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The occupational well-being of teachers and their job satisfaction are interconnected, both influencing teacher performance and student well-being. After several years of ongoing economic and financial crises, this cross-sectional descriptive study highlighted several factors that impact the quality of education in relation to these concepts. To achieve this, a scale created through principal component analysis was distributed online. The responses of 297 school teachers, from both the public and private sectors were subjected to analysis using descriptive and logistic regression tests. The findings revealed a strong sense of self-efficacy among teachers, indicating their dedication to providing quality instruction to students on the one hand and helping them overcome challenges on the other. Additionally, the factor of income and financial security emerged as the primary concern for teachers, with approximately 80% of respondents expressing this sentiment. Similarly, collegiality, working conditions, and attitudes towards teaching itself were also sources of concern.

Very few Lebanese students have been able to perform at the highest level in mathematics and science in TIMSS, leading to the belief that current curricula and/or pedagogies are not supporting our highly able students to realize their potentials. In this research, we investigate how the national Policy documents and the mathematics and science centralized curricula, and textbooks address the needs of highly able students. Teachers' perceptions and role in providing for the educational needs of highly able is also examined. Through qualitative methods, the following data sources were used to address the research aim: policy document analysis, curriculum analysis, and teacher interviews. Findings indicated no specific policy for highly able students in Lebanon and little evidence of curricular provisions and attention to the needs of highly able learners in the mathematics and science national curricula and textbooks. The resultant data also provided important insights into the limited knowledge of teachers in the area of supporting highly able learners. The findings of the current study will inform the efforts of the policy makers and the Ministry of Education faced with the challenge of effectively educating their most able students.

Abstract Background The EQ-5D is one of the most commonly used tools to establish health-related quality of life (QoL). EQ-5D data in atrial fibrillation (AF) patients in the Middle East are lacking. Objectives This study aims to evaluate the reliability and validity of the Arabic version of the EQ-5D in AF inpatients in Syria. Methods The study involved patients admitted to the emergency department of Tishreen’s University Hospital in Latakia with AF as the primary diagnosis between the 1st of June 2021 and the 1st of June 2023. Arabic versions of the EQ-5D, EQ-VAS and SF36 questionnaires were administered to patients. Validation was done using convergent, discriminant, and known-groups validity, while reliability was conducted using EQ-5D retesting within 2–4 weeks. Results 432 participants were included in the study with a mean ± standard deviation of 63 ± 15. Males represented 242 (56%) of the participants. All hypotheses relating EQ-5D responses to external variables were satisfied. All three validation hypotheses demonstrated that the EQ-5D had the convergent, discriminant and known group validity to assess QoL in this cohort. The intraclass correlation coefficient (ICC) for test-retest reliability ranged between 0.74 and 0.88, while Cohen’s κ ranged between 0.72 and 0.86. Cronbach’s α value for internal consistency was 0.73. Conclusion The Arabic version of EQ-5D was valid and reliable in measuring QoL in AF inpatients in Syria. This validation opens the door for more widespread use of the EQ-5D in Arabic-speaking regions, facilitating better-informed healthcare decisions and improving patient care strategies in Syria and other Middle Eastern countries.

Bioceramic endodontic cements, known for their antibacterial properties, calcium ion release, and alkaline pH, may come into contact with various irrigants after furcal perforation repair. This study aimed to evaluate the effect of different irrigating solutions and setting times on the shear bond strength (SBS) of Biodentine® (Septodont, Saint-Maur-des-Fosses Cedex, France) to a self-adhering flowable composite. Sixty Biodentine® (Septodont, Saint-Maur-des-Fosses Cedex, France) blocks were prepared and divided into two groups based on the setting time: 72 h and 7 days. These were further subdivided into five subgroups based on the irrigation solution applied: distilled water, sodium hypochlorite, ethylenediaminetetraacetic acid, chlorhexidine, and phosphoric acid. They were then restored with Dyad FlowTM (KerrTM, Orange, CA, USA). SBS and failure modes were assessed at 24 h and 6 months. A two-way analysis of variance (ANOVA) test was performed to analyze the effect of the different irrigating solutions and setting times on the SBS of Biodentine® (Septodont, Saint-Maur-des-Fosses Cedex, France) and Dyad FlowTM (KerrTM, Orange, CA, USA). The level of significance was set at a ≤0.05. At 24 h, SBS was significantly influenced by both the irrigant solution (p = 0.029) and setting time (p = 0.018); at 6 months, SBS was influenced only by the irrigating solutions (p < 0.001). The predominant mode of bond failure was adhesive across all groups. In conclusion, while the setting time did not affect the bond strength, certain irrigating solutions reduced it. Thus, careful consideration of surface treatments applied to Biodentine® is crucial for successful endodontic and restorative outcomes.

