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Pengetahuan dan kebijaksanaan adalah nilai keutamaan tentang fungsi kognitif. Pengetahuan dapat diimplementasikan dalam peningkatan kualitas hidup manusia. Dalam konteks pendidikan karakter bangsa, nilai kreatif, rasa ingin tahu, dan gemar membaca merupakan faktor kekuatan karakter yang membangun nilai keutamaan pengetahuan dan kebijaksanaan. Kajian ini bertujuan untuk memeriksa struktur nilai-nilai karakter bangsa yang menjadi bagian dari nilai keutamaan pengetahuan dan kebijaksanaan. Penelitian ini melibatkan 780 responden siswa SMA. Dapatan kajian menunjukkan bahwa terbentuk tiga faktor kekuatan karakter yaitu kreatif, rasa ingin tahu, dan gemar membaca. Ketiga faktor tersebut merupakan faktor yang dapat membangun nilai keutamaan pengetahuan dan kebijaksanaan.Kata kunci: pengetahuan dan kebijaksanaan, pendidikan karakter bangsa THE EXCELLENCE VALUES OF KNOWLEDGE AND WISDOM IN NATIONAL CHARACTER EDUCATION CONTEXT Abstract Knowledge and wisdom are the excellence value of cognitive function. Knowledge can be implemented in improving the quality of human life. In the context of the nation’s character education, the values of creativity, curiosity and reading habits are the factors of character strengths that build the excellence value of knowledge and wisdom. This study is aimed at examining the structure of the nation's character values which become part of knowledge and wisdom priorities. The study involved 780 senior high school students as the respondents. The findings of the study show that there are three factors of character strength, including creativity, curiosity, and reading habits. These three factors are the factors that can build the excellence value of knowledge and wisdom. Keywords: knowledge and wisdom, national character education

In recent years, low-impact development (LID) has been well established as a method to provide the best and most affordable solutions for managing and alleviating the negative impacts of urban floods. Application of this practical method is regarded as a major step toward sustainable development as it employs eco-friendly storage instruments, reduces the effects of urbanization on impervious surfaces, and helps water infiltration to recharge groundwater resuorces. Although low-impact development tools have proved effective in the management of surface water resources and conservation of water quality, finding proper locations for the deployment of the equipment and the optimal use of each tool are still questions of much controversy and no definitive solutions are provided yet as environmental conditions keep changing. The present study exploits bio-retention cells, rain barrels, green roofs, and vegetable swales as storage instruments under different rainfall scenarios with return periods from 2 to 100 years extracted from the statistical data of Sanadaj City to determine the flood volumes and hydrographs for each sub-basin before and after the low-impact development tools are employed. Moreover, SWMM 5.1 software developed by the American Environmental Protection Agency is used to develop hydraulic and hydrologic models of the basin and the changes are monitored with each development tool selected. The most outstanding results obtained from this study include the change observed in thet form of hydrograph, a reduction of 50% in time of concentration, and reductions of 35 to 50% in peak flow in the city of Sanadaj as a result of employing the low-impact development method. Conclusion: Classification of the equipment into infiltration and storage tools used for urban runoff control allows the best runoff control model to be developed such that the grounds are prepared not only for the return to the conditions before a certain development took place but even for flood management in challenging and riskful urban areas.

Heart failure (HF) is a common, disabling, and costly disease. Despite major advances in medical therapy, morbidity and mortality remain high, in part because current pharmacological regimens may not fully address some unique requirements of the heart for energy. The heart requires a continuous supply of energy-providing substrates and amino acids in order to maintain its function. In HF, defects in substrate metabolism and cardiac energy and substrate utilization may contribute to contractile dysfunction. HF is often accompanied by a deficiency in key micronutrients required for unimpeded energy transfer. Correcting these deficits has been proposed as a method to limit or even reverse the progressive myocyte dysfunction and/or necrosis in HF. This review summarizes the existing HF literature with respect to supplementation trials of key micronutrients involved in cardiac metabolism: coenzyme Q10, l-carnitine, thiamine, and amino acids, including taurine. Studies using a broader approach to supplementation are also considered. Although some of the results are promising, none are conclusive. There is a need for a prospective trial to examine the effects of micronutrient supplementation on morbidity and mortality in patients with HF. [Copyright &y& Elsevier]

