFN-γ induces functional plasticity in human AM, which is mechanistically mediated by glycolysis. Directly comparing responses between macrophages, AM were more responsive to IFN-γ priming and dependent on glycolysis for cytokine secretion than MDM. Interestingly, TNF production was under the control of glycolysis in AM and not in MDM. MDM exhibited glycolysis-dependent upregulation of HLA-DR and CD40, whereas IFN-γ upregulated HLA-DR and CD40 on AM independently of glycolysis. These data indicate that human AM are functionally plastic and respond to IFN-γ in a manner distinct from MDM. These data provide evidence that human AM are a tractable target for inhalable immunomodulatory therapies for respiratory diseases.

Introduction: Pregnant women often experience anxiety due to myths and worries about surgery, particularly caesarean section, which are common during childbirth. Their anxiety can impact overall satisfaction, recovery, and mental health. Addressing these issues is crucial for improving both surgical outcomes and the childbirth experience. Aim: To assess the effectiveness of a preoperative education program utilising materials and videos on spinal anaesthesia in reducing anxiety and enhancing postoperative outcomes for patients undergoing caesarean section. Materials and Methods: An interventional study was conducted with 64 consecutive parturients who were divided into two equal groups, the study group (group A) and the control group (group B) at Government TD Medical College Alappuzha, Kerala, India. Group A received structured education on spinal anaesthesia, with individual questions and concerns addressed using the video and handbook. Group B received routine preoperative information. Preoperative anxiety was measured using Amsterdam Preoperative Anxiety and Information Scale (APAIS), while postoperative pain was assessed using Visual Analogue Scale (VAS) at 4, 12, and 24 hours after surgery. Data analysis was performed using Statistical Package for the Social Sciences (SPSS). Results were presented as frequencies for qualitative variables and as mean with standard deviation for quantitative variables. Statistical tests included Student’s t-test, Chi-square test, Fisher’s exact test, and paired t-test. Statistical significance was set at p-value

This study aimed to examine the causal model of eating behaviors among pregnant women working in industrial factories.

Introduction: Thyroid enlargement is considered a risk factor for challenging direct laryngoscopy and intubation. Airway management in patients with thyroid swelling presents unique challenges, requiring thorough preparation for potential difficult airways. Although airway management in the overall population has been thoroughly researched, there is a scarcity of literature specifically addressing airway management in individuals who have thyroid enlargement. Aim: To evaluate the incidence of difficult intubation in patients undergoing thyroid surgery, utilising the Intubation Difficulty Score (IDS). Materials and Methods: This cross-sectional observational study was conducted among 258 patients in the Department of Anaesthesiology, Government TD Medical College, Alappuzha, Kerala, India. Various parameters including Modified Mallampati score, neck circumference, Body Mass Index (BMI), inter-incisor distance, retrognathia, neck extension, thyromental distance, tracheal deviation, and tracheal compression were assessed for all patients with thyroid swelling. The incidence of difficult endotracheal intubation was analysed using the IDS and the time taken for successful intubation was recorded. Data were presented as mean±standard deviation (SD), frequencies, and percentages. The association between variables was analysed using the Chi-square test. R esults: Thyroid disorders were more common in females 220 (85.3%) than in males 38 (14.7%). The variables such as BMI, Mallampati score, thyromental distance, inter-incisor distance, and neck mobility were not found to be associated with difficult intubation. However, increased neck circumference (>43 cm) was statistically significant (p-value=0.007) in relation to difficult intubation. According to IDS, 94.2% of patients had easy intubation, while 5.8% experienced difficult intubation. In terms of intubation times, 72.5% of patients were intubated within 10-15 seconds, 24.4% within 16-20 seconds, and 3.1% took longer than 20 seconds. C onclusion: Thyroid surgery itself is not an independent predictive factor for difficult intubation. Among the predictive factors in the study population, a neck circumference greater than 43 cm was found to be associated with difficult endotracheal intubation during thyroid surgery.