Background: Family medicine (FM) is a medical specialty that provides continuing, comprehensive health care for the individual and the family. This study aimed to describe Lebanese citizens’ knowledge, attitudes, and practices toward FM as a specialty. Methods: This is a national cross-sectional phone-based survey targeting the knowledge of the public about FM and its scope of practice. Questions were asked whether participants had primary health care doctors and their specialties Results: A total of 373 participants were included, with a response rate of 85.2%. Two-thirds were aware of the specialty of FM, while only 16.6% of the participants had previously visited a family physician. Most participants (69.7%) had a doctor they regularly consulted. One-third of participants had a general practitioner as their regular doctor. More than 80% of the participants agreed that FM physicians treat all family members with common and chronic diseases. Around 60% to 75% of participants knew that family physicians provide medical care to children, treat patients with psychiatric impairments, and perform minor surgeries. There was a significant gap in the participants’ knowledge of FM physicians’ role in managing obstetric or gynecologic patients. Conclusion: Despite public awareness of FM, limited understanding and system challenges hinder its utilization in Lebanon. Educational campaigns, government-supported FM practices, and collaborations with public health initiatives are crucial to bridging the knowledge gap and establishing FM as the cornerstone of primary care. This knowledge gap challenges the specialty’s identity and necessitates promoting FM as the cornerstone of primary care, potentially requiring a system-wide endorsement.

The worldwide use of open educational resources (OER) has highly increased during the recent years. However, there is no clear idea about how these resources are utilized by teachers in Lebanon. Hence, this study aims at examining the extent to which the concept of OER is well known among the teachers. It also investigates the practices of OER users and explores the barriers to powerful use and sharing of OER among teachers. Nevertheless, this is quantitative research designed for analyzing the data collected from 308 teachers through an online questionnaire. The results showed that 60% of the respondents have heard about OER. Moreover, they revealed that OER users showed misunderstanding of the concept of OER due to their lack of knowledge about the open licenses. Hence, a national policy for e-learning is needed to leverage open education and ignite the power of OER by encouraging teachers to be producers of knowledge.

Financial wellbeing and financial literacy are crucial aspects of personal and professional lives, particularly in graduate medical education. Low financial literacy among healthcare professionals, including physicians, has been identified as a concern, impacting job satisfaction, productivity, and burnout. Few studies have used validated methods, assessed financial wellbeing, or compared financial outcomes across the continuum of medical education and practice. This study aims to measure the financial wellbeing of healthcare professionals and trainees and its predictors using validated instruments on a nationwide scale in Lebanon. This is a multi-institutional cross-sectional study using an online survey using validated instruments, including the CFPB Financial Well-Being Scale and Lusardi and Mitchell’s “Big Five” financial literacy questions. The data was collected in April and May 2020. The population includes medical students, residents, and practicing physicians in all six private medical schools and their affiliated medical centers in Lebanon. A total of 330 responded, with a response rate of 20.7%. The financial wellbeing score (out of 10 was 57.2 ± 9.7 before the financial crisis and dropped to 45.2 ± 10.1 during the country’s financial crisis. With a passing grade of 60%, 75.3% (195/259) failed the financial knowledge questions. Attending physicians outperformed students and residents/fellows regarding knowledge scores. Financial wellbeing was positively associated with age, family socioeconomic status, and household income. It was negatively associated with the crowding index and agreement with the attitude of living for today and letting tomorrow take care of itself. Medical students, residents, and physicians in Lebanon had low financial literacy. Attending physicians have high financial wellbeing despite low financial literacy and lack of formal education. The COVID-19 pandemic and economic crisis adversely affected the financial wellbeing of all three groups.

This article reviews and further develops understandings gleaned from an investigation of public and private school teachers' perceptions of talent development and their ability to implement specialized approaches for gifted students in a country without specific educational policies for this population. Through a discussion of findings from a previous study investigating the perceptions and practices of more than 280 Lebanese teachers, new insights to inform future policy are provided into how talent development is perceived and responded to within the Lebanese educational context. These understandings helped inform the development of a culturally appropriate conceptual framework, derived from Gagné's Differentiated Model of Giftedness and Talent (2008). The resultant framework addresses how the broader socio-economic cultural context within Lebanon appears to have influenced teachers' perceptions and practices and the choices made in terms of gifted provision in classrooms. This framework could assist educational leaders in Lebanon to implement changes that would not only benefit gifted learners but also have potential flow on benefits for the country as a whole.

Coronavirus disease-19 (COVID-19) has disproportionately affected certain demographics in England, exacerbating existing health disparities. Effective therapeutics are a critical line of defence against COVID-19, particularly for patients at elevated risk for severe disease. Surveillance systems were established to monitor the usage of COVID-19 therapeutics in hospital and community settings and to inform stewardship. Three antiviral therapies—nirmatrelvir plus ritonavir (Paxlovid®), remdesivir (Veklury®), and molnupiravir (Lagevrio®)—and two neutralising monoclonal antibody therapies (nMAbs)—sotrovimab (Xevudy®) and casirivimab with imdevimab (Ronapreve®)—were in use in England between July 2020 and April 2023. This paper aims to illuminate trends in the utilisation of COVID-19 therapeutics treatment in both hospital and community settings, stratified by the Index of Multiple Deprivation (IMD) in England. Chapter 3 of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2022 to 2023 also discusses the epidemiological surveillance of these five directly acting antiviral COVID-19 therapeutics’ use in England between 2022 and 2023.