Background: Previous studies have found that children with epilepsy, are at higher risk of psychiatric comorbidity compared to children with other illnesses. Objective: To study the psychiatric comorbidity and associated. risk factors in children with epilepsy in a Malaysian population. Design: This was a cross sectional study. Materials and Methods: Data on IQ (which had been previously determined), sociodemography and seizure characteristics were collected. Screening for psychiatric disorder was performed using MINI Kid screening and clinical interview based on DSM-IV criteria. Descriptive analysis was used for sociodemographic data and seizure characteristics. The association between risk factors and psychiatric comorbidity was determined using chi-square and independent t-tests. Results: 92 patients with epilepsy were examined. 14 (15.2%) were found to have a comorbid psychiatric disorder. The diagnoses were Major depressive disorder (7.1%), Separation anxiety disorder (7.1%), Tic disorder (14.3%), Psychotic disorder (14.3%), Attention deficit hyperactive disorder (ADHD) (57.1%). There was a significant association between psychiatric comorbidity and mental retardation but no association with age of onset, frequency or type of seizure, number of antiepileptic drug taken, or family history of mental illness. Conclusion: Psychiatric comorbidity was relatively frequent among children with epilepsy and the most common diagnosis was ADHD. Screening for psychiatric disorder in children with epilepsy may be useful for early detection and intervention. [ABSTRACT FROM AUTHOR]

Abstract Background Mental disorders are considered important public health problems not only to people with mental illness but also their caregivers. As is the case in many countries, the deinstitutionalization of mental health services in Saudi Arabia, has meant that informal caregivers are shouldering responsibilities for which they are not usually prepared; therefore, the current study was aimed at assessment of the burden on caregivers of people with mental illness. Methods Through a cross-sectional design, a sample of the caregivers of people with mental illness (n = 377) was selected randomly from a psychiatric hospital in Jeddah. An Arabic version of the Involvement Evaluation Questionnaire (IEQ) was used for collection of data. The data were analyzed on the subscale scores and the 27 items in two ways. First, we used the summed scores for the subscales based on the Likert scale (0–4) for univariate and multivariate statistical analyses, as recommended. We also used parametric statistics (t-tests, one-way ANOVA) because the IEQ subscale scores were fairly normally distributed. Results Males constituted more than one-half of the participating caregivers (55%), with a mean age of 36.6, SD = 11.4 years. As reported by the caregivers, most of the patients were males (62.7%) with a mean age of 33.8, SD = 13.7 years and a range of 17–90 years old. The total mean IEQ burden score of the caregivers was 38.4, SD = 17.5. “Tension” was significantly prominent among younger caregivers aged ≤30 years. “Worrying” was significantly higher among caregivers living with their spouse and children and those living in families with relatively fewer members (

Objectives: Health promotion is the main strategy for encouraging people to adopt a healthy lifestyle and for preventing non-communicable diseases. Medical students, in particular, are expected to have an important role in health promotion in their near future as physicians. The aim of this study was to determine and evaluate all six components of the Health-Promoting Lifestyle Profile and its sociodemographic determinants among medical students. Methods: A cross-sectional descriptive study was conducted in January 2018 in Jeddah, Saudi Arabia. The questionnaire used in this study consisted of two parts: the first part included sociodemographic questions and body mass index measurement and the second part consisted of questions from the Health-Promoting Lifestyle Profile II. Results: The study enrolled 243 medical students, of which 55.1% were male, 39.5% were in their fifth year, and more than half had a monthly family income above 20,000 Saudi Riyal. The mean body mass index of the respondents was 25.1 ± 5.2 (range = 13.7–43.8). The total mean score of the Health-Promoting Lifestyle Profile II was 123.8 ± 19.8 (range = 72–191). Study findings showed that health-promoting profiles differed by gender, particularly with respect to physical activity and interpersonal relationships. Factors were found to be associated with the Health-Promoting Lifestyle Profile II subscales, including income and year of study. Conclusions: University students, and in particular health science students, represent an appropriate area for health promotion interventions to be established.

