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The world’s move to a global economy has an impact on the high rate of student academic failure. Higher education, as the affected party, is considered crucial in reducing student academic failure. This study aims to construct a prediction (predictive model) that can forecast students’ time to graduation in developing countries such as Indonesia, as well as the essential factors (attributes) that can explain it. This research used a data mining method. The data set used in this study is from an Indonesian university and contains demographic and academic records of 132,734 students. Demographic data (age, gender, marital status, employment, region, and minimum wage) and academic (i.e., grade point average (GPA)) were utilized as predictors of students’ time to graduation. The findings of this study show that (1) the prediction model using the random forest and neural networks algorithms has the highest classification accuracy (CA), and area under the curve (AUC) value in predicting students’ time to graduation (CA: 76% and AUC: 79%) compared to other models such as logistic regression, Naïve Bayes, and k-nearest neighbor; and (2) the most critical variable in predicting students’ time to graduation along with six other important variables is the student’s GPA.

Evaluasi non-tes, atau evaluasi formatif, memiliki peran krusial dalam pengembangan pendidikan, menilai kemajuan siswa di luar aspek akademis. Metode ini memungkinkan penilaian holistik terhadap keterampilan sosial, kepribadian, dan bakat siswa. Keunggulan utamanya terletak pada identifikasi keterampilan sosial dan kepribadian, kunci keberhasilan dalam masyarakat kompleks saat ini. Evaluasi ini juga memberikan guru peluang untuk memberikan umpan balik mendalam dan mendukung pendekatan pembelajaran yang responsif. Namun, penelitian ini menyoroti kendala dalam implementasi evaluasi non-tes di MAN 2 Surakarta, terutama pada pelaksanaan evaluasi pembelajaran PAI. Guru mengalami kesulitan dalam mengembangkan instrumen non-tes, kurangnya pengembangan teknik evaluasi, dan perhatian yang masih lebih besar pada instrumen tes. Observasi menunjukkan bahwa evaluasi non-tes belum mendapatkan perhatian yang memadai, menghasilkan hambatan teknis, fokus pada penilaian sikap, kendala waktu, dan kurangnya keterampilan guru. Solusi yang diusulkan guru melibatkan peningkatan pengetahuan dan keterampilan guru melalui sosialisasi, pengembangan soft skill siswa, dan manajemen waktu yang lebih baik. Kesimpulannya, evaluasi non-tes diidentifikasi sebagai tantangan utama yang dapat diatasi dengan upaya peningkatan keterampilan guru dan manajemen pendidikan yang lebih efisien. Seiring dengan itu, penerapan evaluasi non-tes di MAN 2 Surakarta memberikan gambaran tentang pentingnya evaluasi, variasi instrumen yang digunakan, dan peran guru dalam memastikan evaluasi mencakup aspek hasil dan proses belajar siswa.

This study is aimed to determine polymorphism of the Prolactin gene (PRL|PstI) in Sikumbang Jonti ducks using PCR-RFLP (Polymerase Chain Reaction–Restriction Fragment Length Polymorphism) method. This study used 56 Sikumbang Jonti ducks whose blood samples were taken. Gene amplification used a pair of primers forward 5' TGC AAA CCA TAA AAG AAA AGA 3' and reverse 5' CAA TGA AAA GTG GCA AAG CAA 3', which resulted in a 400 bp fragment in exon 5 of the Prolactin (PRL) gene. The amplification product was restricted using the PstI enzyme, which recognizes the truncation site (5' G↓ACGTC 3'). From 56 samples of Sikumbang Jonti ducks identified, just one genotype was found, homozygous (-/-) with only one allele (-). Analysis of the restriction product in Sikumbang Jonti ducks obtained a uniform genetic variation of PRL|PstI (monomorphic) with an allele frequency (-) of 100%.