Abstract Prodrugs have been explored as an alternative to conventional chemotherapy; however, their target specificity remains limited. The tumor microenvironment harbors a range of microorganisms that potentially serve as tumor-targeting vectors for delivering prodrugs. In this study, we harness bacteria-cancer interactions native to the tumor microbiome to achieve high target specificity for prodrug delivery. We identify an oral commensal strain of Lactobacillus plantarum with an intrinsic cancer-binding mechanism and engineer the strain to enable the surface loading of anticancer prodrugs, with nasopharyngeal carcinoma (NPC) as a model cancer. The engineered commensals show specific binding to NPC via OppA-mediated recognition of surface heparan sulfate, and the loaded prodrugs are activated by tumor-associated biosignals to release SN-38, a chemotherapy compound, near NPC. In vitro experiments demonstrate that the prodrug-loaded microbes significantly increase the potency of SN-38 against NPC cell lines, up to 10-fold. In a mouse xenograft model, intravenous injection of the engineered L. plantarum leads to bacterial colonization in NPC tumors and a 67% inhibition in tumor growth, enhancing the efficacy of SN-38 by 54%.

As differences in seed dormancy between Actinidia species have not been reported previously, in this study we characterized the variation in the dormancy of seeds in 13 kiwifruit species that originated from different regions of China and Taiwan, and for which mature plants are now growing in New Zealand orchards. Dormancy-breaking treatments, including cold-moist stratification, seed coat scarification and soaking in water and gibberellic acid (GA3), were tested for their efficacy in alleviating dormancy and improving final germination and germination rates. In addition, we assessed seed viability using RNA integrity analysis to distinguish dead seeds from dormant seeds. This study identified that dormancy type in Actinidia seeds is species-specific and can be morphological, morphophysiological or a combination of physiological and physical, and that seed RNA integrity is a useful metric to incorporate into seed dormancy studies. Our results also suggest that species originating from colder climates that experience large differences between winter minimum and summer maximum temperatures exhibit physiological dormancy and require cold-moist stratification, contrasting with species originating in milder climates. Interestingly, although not all seeds from all the species were dormant, the proportion of dormant seeds in each species did not correlate to the climatic data of the region from which they originated. These findings provide new insights into mechanisms of seed dormancy in kiwifruit.

Purpose: The power of forum theatre in education and various other fields is well known by educators. However, the use of forum theatre in Malaysia, particularly in the field of moral education, is still limited. At the same time, the development of thinking skills is one of the aims of the Malaysian moral education curriculum. Therefore, this study examined the use of forum theatre as a pedagogical tool in developing various levels of thinking skills among moral education students. Method: The study adopted a qualitative research design and was underpinned by Bloom's revised taxonomy as the theoretical and analytical framework. A total of 14 moral education students participated in this study. Data were collected qualitatively using classroom observations, interviews, and journal writing. Thematic analysis was utilized to analyse and present the findings. Findings: The findings revealed that various theatrical activities that underpinned the four elements of forum theatre: (i) writing a script, (ii) delivering a dialogue in an anti-model play, (iii) discussion and decision-making in a forum session, and (iv) improvisation in an intervention play, show the development of students' thinking skills at the level of analysing, evaluating and creating. Therefore, this study suggests that forum theatre can be used in moral education pedagogy to enhance higher order thinking skills. Significance: Meaningful instructional pedagogy must inspire thinking skills to foster creativity and innovation among students. This is considered an important skill in 21st century learning. Hence, these findings are beneficial for teachers, lecturers, parents and instructional designers who wish to plan and implement suitable teaching methods such as forum theatre to empower and improve students' thinking skill levels.

The aim of this study is to discuss the development of education during the British Colonial rule in Malaya. The scope of this study is focussed on four school systems under British colonialists, namely the Malay Vernacular School, Chinese Vernacular School, Tamil Vernacular School, and English Schools and its implications to the society and nation. The introduction of these four school systems is aimed at the economic and political interests of the British in Malaya. The Colonial Education System does not have a National Education Policy and brings many implications to the society and nation. It has caused class and status disparities among the societies and also caused socio-economic differences between races in Malaya. The process of socialization is not achieved among all races in Malaya under the Colonial Education. This study is qualitative and is approached through the library and archival research.

Abstract This review paper describes the development of the pre-hospital system in Singapore from the pre-war days. Every country’s prehospital community needs a deep understanding of how they developed over the years, factors that played a part, and the aspirations their community and government have set for this. This can guide future evolution of the services to ensure that care provided is relevant, applicable and in keeping with the community’s needs. Countries with similar contextual circumstances, but at a different stage of development of their PECs, may learn from these.