Perceived control can be broadly defined as the belief in one’s ability to exert control over situations or events. It has long been known that perceived control is a major contributor toward mental and physical health as well as a strong predictor of achievements in life. However, one issue that limits a mechanistic understanding of perceived control is the heterogeneity of how the term is defined in models in psychology and neuroscience, and used in experimental settings across a wide spectrum of studies. Here, we propose a framework for studying perceived control by integrating the ideas from traditionally separate work on perceived control. Specifically, we discuss key properties of perceived control from a reward-based framework, including choice opportunity, instrumental contingency, and success/reward rate. We argue that these separate reward-related processes are integral to fostering an enhanced perception of control and influencing an individual’s behavior and well-being. We draw on select studies to elucidate how these reward-related elements are implicated separately and collectively in the investigation of perceived control. We highlight the role of dopamine within corticostriatal pathways shared by reward-related processes and perceived control. Finally, through the lens of this reward-based framework of perceived control, we consider the implications of perceived control in clinical deficits and how these insights could help us better understand psychopathology and treatment options.

On one hand businesses can be criticized by Non-Governmental Organization (NGOs) scrutiny, one the other hand companies can be supported from NGOs to remove the barriers and positively influence on customer perceptions. The aim of this study is to critically assess the role of NGOs in sustainability two different perspectives, namely, “coercive view” and “supportive view”. This study may benefit the NGOs partnering with Multination Companies (MNCs) to identify the effect of this partnership on small and medium enterprises (SMEs). Also, SMEs and MNCs can use the framework to mind more the role of NGOs in their SSCM. Using literatures support, This Study found that, NGOs support MNCs can lead to MNCs reputation and empowering, whereas this relationship make some barrier in SMEs’ sustainability practice by increasing costs of new market entry. Moreover, SMEs can use NGOs support to remove adoption barriers and increase their profits.

To determine whether the free availability of antimicrobial agents leads to misuse through self-medication, a house-to-house semi-structured interview was held in three different socio-economic areas of Karachi, Pakistan. Of the 2348 households visited, 1342 (57%) participated; this included 9209 individuals. Three hundred and twenty-two (3.5%) had used one or more antimicrobial in the previous 4 weeks, equivalent to 43 agents per 1000 persons per month. The most frequently used agents were amoxycillin (16.7%), co-trimoxazole (15.7%), erythromycin (10.9%), ampicillin/cloxacillin (Ampiclox, 9.1%) and metronidazole (4.5%). Of these, 91.4% were prescribed by a physician, 2.3% were advised by a chemist and 6.3% were used as self-medication. Self-medication increased with socio-economic status. High levels of resistance were found to ampicillin, co-trimoxazole, chloramphenicol and erythromycin. If these high resistance levels are related to the high frequency of antimicrobial use, over-the-counter availability cannot be held responsible. Education of the medical profession seems to be the single most important tool to control misuse of antimicrobial agents. Innovative approaches for continuous medical education are urgently needed. [ABSTRACT FROM AUTHOR]

OBJECTIVES:This matched-cohort retrospective study investigated the long-term (9-year) safety and efficacy outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention (pPCI) with Genous (n = 102) versus TAXUS Liberté (n = 101) stents in 2006-2008. BACKGROUND:In the era of off-label use of drug-eluting stents for pPCI in patients with STEMI, the use of first-generation Genous stents (endothelial progenitor cell capture stents that have a passive coating and accelerate re-endothelialization) was proposed. METHODS:The primary endpoint was 9-year major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, re-infarction, target vessel revascularization (TVR), and stroke. The secondary endpoints were the separate primary endpoint events at pre-defined time-points (in-hospital, 6 months, and yearly) and stent thrombosis. Time-dependent 9-year composite MACCE, all-cause death, and TVR were compared using Kaplan-Meier estimates and multivariate Cox regression models. RESULTS:Propensity score analysis confirmed the comparability of the groups. Patients in the Genous and TAXUS groups had 7 and 1 acute definitive stent thrombosis events, respectively (p

Hurricane Matthew caused flooding in Eastern North Carolina that was categorized as a one in 500-year frequency event. Matthew was the second such event in less than 20 years, following Hurricane Floyd in 1999. The frequency of intense storms is projected to increase for many coastal areas, including North Carolina, because of climate change. The goal of this study was to gain a better insight into the geochemistry of flood waters associated with major flood events. Water samples (n = 22) from the Tar River in Greenville, North Carolina were collected over a two-week period after Matthew moved across the state. Results show that total Kjeldahl nitrogen, dissolved organic carbon, phosphate, and Escherichia coli concentrations and exports were significantly (p < 0.05) higher when the river was above flood stage relative to below. Isotopic analyses of δ15N and δ18O in NO3 in flood waters suggest that wastewater, possibly from sanitary sewer and confined animal feeding operation overflows, was the major source of nitrate associated with flood waters. Regulatory efforts to reduce nutrient loading to coastal waters may be complicated by contributions associated with intense storm events, given that such storms are becoming more frequent.