Mono anaerobic digestion (AD) of dairy cow manure (DCM) is constrained by high moisture, ash and crude fibre content. Anaerobic co-digestion DCM and other biomass is one of the methods to overcome this drawback. This study aimed to evaluate: methane production from different parts of Pistia stratiotes (PS), methane production from the mixed substrate of PS and DCM in different proportions of PS in terms of volatile solids (VS) (0%, 7.99%, 14.91%, and 20.94%) using continuous digesters, and the potency of biogas yield from the digested slurry. Methane production from the whole plant, shoot system, and root of PS was 405.68, 416.82, and 326.42 L/kg VS, respectively. The highest methane production was obtained from the shoot system because that part contained higher crude protein and hemicellulose contents. Utilization of PS as a co-substrate for AD of the DCM can increase methane production by 28.65–56.98% compared to the control digester. No effect on pH, total ammonia nitrogen and total volatile fatty acid indicated that PS was suitable as a co-substrate of DCM and can significantly increase methane yield of the mixed substrate. AD of digested slurries showed that to recover the biogas production from the mixed substrate, the post-digestion treatment should be applied before the slurries are used as organic fertilizer.

The present study sought to inquire into the subjective experience of 156 preschoolers (age 4–6.9 years) living in an area of political violence in Israel (on the border with the Gaza Strip) during a period of massive bombing. Children were invited to draw a Person Picking an Apple from a Tree (PPAT), and were interviewed on their sense of self-potency using the CAMP, a measure of potency. Teachers were asked to report problems in executive functions using a few BRIEF scales; and mothers filled out a questionnaire for maternal distress (BSI), a measure of their child strengths and difficulties (SDQ), and were asked to provide their assessment regarding the extent to which their child was exposed to political violence. Findings reveal associations between mothers’ distress, the degree of exposure of their child to trauma, and the child’s emotional symptoms. PPAT analysis identified four main factors: Tree Generosity, Person Agency, Vividness, and As-Real-R. Positive associations were found between self-potency and the main factors of the drawings; negative associations were found between the child’s difficulties in executive functions and the drawing’s four main factors; and two small negative associations were found between the child’s emotional symptoms and Tree Generosity and As-Real-R factors. The following associations were found within each gender group: mothers’ depression degree was associated with boy’s Tree Generosity, and mother’s perceptions of their girl’s exposure to trauma was related to Person Agency, Tree Generosity, and As-Real-R factors; furthermore, a significant difference was found between the narrative focus of drawings in this sample and the narrative focus of drawings of a sample of the same age group from a non-war zone. In addition, narrative focus was found to be related to children’s self-potency. The discussion deals with the study’s findings through the prism of developmental psychology, self-agency, object-relations, and art-therapy theories.

Background: Information is lacking on how concerns about child maltreatment are recorded in primary care records.Aim: To determine how the recording of child maltreatment concerns can be improved.Design and Setting: Development of a quality improvement intervention involving: clinical audit, a descriptive survey, telephone interviews, a workshop, database analyses, and consensus development in UK general practice.Method: Descriptive analyses and incidence estimates were carried out based on 11 study practices and 442 practices in The Health Improvement Network (THIN). Telephone interviews, a workshop, and a consensus development meeting were conducted with lead GPs from 11 study practices.Results: The rate of children with at least one maltreatment-related code was 8.4/1000 child years (11 study practices, 2009-2010), and 8.0/1000 child years (THIN, 2009-2010). Of 25 patients with known maltreatment, six had no maltreatment-related codes recorded, but all had relevant free text, scanned documents, or codes. When stating their reasons for undercoding maltreatment concerns, GPs cited damage to the patient relationship, uncertainty about which codes to use, and having concerns about recording information on other family members in the child's records. Consensus recommendations are to record the code 'child is cause for concern' as a red flag whenever maltreatment is considered, and to use a list of codes arranged around four clinical concepts, with an option for a templated short data entry form.Conclusion: GPs under-record maltreatment-related concerns in children's electronic medical records. As failure to use codes makes it impossible to search or audit these cases, an approach designed to be simple and feasible to implement in UK general practice was recommended. [ABSTRACT FROM AUTHOR]

This paper discusses patriarchy culture and women’s struggles in Pesan Cinta Dari Hujan, a novel written by Erni Aladjai (2010). Patriarchy culture can be seen in attitudes, behaviors, and actions conducted by male characters toward female characters. This paper adopts a feminist approach to explore patriarchy culture and women’s struggles in the novel. The findings show that patriarchy culture includes violence of domestic or women, violence of education and building children’s characters, and violence of space and movement given for self-actualization. Women characters’ struggles to fight patriarchy culture are determination, tear, and running.