Second language learning motivation is often analyzed as a multidimensional construct involving learner's images of their individual selves and complex statistical measures. While many of these analysis have deepened understanding of various cognitive and affective factors influencing language learner behavior, research investigating the different motivation factors that combine learner types remains scarce. Involving 78 Malaysian undergraduates from a University in East Malaysia taking a proficiency course, the study looked at learner motivation in relation to L2 motivational dimensions, classroom factors and learning goals. An exploratory cluster analysis identified 4 group motivational profiles: 1-motivated, 2-amotivated, 3- externally motivated and 4-self-determined. Initial data analysis found both learner images (the ideal L2 learner) and instrumental (Ought to L2 learner) as main factors influencing motivated learning behavior. The combined findings for learner confidence in the classroom and vitality of L2 speaker communities revealed that except for the extrinsically motivated communities (e.g. International Finance students), most students indicated learning as more meaningful if attention was given to their first language resources. Classroom activities that integrate first language resources have a positive influence on learner's effort and willingness to invest while a strict L2-only perspective have a negative effect on learner motivation. Given the role of English for the digital world, L2 universities may benefit from including learners' first language resources and experience for engaging and helping learners to perform academically.

Abstract Background Tumours on the scalp are diverse and often exhibit site- and histology-specific characteristics. Reconstructing the scalp after oncological resection has always been challenging because of its unique anatomy. Methodology A retrospective review of patients with malignant scalp tumour operated on at a single institution over 10 years was performed. Data were collected and analysed regarding the scalp tumour profile, treatment, and the outcome of these procedures. Results Of the 66 patients in our study, 33 (50%) had SCC. In addition to this, 21% were sarcomas, 17% were appendageal carcinomas, 11% were BCCs, and 1% was neuroendocrine carcinoma. Cortical erosion was observed in 6 patients in the CT imaging, all with SCC histology. Among the eight patients with pathological nodal involvement, three had angiosarcoma, three had SCC, one had appendageal carcinoma, and one had neuroendocrine carcinoma. The mean surgical defect size was 67.4 cm2. The surgical defect was reconstructed with local flaps in 58% of patients and primary closure in 27%. Local and systemic recurrence was noted in 25% of patients. Tumour size more than 6 cm, tumour histology (SCC & sarcoma), unplanned margin-positive excision, and residual disease in re-excision had higher recurrence, even though the p-value was not significant. Conclusion Scalp tumours are heterogeneous in their clinical profiles. Often, its tumour biology and microscopic extent are underestimated. High suspicion, histological diagnosis, and clear surgical margins are all requirements in successfully treating scalp tumours. In order to minimize morbidity and restore an aesthetic and functional outcome, it is critical to use the simplest scalp reconstruction whenever possible.

Of the recognized 24 crocodilian species, two species are found in Sarawak: the saltwater crocodile (Crocodylus porosus) and Malayan false gharial (Tomistoma schlegelii). C. porosus is the most commonly found crocodile and currently listed in Appendix II of the Convention on International Trading in Endangered Species of Wild Flora and Fauna (CITES), which allows harvesting wild populations for commercial purposes. To strengthen conservation efforts, ecological and genetic data are needed to inform management decisions. Thus, this study was designed to estimate relationship coefficients between crocodiles in thirteen river basins using 13 microsatellite markers. Fifty-eight wild crocodile samples were obtained and finally analysed by clustering of PCR products. Of the 60 samples amplified, one marker (Cj35) was polymorphic and showed double bands, whereas the other seven markers (Cj127, Cj131, Cj122, Cj101, Cj119, CUD68 and Cj16) revealed a single band. Microsatellite loci (Cj105, Cj18, Cj104, Cp10, and Cu4-121) displayed multiple bands. Using the unweighted pair group with the arithmetic mean (UPGMA) clustering method, an unrooted phylogenetic tree was obtained, with coefficients ranging between 0.51 and 1.00. We successfully assessed population genetic structure and resolved genetic relationships among six clades (Clade A to F) out of the total seven clades. DNA microsatellites are a promising resource for determining the relationships among crocodiles in Sarawak. The findings are useful for future sustainable utilization of the wild crocodile population.