On one hand businesses can be criticized by Non-Governmental Organization (NGOs) scrutiny, one the other hand companies can be supported from NGOs to remove the barriers and positively influence on customer perceptions. The aim of this study is to critically assess the role of NGOs in sustainability two different perspectives, namely, “coercive view” and “supportive view”. This study may benefit the NGOs partnering with Multination Companies (MNCs) to identify the effect of this partnership on small and medium enterprises (SMEs). Also, SMEs and MNCs can use the framework to mind more the role of NGOs in their SSCM. Using literatures support, This Study found that, NGOs support MNCs can lead to MNCs reputation and empowering, whereas this relationship make some barrier in SMEs' sustainability practice by increasing costs of new market entry. Moreover, SMEs can use NGOs support to remove adoption barriers and increase their profits. Keywords: NGOs, Sustainable Supply Chain Management JEL Classifications: L31, M14, Q50

Objetivo: descrever as possíveis ações gerenciais do enfermeiro no setor de emergência. Método: estudo exploratório e descritivo, com abordagem qualitativa, do tipo bibliográfica, onde se evidenciou periódicos pertinentes à pesquisa nos anos de 2000 a 2007, através do meio eletrônico da Biblioteca Virtual em Saúde (BVS), com acesso a artigos científicos contidos na SCIELO. Resultados: Emergiram três categorias: teorias administrativas no trabalho de enfermagem; o gerenciamento de enfermagem; e gerenciamento e sistematização da assistência de enfermagem no setor de emergência. Conclusão: o enfermeiro deve buscar constantemente ações que o auxiliem no gerenciamento, oportunizando assistência qualificada, identificando dados e aspectos referentes àquele setor e usuários. Adotar uma reflexão sobre o contexto social e organizacional, no qual está imerso, o conduz à possibilidade de se tornar crítico, para tanto, evidencia-se a necessidade de investimentos na capacitação, na educação permanente, a fim de possibilitar interpretações de posturas cristalizadas no cotidiano.

Developing new products in a complex environment, such as in the telecommunications industry, involves significant integrated effort-particularly between that of R&D and Marketing. The failure to integrate R&D and Marketing in new product development can result in over-designed, over-priced, and either obsolete or radically-advanced products with little customer value. This paper attempts to offer insights into R&D and Marketing integration in. the telecommunications industry in Malaysia. In general, only a few telecommunication companies have achieved effective R&D-Marketing integration which is significant in certain areas requiring the integration.

Abstract Background Tuberculosis causes 3 million deaths annually. The most common site of tuberculosis is pulmonary however; extra-pulmonary forms of the disease also remain prevalent. Restriction of Mycobacterium tuberculosis depends on effective recruitment and subsequent activation of T lymphocytes, mononuclear and polymorphonuclear cells to the site of infection. Tumor necrosis factor (TNF)-α is essential for granuloma formation and is a potent activator of monocyte chemotactic protein (MCP-1, CCL2). CCL2 is essential for recruitment of monocytes and T cells and has been shown to play a role in protection against tuberculosis. Interleukin -8 (CXCL8) is a potent activator of neutrophils. Increased levels of CCL2, CXCL8 and TNFα are reported in tuberculosis but their significance in different forms of tuberculosis is as yet unclear. We have used an ex vivo assay to investigate differences in immune parameters in patients with either pulmonary or extra-pulmonary tuberculosis. Methods Serum levels of CCL2, CXCL8 and TNFα were measured in patients with pulmonary tuberculosis (N = 12), extra-pulmonary tuberculosis (N = 8) and BCG-vaccinated healthy volunteers (N = 12). Whole blood cells were stimulated with non-pathogenic Mycobacterium bovis bacille-Calmette Guerin (BCG) vaccine strain or bacterial lipopolysaccharide (LPS) and cyto/chemokines were monitored in supernatants. Results Circulating serum levels of CXCL8 and TNFα were raised in all tuberculosis patients, while CCL2 levels were not. There was no difference in spontaneous cytokine secretion from whole blood cells between patients and controls. M. bovis BCG-induced ex vivo CCL2 secretion was significantly greater in pulmonary as compared with both extra-pulmonary tuberculosis patients and endemic controls. In response to LPS stimulation, patients with pulmonary tuberculosis showed increased CCL2 and TNFα responses as compared with the extra-pulmonary group. BCG-, and LPS-induced CXCL8 secretion was comparable between patients and controls. Conclusion CCL2 is activated by TNFα and is essential for recruitment of monocytes and T cells to the site of mycobacterial infection. Increased CCL2 activation in pulmonary tuberculosis may result in a stronger cellular response as compared with extra-pulmonary tuberculosis patients, and this may contribute to the localization of infection to the pulmonary site.