Introduction: In the late 20th century, limb salvage surgery emerged as a game-changer for treating musculoskeletal tumors, evolving with advanced techniques to offer both survival and functional preservation. The objective of the study is to discuss key metrics, such as overall survival, metastasis-free survival, local recurrence-free survival, and functional outcomes, recognizing the importance of these measures. Despite hurdles such as potential infections and implant issues, it is crucial to understand and address complications, which is also highlighted in this study., Methods: This was a retrospective review of patients with primary malignant bone tumors from January 2017 to December 2023 and the progress was followed up till June 2024. Variables assessed included patient age, size and anatomical location of the primary tumor, metastasis, histological subtype, stage and grade of tumor, resection margins, treatment provided, functional outcome, and complications. The data were analyzed with SPSS version 27. Five-year metastasis-free survival, recurrence-free survival, and overall survival were analyzed by using the Kaplan-Meier method., Results: A total of 115 patients were analyzed, among which the most common type of tumor was osteosarcoma, found in 79 (68.7%) patients. Out of the 115 patients, 20 (17.4%) expired, six were lost to follow-up, and the five-year overall survival rate was approximately 78% (95% CI: 69.6-87.5%). Fourteen (12.2%) patients had local recurrence, and the five-year recurrence-free survival rate was approximately 83.2% (95% CI: 74.4-92.6%). Meanwhile, 27 (23.5%) patients had distant metastasis, and the five-year metastasis-free survival rate was approximately 67.5% (95% CI: 55.3-82.3%). Complications occurred in 31 (27%) patients, with 13 (11.3%) patients having local soft-tissue-related complications., Conclusion: We observed good survival and functional outcomes in patients treated with wide-margin excision of bone sarcomas and reconstruction with mega prostheses., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board (IRB) of Shaukat Khanum Memorial Cancer Hospital & Research Center (SKMCH&RC) issued approval EX-04-10-23-02. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Farooque et al.)

Introduction: Adamantinoma is a rare, locally aggressive bone tumor that primarily affects the long bones, with a predilection for the tibia. Although considered a low-grade malignancy, adamantinoma is notorious for its high propensity for recurrence, which poses significant clinical challenges in the management of affected individuals. This case report aims to explore the intricacies of recurrent adamantinoma of the tibia, shedding light on its clinical presentation, diagnostic modalities, treatment strategies, and prognostic factors., Objective: This case report aims to evaluate surgical and functional outcomes of post-excision and reconstruction in recurrent adamantinoma., Case Report: This retrospective case report includes the patient who presented in Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore with recurrent adamantinoma. Data were collected after patient's written and informed consent, and a retrospective analysis of the patient's demographics was done with the Statistical Package for the Social Sciences using the information in the Hospital Information System with a predesigned pro forma. Histology slides were collected from the Department of Pathology. Variables that were included are categorized into demographics, history and examination findings, site, and size of the primary tumor, radiological findings, histological type, stage, and resection margins. The patient underwent wide margin excision and reconstruction with free vascularized fibula graft and his functional outcome was evaluated using the musculoskeletal tumor society score which showed good functional outcome., Conclusion: Despite therapeutic challenges, wide excision of the tumor followed by free vascularized fibula grafting for reconstruction is a viable option to treat such patients where advanced prosthesis and allografts are not available., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Background: Rare diseases affect millions of people globally, with a lifetime incidence of 1 in 17. They are complex, multisystem, severe disease, and patients experience a diagnostic delay averaging 5.6 years with associated misdiagnoses, inappropriate treatments, and anxiety. MendelScan is a digital case-finding tool that uses structured primary care data to identify patients at risk of being affected by one of a series of rare diseases. This qualitative study explored primary healthcare professionals' experiences of implementing this technology., Aim: To develop an understanding of primary healthcare professionals' experiences of implementing MendelScan with a focus on their perception of the technology and its implementation, challenges and opportunities., Method: A qualitative appraisal of implementing MendelScan using descriptive analysis of surveys and semi-structured interviews with professionals., Results: A total of 11 professionals from the two project areas participated. Participants included GPs, nurses, a genetic counsellor, and healthcare managers.Participants reported that they received adequate support, the project increased confidence in integrating genetics in primary care, and that it may improve inequity in rare disease diagnosis. Professionals' reservations were related to knowledge, time commitments, primary care pressures, contacting patients, data sharing and confidentiality, and overcoming clinical resistance in sharing data with a non-NHS external body., Conclusion: This study provides a valuable insight into the experiences of primary care professionals using a novel tool to identify rare diseases. The potential of this tool is promising with benefits for skill development. Large-scale implementation faces challenges related to primary care capacity, data, and funding., (© British Journal of General Practice 2024.)