Ex situ conservation involves the maintenance and reproduction of species in areas outside their natural habitats. Seed banking is a well-established ex situ approach used for plant conservation. Seed banking consists of collecting, drying, and storing seeds to preserve genetic diversity. The main limitation of this technique is that the seed must be desiccation tolerant. Seed storage behaviour can vary among species, and for some species, drying without loss of viability is not possible, meaning storage under conventional seed banking conditions (sub-zero temperatures and low relative humidity) is not possible. Understanding seed storage behaviour is an essential prerequisite for establishing whether conventional seed banking is an option for seed conservation. This study investigated the desiccation tolerance and sensitivity of mature seeds of two native New Zealand species of Pittosporum (P. eugenioides and P. crassifolium) from two geographic locations (Palmerston North and Wellington), with the aim of understanding their seed storage behaviour and thereby improving conservation outcomes. The variables measured were seed moisture content, viability, germination, and desiccation responses. We developed sorption isotherm for both species to support the future development of storage protocols. Our results show that both P. eugenioides and P. crassifolium display non-orthodox behaviour, i.e., are desiccation sensitive and cannot be stored under conventional seed banking conditions, but also suggest that seed desiccation responses vary with the geographical origin of the seeds. This study highlights the importance of exploring seed storage behaviour using different populations to optimize ex situ conservation strategies aimed at preserving the genetic diversity of New Zealand’s threatened and endangered species.

Neotropical orchids are vulnerable to extinction due to overharvesting, habitat destruction and climate change. However, a basic understanding of orchid seed biology to support conservation efforts is still lacking for most species. Seed morphology is linked to plant adaptation and evolution, influencing seed dispersal, dormancy, longevity, and germination, which are valuable traits for conservation. In this study, we characterized and compared the morphological traits of seed capsules (size, shape, and colour) and seeds (seed and embryo shape and size and internal airspace volume) for three epiphytic Neotropical orchid species of the genus Lycaste native to Guatemala: L. cochleata, L. lasioglossa, and L. virginalis. The three species show qualitative similarities in seed capsule colour and appearance and in seed morphology (i.e., scobiform oval-shaped seeds and prolate-spheroid embryos). All species have small-sized seeds (length of L. cochleata: 210 µm, L. lasioglossa: 230 µm, and L. virginalis: 260 µm), with proportionally large embryos (length of L. cochleata: 140 µm, L. lasioglossa: 120 µm, and L. virginalis: 150 µm) and an internal air-space volume that occupies less than half of the seed (L. cochleata: 17%, L. lasioglossa: 42%, and L. virginalis: 30%). This finding is consistent with previous reports for other epiphytic orchid species, which typically have lower air volumes than terrestrial orchids. These differences are likely a result of evolutionary changes associated with different habits and may influence seed dispersal. We also found some significant differences in seed morphology between the studied species, but their taxonomic, biological, and ecological relevance remain to be elucidated. More comparative studies, including on other Lycaste species with different habits, are needed to explore relationships between seed morphology, taxonomy, biology, and ecology in this genus to support its conservation.

Objectives: With more elderly presenting with Out-of-Hospital Cardiac Arrests (OHCAs) globally, neurologically intact survival (NIS) should be the aim of resuscitation. We aimed to study the trend of OHCA amongst elderly in a large Asian registry to identify if age is independently associated with NIS and factors associated with NIS. Methods: All adult OHCAs aged ≥18 years attended by emergency medical services (EMS) from April 2010 to December 2019 in Singapore was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Cases pronounced dead at scene, non-EMS transported, traumatic OHCAs and OHCAs in ambulances were excluded. Patient characteristics and outcomes were compared across four age categories (18–64, 65–79, 80–89, ≥90). Multivariable logistic regression analysis determined the factors associated with NIS. Results: 19,519 eligible cases were analyzed. OHCA incidence increased with age almost doubling in octogenarians (from 312/100,000 in 2011 to 652/100,000 in 2019) and tripling in those ≥90 years (from 458/100,000 in 2011 to 1271/100,000 in 2019). The proportion of patients with NIS improved over time for the 18–64, 65–79- and 80–89-years age groups, with the greatest improvement in the youngest group. NIS decreased with each increasing year of age and minute of response time. NIS increased in the arrests of presumed cardiac etiology, witnessed and bystander CPR. Conclusions: Survival with good outcomes has increased even amongst the elderly. Regardless of age, NIS is possible with good-quality CPR, highlighting its importance. End-of-life planning is a complex yet necessary decision that requires qualitative exploration with elderly, their families and care providers.

Writing has always been subjected as a difficult task for students taking English language subjects during their first two semesters studying in tertiary education. For these students, writing a composition has been a task they would prefer to avoid doing. One of many reasons is the inability to first generate and organize their ideas for writing tasks. Besides, they faced difficulty in expressing themselves fluently or being able to write sentences that are grammatically correct in the target language. Realizing the importance of writing skills among undergraduates in the tertiary education, a study was carried out on 200 undergraduates who attended a day Malaysian University English Test (MUET) workshop to examine students' writing ability through a proposed model of Transferring, Restructuring, Engaging, Negotiating and Documenting (T.R.E.N.D.). The findings had shown significant improvement in learners' writing in term of coherency and the development of ideas after the workshop. As a whole, the use of T.R.E.N.D. Model had helped to improve students' writing ability in terms of not only language proficiency, but also their level of confidence.