When presented with a novel word in a sentence, word order can be used to determine the category (noun, verb, etc.) to which that word belongs. However, it is unclear whether this tendency to use sequence information to infer category membership is specific to language, or is more domain-general. To examine this, we conducted experiments in humans and Rhesus macaques, using three perceptually distinct shape categories. Subjects were taught to categorize shapes, then to select them in a fixed order. Ambiguous stimuli were then generated by combining shapes from different categories. In humans, when an ambiguous morph was presented in a sequence, its subsequent categorization shifted radically based on its position in the sequence. These results demonstrate that the tendency to use sequence information to infer category membership is not unique to language. Data collection in macaques is underway, and will help determine whether this tendency is restricted to humans.

Comparative sequence learning experiments allow cognitive processes that are required for language in humans to be studied in nonhuman animals. We investigated Rhesus macaques’ ability to detect abstract regularities in visual sequences, and their capacity to generalize to novel stimuli. On each trial, two colors were randomly generated and arranged into three-element long sequences based on three rules (‘AAB’, ‘ABA’, ‘BAA’). Monkeys were able to learn the rules and select appropriate sequences of colored squares, and generalized this learning to the novel color combinations. To further assess generalization, we presented probe trials using sequences comprised of randomly generated white shapes. Monkeys showed no evidence of spontaneous generalization between stimulus categories. Our results demonstrate that monkeys are able to learn abstract rules governing visual sequences and that they generalize these to novel sequences within a stimulus category, but provides no evidence of generalization between stimulus categories.

Cancer risk is modulated by hereditary and somatic mutations, exposures, age, sex, and gender. The mechanisms by which sex and gender work alone and in combination with other cancer risk factors remain underexplored. In general, cancers that occur in both the male and female sexes occur more commonly in XY compared with XX individuals, regardless of genetic ancestry, geographic location, and age. Moreover, XY individuals are less frequently cured of their cancers, highlighting the need for a greater understanding of sex and gender effects in oncology. This will be necessary for optimal laboratory and clinical cancer investigations. To that end, we review the epigenetics of sexual differentiation and its effect on cancer hallmark pathways throughout life. Specifically, we will touch on how sex differences in metabolism, immunity, pluripotency, and tumor suppressor functions are patterned through the epigenetic effects of imprinting, sex chromosome complement, X inactivation, genes escaping X inactivation, sex hormones, and life history., In humans, cancer occurs more commonly in males, and males die more rapidly of their disease compared with females (1). When we observe significant sex differences such as these, they [...]

Abstract People with end‐stage kidney disease (ESKD) often exhibit impaired cardiac structure and function, which may contribute to poor exercise capacity. This study used multimodal exercise testing to investigate the central and peripheral mechanisms of exercise limitation in adults with ESKD, also comparing in‐centre hemodialysis (ICHD) to home hemodialysis (HHD). Seventeen adults (55.5 ± 14.5 years; n = 14 male; n = 12 HHD) participated. Resting cardiac examinations, followed by submaximal cycling cardiopulmonary exercise testing (CPET) and functional exercise testing, revealed cardiac structural abnormalities (increased left ventricular mass) and cardiac injury. Aerobic fitness in adults with ESKD was low, with pulmonary oxygen uptake (V̇O2) at the gas exchange threshold (GET) occuring at 39 ± 8% predicted V̇O2peak. O2 pulse, an estimate of stroke volume (SV), was higher in HHD at rest (p = 0.05, ES = 0.58) and during unloaded cycling (p = 0.05, ES = 0.58) compared to ICHD. However, thoracic bioreactance derived SV at the GET was significantly higher in adults receiving ICHD versus HHD (p = 0.01, ES = 0.74). In adults with ESKD, cardiac output was positively associated with V̇O2 at the GET (r = 0.61, p = 0.04). This study highlights prevalent exercise dysfunction in adults with ESKD undergoing dialysis, with potential distinct differences between in‐centre and home hemodialysis, mechanistically linked to underlying cardiac abnormalities.

Key Clinical Message Multiple methods are used to tackle ipsilateral obstructed venous access in patients undergoing a device upgrade by implanting a new left ventricular lead. One feasible solution to tackle this is implantation of the upgrade lead contralaterally with pre‐sternal tunnelization to the opposite side under conscious sedation.

Objectives Inappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice.Design A retrospective population-based study using administrative data.Setting IQVIA Medical Research Database (IMRD) data from general practices in England, 2015–2022.Participants Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD.Outcome measures Trends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test.Results There were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016–2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds.Conclusion Urine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.