Introduction: The recommended treatment method for bone sarcoma is wide local excision and reconstruction to preserve limb function. Established methods of reconstruction are mega prosthesis or biological reconstruction. This study aimed to determine the complications and functional outcomes associated with limb salvage surgery using liquid nitrogen-treated bone., Materials and Methods: We retrospectively observed the short-term outcome of limb salvage surgeries where liquid nitrogen bone was used for reconstruction. A total of 15 patients underwent reconstruction with liquid nitrogen auto graft from January 2018 to December 2020. We used the free freezing method of liquid nitrogen treatment after wide local excision of sarcoma. We observed short-term outcomes after liquid nitrogen-treated bone reconstruction in limb salvage surgery. Survival of the auto grafts was recorded using the Kaplan-Meier method with a 95% confidence interval., Results: The mean follow-up was 19.83 ± 4.5 months. The mean musculoskeletal tumor society score was 62.4 ± 7.9%, while the average Toronto extremity score was 59.6 ± 5.7%. Three patients died during the study duration due to visceral metastasis. Skin necrosis and wound breakdown were major complications in 9 (60%) patients. Deep infection was observed in 4 (26.7%). Similarly, 4 (26.7%) patients had non-union at either the proximal or distal osteotomy site, while the average time of bone union in the rest of the patients was 6.3 ± 1.7 months. A total of 6 (40%) patients underwent reoperation after liquid nitrogen treatment, either due to infection or non-union at the osteotomy site. Recurrence was observed in 3 (20%) of patients., Conclusion: We observed a high complication rate with liquid nitrogen-treated autograft reconstruction. Vascularized fibula with liquid nitrogen-treated autograft or endoprosthesis should be encouraged., Competing Interests: The author(s) declare(s) that there is no conflict of interest., (Copyright: © 2024 Farooq MZ, et al.)

Sign language is a form of communication medium for speech and hearing disabled people. It has various forms with different troublesome patterns, which are difficult for the general mass to comprehend. Bengali sign language (BdSL) is one of the difficult sign languages due to its immense number of alphabet, words, and expression techniques. Machine translation can ease the difficulty for disabled people to communicate with generals. From the machine learning (ML) domain, computer vision can be the solution for them, and every ML solution requires a optimized model and a proper dataset. Therefore, in this research work, we have created a BdSL dataset and named `KU-BdSL', which consists of 30 classes describing 38 consonants ('banjonborno') of the Bengali alphabet. The dataset includes 1500 images of hand signs in total, each representing Bengali consonant(s). Thirty-nine participants (30 males and 9 females) of different ages (21-38 years) participated in the creation of this dataset. We adopted smartphones to capture the images due to the availability of their high-definition cameras. We believe that this dataset can be beneficial to the deaf and dumb (D&D) community. Identification of Bengali consonants of BdSL from images or videos is feasible using the dataset. It can also be employed for a human-machine interface for disabled people. In the future, we will work on the vowels and word level of BdSL., (© 2023 The Authors.)