The diversity of the U.S, population is currently not reflected in the genomic workforce and across the greater scientific enterprise. Although diversity and inclusion efforts have focused on increasing the number of individuals from underrepresented groups across scientific fields, structural racism remains. Thus, the cultivation and adoption of diversity as an ethos requires shifting our focus to being intentional about an institution's character, culture, and climate. One way for this ethos to be sustained is by facilitating an intentional anti-racism approach within the field. Adopting a new perspective on diversity utilizing art anti-racism approach will support genomics researchers as we build supportive, collaborative research environments. We seek to expand critical thought in the framing of diversity in the research enterprise and propose an anti-racism approach that informs deliberate actions required to address structural racism. [ABSTRACT FROM AUTHOR]

Objective: To determine whether apolipoprotein (APOE) genotype influences neuropsychological outcome in patients with mild and moderate traumatic brain injury (TBI). Patients and Method: Subjects were 19 patients (one female and 18 males, 25.79 ± 7.22 years) diagnosed with non-penetrating mild and moderate head injury based on the Glasgow Coma Scale at the time of admission and resuscitation. Blood samples were analyzed for the APOE gene utilizing the restriction enzyme method. Seven subjects had at least 1 APOE ε4 allele and were compared on neuropsychological measures (executive function, verbal learning and memory, verbal fluency, abstract reasoning, speed of processing and index of emotional distress) to those who were APOE e4 negative at baseline (approximately 6 weeks) and 6 months post-injury. Both groups were matched on age, years of education and intelligence. Data were analyzed using a 2-way (APOE Genotype x Time) ANOVA with repeated measures on the second factor. Results: There was a time effect for executive function (22.21±15.28 vs. 13.58±10.16, p=0.006, eta2=0.367). No interaction or main effects were found for verbal learning and memory, verbal fluency, abstract reasoning, speed of processing and emotional distress index. Discussion and Conclusion: While the sample size is small, the initial results seem to agree with the current findings that there might be no clear APOE genotype influence on the recovery curves of patients with mild and moderate TBI. An extension of this research to include a larger sample size and longer follow-up may further elucidate the understanding of the association of APOE genotype and neuropsychological outcome. [ABSTRACT FROM AUTHOR]

This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44-69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28-34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13-9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38-3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26-4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28-3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95-3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35-0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39-3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37-5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves., (© 2024. The Author(s).)

Background: Research evidence suggests gender-based differences in the extent and experiences of academic leaders across the globe even in developed countries like USA, UK, and Canada. The under-representation is particularly common in higher education organizations, including medical and dental schools. The current study aimed to investigate gender-based distribution and explore leaders' experiences in the medical and dental institutes in a developing country, Pakistan., Methods: A mixed-method approach was used. Gender-based distribution data of academic leaders in 28 colleges including 18 medical and 10 dental colleges of Khyber Pakhtunkhwa, Pakistan were collected. Qualitative data regarding the experiences of academic leaders (n = 10) was collected through semi-structured interviews followed by transcription and thematic analysis using standard procedures., Results: Gender-based disparities exist across all institutes with the greatest differences among the top-rank leadership level (principals/deans) where 84.5% of the positions were occupied by males. The gender gap was relatively narrow at mid-level leadership positions reaching up to as high as > 40% of female leaders in medical/dental education. The qualitative analysis found gender-based differences in the experiences under four themes: leadership attributes, leadership journey, challenges, and support., Conclusions: The study showed that women are not only significantly under-represented in leadership positions in medical and dental colleges in Pakistan, they also face gender-based discrimination and struggling to maintain a decent work life balance. These findings are critical and can have important implications for government, organizations, human resource managers, and policymakers in terms of enacting laws, proposing regulations, and establishing support mechanisms to improve gender-based balance and help current and aspiring leaders in their leadership journey., (© 2024. The Author(s).)