Global seaport network efficiency can be measured using the Liner Shipping Connectivity Index (LSCI) with Gross Domestic Product. This paper utilizes k-means and hierarchical strategies by leveraging the results obtained from Data Envelopment Analysis (DEA) and Fuzzy Data Envelopment Analysis (FDEA) to cluster 133 countries based on their seaport network efficiency scores. Previous studies have explored hkmeans clustering for traffic, maritime transportation management, swarm optimization, vessel trajectory prediction, vessels behaviours, vehicular ad hoc network etc. However, there remains a notable absence of clustering research specifically addressing the efficiency of global seaport networks. This research proposed hkmeans as the best strategy for the seaport network efficiency clustering where our four newly founded clusters; low connectivity (LC), medium connectivity (MC), high connectivity (HC) and very high connectivity (VHC) are new applications in the field. Using the hkmeans algorithm, 24 countries have been clustered under LC, 47 countries under MC, 40 countries under HC and 22 countries under VHC. With and without a fuzzy dataset distribution, this demonstrates that the hkmeans clustering is consistent and practical to form grouping of general data types. The findings of this research can be useful for researchers, authorities, practitioners and investors in guiding their future analysis, decision and policy makings involving data grouping and prediction especially in the maritime economy and transportation industry.

Objectives Strengthening of emergency care systems, including prehospital systems, can reduce death and disability. We aimed to identify perspectives on barriers and facilitators relating to the development and implementation of a prehospital emergency care system assessment tool (PEC-SET) from prehospital providers representing several South and Southeast (SE) Asian countries.Design We conducted a qualitative study using focus group discussions (FGD) informed by the Consolidated Framework for Implementation Research (CFIR). FGDs were conducted in English, audioconferencing/videoconferencing was recorded, transcribed verbatim and coded using an inductive and deductive approach. Participants suggested specific elements to be measured within three main ‘pillars’ of disease conditions proposed by the research team of the tool being developed (cardiovascular, trauma and perinatal emergencies).Setting We explored the perspectives of medical directors in six low-income and middle-income countries (LMICs) in South and SE Asia.Participants A total of 16 participants were interviewed (1 Vietnam, 4 Philippines, 4 Thailand, 5 Malaysia, 1 Indonesia and 1 Pakistan) as a part of 4 focus groups.Results Themes identified within the four CFIR constructs included: (1) Intervention characteristics: importance of developing an contextually specific tool, need for generalisability, trialling in one geographical area or with one pillar before expanding; (2) Inner setting: data transfer barriers, workforce shortages; (3) Outer setting: underdevelopment of EMS nationally; need for further EMS system development prior to implementing a tool and (4) Individual characteristics: lack of buy-in by prehospital personnel. Elements proposed by participants included both process and outcome measures.Conclusions Through the CFIR framework, we identified several themes which can provide a basis for codeveloping a PEC-SET for LMICs with local stakeholders. This work may inform development of quality improvement tools in LMIC PEC systems.

(1) Background: Data on COVID-19 outcomes and disease course as a function of different medications used to treat cardiovascular disease and chronic kidney disease (CKD), as well as the presence of different comorbidities in primarily Black cohorts, are lacking. (2) Methods: We conducted a retrospective medical chart review on 327 patients (62.6% Black race) who were admitted to the Detroit Medical Center, Detroit, MI. Group differences (CKD vs. non-CKD) were compared using the Pearson χ2 test. We conducted univariate and multivariate regression analyses for factors contributing to death during hospitalization due to COVID-19 (primary outcome) and ICU admission (secondary outcome), adjusting for age, sex, different medications, and comorbidities. A sub-analysis was also completed for CKD patients. (3) Results: In the fully adjusted model, a protective effect of ACEi alone, but not in combination with ARB or CCB, for ICU admission was found (OR = 0.400, 95% CI [0.183–0.874]). Heart failure was significantly associated with the primary outcome (OR = 4.088, 95% CI [1.1661–14.387]), as was COPD (OR = 3.747, 95% CI [1.591–8.828]). (4) Conclusions: Therapeutic strategies for cardiovascular disease and CKD in the milieu of different comorbidities may need to be tailored more prudently for individuals with COVID-19, especially Black individuals.