Primary care remains the point of access to the NHS as well as having key roles in care coordination and prescribing. Therefore, embedding of genomic medicine in the NHS relies on successful implementation into the primary care landscape. Primary care is currently facing considerable challenges, including increasing numbers of patients and consultations per GP, multiple health conditions and polypharmacy, all contributing to increasing workload within a resource-constrained system. Although genomic medicine has enormous potential to benefit patients, its successful implementation demands alignment with existing skills and working practices, development of underpinning informatics infrastructure, integration into care pathways with consideration of commissioning and leadership. Here, we set out current initiatives and future strategies to support primary care colleagues in the delivery of genomic medicine, covering issues of workforce development and education, primary care leadership, and data and digital considerations., (© Royal College of Physicians 2023. All rights reserved.)

In November 2021 Claire Fuller led a national piece of work looking at primary care within integrated care systems (ICSs) to identify what was working well and why. The published report from this piece of work became known as the Fuller Stocktake. 1 In this interview, Professor Fuller sets out the process and principles behind the Stocktake., (© Royal College of Physicians 2023. All rights reserved.)

Purpose: When combined with radiotherapy, limb salvage surgery is an alternative to amputation. This study sought to determine the limb-sparing treatment outcomes in patients diagnosed with soft tissue extremity sarcomas treated at our institution., Materials and Methods: All adult patients with extremity soft tissue sarcoma treated with the radical limb salvage strategy at Shaukat Khanum Memorial Cancer Hospital and Research Canter, Lahore, Pakistan, between January 2017 and December 2019 were retrospectively assessed., Results: A total of 122 patients were included in the study. The mean age was 42 years (range 19-82), and 64 (52.5%) were males. The majority of patients, 65 (53.3%), were diagnosed with stage III and grade III disease according to American Joint Committee on Cancer TNM classification (Eighth edition). The most common surgical modality was wide local excision that was performed in 106 (86.9%) patients. Adjuvant radiation treatment was given in 111 (91%) patients, whereas 11 (9%) patients received neoadjuvant radiation treatment. The mean dose was 58 Gy (range: 46-66 Gy). Eighty-two (67.2%) of the patients were disease-free on post-treatment radiologic scans with disease recurrence observed in 40 (32.8%) patients. The median disease-free survival was 8 months (95% CI, 5.45 to 10.55). Local recurrence and distant metastases developed in 16 (13%) and 24 (20%) patients, respectively., Conclusion: About two thirds of patients with extremity soft tissue sarcoma were successfully treated with limb salvage strategy, surgery, and radiation therapy. However, high rate of relapse warrants further novel strategies in this patient population.

Seasonal vaccination against influenza and in-pandemic COVID-19 vaccination are top public health priorities; vaccines are the primary means of reducing infections and also controlling pressures on health systems. During the 2018-2019 influenza season, we conducted a study of the knowledge, attitudes, and behaviours of 159 general practitioners (GPs) and 189 patients aged ≥65 years in England using a combination of qualitative and quantitative approaches to document beliefs about seasonal influenza and seasonal influenza vaccine. GPs were surveyed before and after a continuing medical education (CME) module on influenza disease and vaccination with an adjuvanted trivalent influenza vaccine (aTIV) designed for patients aged ≥65 years, and patients were surveyed before and after a routine visit with a GP who participated in the CME portion of the study. The CME course was associated with significantly increased GP confidence in their ability to address patients' questions and concerns about influenza disease and vaccination ( p < 0.001). Patients reported significantly increased confidence in the effectiveness and safety of aTIV after meeting their GP. Overall, 82.2% of the study population were vaccinated against influenza (including 137 patients vaccinated during the GP visit and 15 patients who had been previously vaccinated), a rate higher than the English national average vaccine uptake of 72.0% that season. These findings support the value of GP-patient interactions to foster vaccine acceptance.