The use of alternative energy sources, particularly solar energy, in buildings is rising and spreading around the globe. In this paper, a solar wall is analyzed using a numerical method. On the wall, a number of obstacles are placed in two shapes, rectangular (REC) and semicircular (SEC). The cavities are filled with organic phase-change materials. This study was performed in 7 h in the absence of solar radiation on the wall for different dimensions of obstacles in 5 different modes. Various temperatures have been investigated, including exhaust air temperature (TAR), Trombe wall temperature (TWL), and mean volume % of molten PCM in cavities. COMSOL software is used to carry out this numerical study. The results of this study showed that the use of SECs compared to RECs causes the TWL to be higher. In the most extreme case, at a 16 cm aspect ratio, the use of SECs gives a 2.1 °C increase in TWL relative to the REC one. The outlet TAR is also increased by the usage of SECs. The use of larger dimensions of the cavities has increased the TAR leaving the wall so that the TAR after 7 h of the absence of solar radiation, in the most significant case of SECs, was more than 295.5 K. The use of SECs also increases the PCM freezing time. In the largest case of cavities, using SECs increases the freezing time by 15 min compared to RECs., (© 2023. The Author(s).)

The key feature that enables soft sensors to shorten the performance gap between robots and biological structures is their deformability, coupled with their capability to measure physical changes. Robots equipped with these sensors can interact safely and proprioceptively with their environments. This has sparked interest in developing novel sensors with high stretchability for application in human-robot interactions. This study presents a novel ultrasoft optoelectronic segmented sensor design capable of measuring strains exceeding 500%. The sensor features an ultrastretchable segment physically joined with an asymmetrically configured soft proprioceptive segment. This configuration enables it to measure high strain and to detect both the magnitude and direction of bending. Although the sensor cannot decouple these types of deformations, it can sense prescribed motions that combine stretching and bending. The proposed sensor was applied to a highly deformable scissor mechanism and a human-robot interface (HRI) device for a robotic arm, capable of quantifying parameters in complex interactions. The results from the experiments also demonstrate the potential of the proposed segmented sensor concept when used in tandem with machine learning, affording new dimensions of proprioception to robots during multilayered interactions with humans.

Objective: Dental institutes continue to face challenges in making the transition from a discipline-based to an integrated curriculum. The need analysis is often the first step in the development and implementation of any curriculum. This study intends to carry out a needs analysis for a contemporary dental curriculum in private and public sector dental colleges of Peshawar, KPK, Pakistan., Methods: The mixed method study was carried out at public and private dental institutes in Peshawar from April to July 2022. To guarantee triangulation, data were gathered from three sources. The first source was an analysis of the Pakistan Medical and Dental Council's dental curriculum accreditation standards. The second source was gathering the experts' perspectives, and the final source was a systematic literature search to explore the necessity for an integrated undergraduate dental curriculum from the experiences and expertise of contemporary curricula., Results: Thematic analysis identified the need for the dental curriculum to be a five-year BDS program, involvement of students, and inclusion of digital dentistry and environmental sustainability in the dental curriculum. PMDC accreditation standards focus on alignment in mission, vision, curricular outcomes, an integrated curriculum, and a quality assurance system for assessment. Experts identified the need for a patient-centered curriculum focusing on integrated patient care. They also identified that the current educational environment should be improved to sustain a contemporary dental curriculum in Pakistan. For the literature review, nine articles were included in the final review., Conclusion: The current dental curriculum is not accommodating to the needs of the students in Peshawar. The current dental education environment lacks the infrastructure, logistics, and teacher training to sustain the standards set by PMDC., (Copyright: © Pakistan Journal of Medical Sciences.)