Medical students represent a significant part of the health-care community and are active members of the coronavirus disease 2019 (COVID-19) response. This study aimed to evaluate various factors associated with COVID-19 vaccine intention among medical students via an online anonymous survey. A total of 370 students completed the online survey, with 229 (61.89%) not vaccinated for COVID-19. Of students not yet vaccinated, 45 (19.65%) were unsure or did not intend to accept the vaccine, while 184 (80.35%) intend to be vaccinated within 6 months. Overall, female gender, health status, clinical science enrollment, and the practice of COVID-19 preventative behaviors significantly correlated with the intention to be vaccinated within 6 months. Greater perceived risk for contracting COVID-19, lesser beliefs that the COVID-19 vaccination trials were rushed, and greater beliefs that being vaccinated would help complete their medical education were uniquely associated with the intention to be vaccinated within 6 months. Collectively, this study identified several factors that influenced medical students' intention to receive the COVID-19 vaccination. This information may be used in future immunization strategies to increase the vaccination rates among this group of future medical professionals.

Introduction Extremity soft-tissue sarcomas are uncommon malignancies of mesenchymal tissue, it accounts for <1 % of cancers and has a high recurrence rate with positive resection margins and unplanned excision. This study aims to determine the influence of unplanned excision and resection margins on local recurrence, metastasis, and overall survival in soft tissue sarcoma of the extremities. Methods A retrospective review was conducted from January 2005 to December 2015 on all the patients with soft tissue sarcoma of the extremities. Age, sex, histopathology, site, tumor grade, biopsy type, recurrence, metastasis, and end outcome were analyzed. Kaplan-Meir curves were used for Survival analysis, and log-rank or the Cox proportional-hazards regression model was used for Significance analysis. The data were entered into SPSS version 20, and Statistical significance was set at a p-value ≤0.05. Results One hundred forty-five patients with soft tissue sarcoma of extremities were managed with a mean follow-up of 76.3+/-6.7 months. Undifferentiated pleomorphic sarcoma 47 (32.4%) was the most common pathology found in this cohort, followed by Synovial sarcoma 34 (23.4%) and Liposarcoma 19 (13.1%). The most common site of occurrence was lower extremity 102 (70.3%). All the patients had residual disease after unplanned excisions; 107 underwent R0 resection, while 38 underwent R1 resection. Five-year overall survival was 70.2 & 71.1 % for R1 & R0 resections, respectively, and 71.3% for excisional and 74.2% for incisional biopsy. The tumor grade significantly influences overall survival, while other variables were not found to affect Recurrence-free survival and metastasis-free survival. Conclusion The data indicates that the high-grade tumor has a negative influence on overall survival, while resection margins width and unplanned excision have no significant effect on local recurrence, Metastasis free survival, and overall survival; however, before excision, adequate planning and awareness among general surgeons is necessary to improve the surgical morbidity and financial burden over the health care facilities., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Shafiq et al.)

Acacia modesta (AM) and Opuntia monocantha (OM) are distributed in Pakistan, Afghanistan and India. Both of these plants have different pharmacological properties. This study was designed to evaluate anticancer potential of Acacia modesta (AM) and Opuntia monocantha (OM). Liver cancer cell line HepG2 was used for assessment of anticancer activity. For the evaluation of anti-proliferative effects, cell viability and cell death in all groups of cells were evaluated via MTT, crystal violet and trypan blue assays. For the evaluation of apoptosis ELISA of p53 performed. Furthermore, LDH assay to find out the ability of malignant cells to metabolize pyruvate to lactate and antioxidant enzymes activity (GSH, CAT and SOD) at the end HPLC was performed to find active compound of AM and OM. Cytotoxicity (MTT), Viability assays (trypan blue, crystal viability, MUSE analysis) showed more dead, less live cells in plant treated groups with increase of concentration. Scratch assay for the anti-migratory effect of these plants showed treated groups have not ability to heal scratch/wound. ELISA of p53 for cellular apoptosis showed more release of p53 in treated groups. Antioxidant assay via glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) showed less anti-oxidative potential in treated cancer groups. LDH assay showed more lactate dehydrogenase release in treated groups compared with untreated. HPLC analysis showed the presence of phytochemicals such as steroids, alkaloids, phenols, flavonoids, saponins, tannins, anthraquinone and amino acids in AM and OM plant extracts. Based on all these findings, it can be concluded that ethanolic extracts of Acacia modesta and Opuntia monocantha have promising anti-cancer potential.

We have produced gene expression profiles of all 302 neurons of the C. elegans nervous system that match the single-cell resolution of its anatomy and wiring diagram. Our results suggest that individual neuron classes can be solely identified by combinatorial expression of specific gene families. For example, each neuron class expresses distinct codes of ∼23 neuropeptide genes and ∼36 neuropeptide receptors, delineating a complex and expansive "wireless" signaling network. To demonstrate the utility of this comprehensive gene expression catalog, we used computational approaches to (1) identify cis-regulatory elements for neuron-specific gene expression and (2) reveal adhesion proteins with potential roles in process placement and synaptic specificity. Our expression data are available at https://cengen.org and can be interrogated at the web application CengenApp. We expect that this neuron-specific directory of gene expression will spur investigations of underlying mechanisms that define anatomy, connectivity, and function throughout the C. elegans nervous system., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The generation of the enormous diversity of neuronal cell types in a differentiating nervous system entails the activation of neuron type-specific gene batteries. To examine the regulatory logic that controls the expression of neuron type-specific gene batteries, we interrogate single cell expression profiles of all 118 neuron classes of the Caenorhabditis elegans nervous system for the presence of DNA binding motifs of 136 neuronally expressed C. elegans transcription factors. Using a phylogenetic footprinting pipeline, we identify cis- regulatory motif enrichments among neuron class-specific gene batteries and we identify cognate transcription factors for 117 of the 118 neuron classes. In addition to predicting novel regulators of neuronal identities, our nervous system-wide analysis at single cell resolution supports the hypothesis that many transcription factors directly co-regulate the cohort of effector genes that define a neuron type, thereby corroborating the concept of so-called terminal selectors of neuronal identity. Our analysis provides a blueprint for how individual components of an entire nervous system are genetically specified., Competing Interests: LG, ST, KL, LP, MR, MB, IR, EY, RP, NS, MH, DM No competing interests declared, OH Reviewing editor, eLife, (© 2021, Glenwinkel et al.)

Sexual differentiation is controlled by diverse master regulatory factors across the animal kingdom. The transcription factor TRA-1 is the master regulator of somatic sexual differentiation in the nematode C. elegans, where it was reported to be expressed sex-specifically in the non-gonadal soma of hermaphrodites. Using a gfp-tagged allele of tra-1, we reveal unanticipated dynamics of TRA-1 protein expression in five dimensions: space, time, sex, environment, and subcellular localization. We show temporal regulation of TRA-1 protein accumulation in somatic tissues with different onsets of expression in different tissue types, indicating that sexual identity is not uniformly imposed. In hermaphrodites, neuronal expression is initially highly restricted and then increases variably between individuals during larval development until reaching panneuronal expression in the fourth larval stage. Unexpectedly, TRA-1 also accumulates in a subset of sex-shared neurons in the male. Additionally, a food signal is required to turn on TRA-1 expression in the intestine, and environmental stressors shut off TRA-1 expression in the entire non-gonadal soma, suggesting that somatic sexual differentiation may be affected by external conditions. We show that, in contrast to the protein degradation mechanisms that control TRA-1 accumulation in the adult, the temporal, sexual, and spatial specificities of TRA-1 accumulation during development are regulated transcriptionally. A nuclear hormone receptor, daf-12, previously implicated in developmental timing in C. elegans, contributes to temporal accumulation of TRA-1 in the nervous system. Our studies reveal a mosaic and dynamic nature of sexual identity acquisition and uncover hormonal control mechanisms for sexual differentiation of the brain., Competing Interests: Declaration of Interests The authors declare no competing interests., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Primary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees' preparation for, or experiences and perceptions of, them., Aim: To understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations., Design & Setting: A mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees., Method: A cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis., Results: The survey response was 16% ( n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence ( R 2 = 0.71, P <0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations., Conclusion: This project sheds light on GP trainees' current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies., (Copyright © 2020, The Authors.)