Introduction: Influenza is a serious underestimated viral infection in Pakistan and influenza vaccination and vaccination awareness are low. The current work aimed to develop consensus on influenza epidemiology, prevention, vaccination, and awareness in Pakistan., Methodology: A systematic literature search was conducted to develop recommendations on influenza vaccines in Pakistan. Experts' feedback was incorporated using the modified Delphi method. A three-step process was used, with 18 experts from different specialties from Pakistan who participated in voting rounds to achieve a minimum 75% agreement level., Results: Pakistan has a low-immunization-rate and is susceptible to serious influenza outbreaks and influenza-related complications. Influenza circulates year-round in Pakistan but peaks during January and February. The subtype A/H1N1 is predominant. The experts urged vaccination in all individuals ≥ 6 months of age and with no contraindications. They highlighted special considerations for those with comorbidities and specific conditions. The experts agreed that the inactivated influenza vaccine is safe and efficient in pregnant women, immunocompromised, and comorbid respiratory and cardiovascular patients. Finally, the experts recommended conducting promotional and educational programs to raise awareness on influenza and vaccination., Conclusions: This is the first regional consensus on influenza and influenza vaccination in Pakistan with experts' recommendations to increase influenza vaccination and decrease influenza cases and its associated detrimental effects., Competing Interests: Raeefuddin Ahmed and Tabrez Ali are salaried and full-time employees of Abbott Laboratories (Pakistan) Limited. Uzma Bashir participated in the activity as a subject matter expert with no financial benefits received for the technical support provided, (Copyright (c) 2024 Bushra Jamil, Raeefuddin Ahmed, Uzma Bashir, Shobha Luxmi, Samreen Kulsoom, Saadia Ashraf, Muhammad H Hamid, Fawad Farooq, Ainan Arshad, Altaf Hussain, Tabrez Ali.)

Pakistan has been a hub of several HIV outbreaks over the last 2 decades, with four major outbreaks being registered since 2018. There has been a recent rise in HIV infections, especially in high-risk populations, mainly consisting of people who inject drugs, men who have sex with men, prisoners, the transgender women community, and female sex workers. Consistently poor infection control practices, unregulated unsafe blood transfusion, questionable ethical practices by healthcare providers, and a general lack of awareness are the main drivers of recent HIV outbreaks, with these issues exacerbated by the presence of untrained health care providers. To stop the spread of HIV systemically and sustainably, aggressive measures need to be taken at all levels by all concerned stakeholders that not only deal with building up testing, tracing, and treatment capabilities but also address underlying grassroots problems that have largely been ignored to date., Competing Interests: The authors have no competing interests to declare., (© 2024 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.)

To make robots more human-like and safer to use around humans, artificial muscles exhibiting compliance have gained significant attention from researchers. However, despite having excellent performance, pneumatic artificial muscles (PAMs) have failed to gain significant traction in commercial mobile applications due to their requirement to be tethered to a pneumatic source. This study presents a thermo-PAM called Thermo-PAM that relies on heating of a volume of air to produce a deformation. This allows for pneumatic actuation using only an electrical power source and thus enables pumpless pneumatic actuation. The actuator uses a high ratio between the heating volume and the deformable volume to produce a high actuation force throughout its entire motion and can produce either contractile or extension motions. The controllability of the actuator was demonstrated as well as its ability to handle heavy payloads. Moreover, it is possible to rely on either positive or negative pressure actuation modes where the positive pressure actuation mode actuates when heated and the negative pressure actuation mode relaxes when heated. The ability to use Thermo-PAMs for different modes of actuation with different operation methods makes the proposed actuator highly versatile and demonstrates its potential for advanced pumpless robotic applications.

Competing Interests: Conflicts of interest; none declared.

Introduction: Blended learning, which integrates classroom face-to-face teaching with both asynchronous and synchronous online learning elements, has swiftly gained acceptance in educational environments. However, the implementation of blended learning presents challenges that impact all stakeholders, necessitating thoughtful consideration. Teachers play a central role in shaping the instructional experience among these stakeholders. To fully realize the potential of comprehensive blended learning, it is imperative to identify the challenges faced by these teachers and develop strategies that sensibly address and overcome them., Methodology: A qualitative exploratory study was conducted with twelve teachers involved in the postgraduate blended learning health professions program at Khyber Medical University, Peshawar in 2022. One-on-one semi-structured Interviews were conducted via WhatsApp/ZOOM, transcribed by Otter AI, coded on NVivo & analyzed using Braun/Clarke's Thematic Analysis., Results: Three themes of challenges faced by teachers of postgraduate blended learning programs were constructed namely (1) Skills, such as (i) digital, (ii) instructional, and (iii) online class management, and (2) Administrative barriers in terms of (iv) resources (iv) training, and (3) Faculty resistance., Conclusion: This study provides profound insights into the daunting challenges that postgraduate blended learning program teachers encounter in terms of skills, administrative barriers, and faculty resistance. These findings offer a valuable opportunity for program directors to identify the critical requirements of these faculties in their pursuit of effective teaching and learning, ultimately transforming the landscape of blended education. This study emphasizes the need for ongoing faculty development and institutional support to address the identified challenges and improve the quality of postgraduate blended-learning programs., (© 2024. The Author(s).)

In the past two decades, Pakistan has faced multiple human immunodeficiency virus outbreaks, with Larkana appearing to be the hub of such outbreaks. While the previous Larkana outbreaks happened in high-risk populations, the alarming outbreak in 2019 occurred in a low-risk paediatric population, raising several concerning questions. Human immunodeficiency virus infections spilling into the general population is indicative of a steady increase in the number of cases, and the failure of control strategies to stem the concentrated epidemic from evolving. Although several causative factors have been identified from previous outbreaks, the one that occurred in 2019 may have been influenced by an additional, hitherto unexplored factor; child sexual abuse. The current narrative review was planned to summarise human immunodeficiency virus risk factors and causes identified in previous Larkana epidemics, to explore potential reasons for the outbreaks in children, and to discuss possible steps needed for stemming human immunodeficiency virus outbreaks in Pakistan.

Objective: The COVID-19 pandemic has led to greater depression and anxiety among college students. Social support may alleviate this risk. We examined how social support from family, friends, and romantic partners may influence internalizing psychopathology outcomes associated with COVID-19-related stressful events. Participants: Participants were first-years ( N  = 425, 34.8% Hispanic/Latinx, 74.9% female) enrolled in a United States public university. Methods: Participants completed an online survey in Fall of 2020. Linear regression models examined associations between COVID-19 stressors, social support, depressive and anxiety symptoms, and differences between White and Hispanic/Latinx students. Results: Reported COVID-19 stressors were associated with elevated depressive and anxiety symptoms and higher among Hispanic/Latinx students. Family and friend support were negatively associated with both internalizing outcomes. Partner support was negatively associated with depression and more predictive among White students whereas friend support was for Hispanic/Latinx students' anxiety. Conclusions : These findings demonstrate the importance of social connectedness during the COVID-19 pandemic.

The novel coronavirus disease (COVID-19) and its infamous "Variants" of the etiological agent termed Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) has proven to be a global health concern. The three antibodies, IgA, IgM, and IgG, perform their dedicated role as main workhorses of the host adaptive immune system in virus neutralization. Immunoglobulin-A (IgA), also known as "Mucosal Immunoglobulin", has been under keen interest throughout the viral infection cycle. Its importance lies because IgA is predominant mucosal antibody and SARS family viruses primarily infect the mucosal surfaces of human respiratory tract. Therefore, IgA can be considered a diagnostic and prognostic marker and an active infection biomarker for SARS CoV-2 infection. Along with molecular analyses, serological tests, including IgA detection tests, are gaining ground in application as an early detectable marker and as a minimally invasive detection strategy. In the current review, it was emphasized the role of IgA response in diagnosis, host defense strategies, treatment, and prevention of SARS-CoV-2 infection. The data analysis was performed through almost 100 published peer-reviewed research reports and comprehended the importance of IgA in antiviral immunity against SARS-CoV-2 and other related respiratory viruses. Taken together, it is concluded that secretory IgA- Abs can serve as a promising detection tool for respiratory viral diagnosis and treatment parallel to IgG-based therapeutics and diagnostics. Vaccine candidates that target and trigger mucosal immune response may also be employed in future dimensions of research against other respiratory viruses., Competing Interests: No competing interests to be declared., (© 2024 The Author(s).)