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Massive Open Online Courses (MOOCs) now offer a variety of options for everyone to obtain a high-quality education. The purpose of this study is to better understand the behaviours of MOOC learners and provide some insights for taking actions that benefit larger learner groups. Accordingly, 2,288,559 learners' behaviours on 174 MITx courses were analysed. The results show that MOOCs are more attractive to the elderly, male, and highly educated groups of learners. Learners' performance improves as they register for more courses and improve their skills and experiences on MOOCs. The findings suggest that, in the long run, learners' adaptation to MOOCs will significantly improve the potential benefits of the MOOCs. Hence, MOOCs should continue by better understanding their learners and providing alternative instructional designs by considering different learner groups. MOOC providers' decision-makers may take these findings into account when making operational decisions.

This study investigated the noticing of teachers who teach mathematics at different grade levels in the context of lesson study. The study specifically focused on teachers' noticing during the planning phase of the lesson. For this, the lesson planning phase of a group of four teachers consisting of kindergarten and primary school 1st grade teachers (vertical teacher team) was investigated. Teachers' planning process for the 1st grade level mathematics lesson was the focus in the context of lesson study. We examined categories and subcategories that emerged in the planning phase of the lesson study and noticing levels dealt with those categories. We examined which categories and subcategories emerged in planning and at which noticing levels they dealt with those categories. The results of the study provide comprehensive data on categories and noticing levels of teachers teaching mathematics at different grade levels in the collaborative planning process of a lesson study focusing on improving problem-solving. The results of the study showed that the teachers' noticing was clustered under three categories: curriculum, teaching methods, and conceptual understanding. In terms of noticing levels, the study's results revealed that noticing is performed at the attending to level in all categories. Although less frequently than the attending to level, teachers noticed making sense of level in all the other categories except the curriculum category. Besides, noticing that the deciding to respond level did not occur at any level might be due to the cultural challenges of adaptation of lesson study and the amount of support, we researchers provided teachers as facilitators.

Triple-negative breast cancer (TNBC) is responsible for a disproportionate number of breast cancer patient deaths due to extensive molecular heterogeneity, high recurrence rates, and lack of targeted therapies. Dysregulation of the phosphoinositide 3-kinase (PI3K)/AKT pathway occurs in approximately 50% of TNBC patients. Here, we performed a genome-wide CRISPR/Cas9 screen with PI3Kα and AKT inhibitors to find targetable synthetic lethalities in TNBC. Cholesterol homeostasis was identified as a collateral vulnerability with AKT inhibition. Disruption of cholesterol homeostasis with pitavastatin synergized with AKT inhibition to induce TNBC cytotoxicity in vitro in mouse TNBC xenografts and in patient-derived estrogen receptor (ER)-negative breast cancer organoids. Neither ER-positive breast cancer cell lines nor ER-positive organoids were sensitive to combined AKT inhibitor and pitavastatin. Mechanistically, TNBC cells showed impaired sterol regulatory element-binding protein 2 (SREBP-2) activation in response to single-agent or combination treatment with AKT inhibitor and pitavastatin, which was rescued by inhibition of the cholesterol-trafficking protein Niemann-Pick C1 (NPC1). NPC1 loss caused lysosomal cholesterol accumulation, decreased endoplasmic reticulum cholesterol levels, and promoted SREBP-2 activation. Taken together, these data identify a TNBC-specific vulnerability to the combination of AKT inhibitors and pitavastatin mediated by dysregulated cholesterol trafficking. These findings support combining AKT inhibitors with pitavastatin as a therapeutic modality in TNBC. Significance: Two FDA-approved compounds, AKT inhibitors and pitavastatin, synergize to induce cell death in triple-negative breast cancer, motivating evaluation of the efficacy of this combination in clinical trials.

It is well known that there are disparities in access to education around the world, with developed countries generally having better educational resources and opportunities compared to developing countries. Massive open online courses (MOOCs) have been proposed as a way to bridge this gap by providing free or low-cost online education to anyone with an Internet connection. This study aimed to better understand the effects of location, both country and region, on the use of MOOCs, using data from 3.5 million learners who registered for MOOCs offered by the Massachusetts Institute of Technology (MIT). The data set provided a broad picture of how MOOCs are being used around the globe. The results of the study indicated significant differences in the use of MOOCs among students from different countries and their corresponding economic levels. In order to address these differences and improve access to education through MOOCs, the study suggested several actions that could be taken. These include providing better infrastructure and support for MOOC learners in developing countries, increasing awareness of and access to MOOCs in these regions, and working to improve the quality and relevance of MOOC offerings. Overall, the study highlighted the potential of MOOCs to bridge the educational gap between developed and developing countries, but also emphasized the need for continued efforts to remove barriers and improve access to these resources.

Although the Rasch model is used to measure latent traits like attitude or ability where there are multiple latent structures within the dataset it is best to use a technique called the Mixture Rasch Model (MRM) which is a combination of a Rasch model and a latent class analysis (LCA). This study used data from a survey for teachers, teacher candidates, and teacher education program faculty with a sample of 296 candidates, 648 graduates, and 501 program faculty. Survey items based on these competencies were administered to in one Western state to ascertain how well the program candidates attended prepared them for the teaching profession. The 40 items common to surveys of the three groups were submitted to mixture Rasch analysis to determine whether distinct patterns of item response were discernible. Analyses yielded two classes which brings the construct validity of the survey into question. Results showed that the Mixture Rasch Model is and can be useful to determine subgroups for survey researchers. This research presents a demonstration of usefulness of the Mixture Rasch Model for the analysis of survey data.

Achievement tests are among the most widely used data collection tools to measure the knowledge and skill levels of individuals. For this reason, the existence of valid and reliable achievement tests that can perfectly reveal the competencies that a person should have in any discipline is of great importance. The purpose of this research is to provide evidence for the validity and reliability of an achievement test that will be used to reveal the verbal competencies of adults and the degree of these competencies. In the first part of the study, 1200 multiple-choice questions were prepared from the verbal domain. The prepared items were reduced to 1030 items by passing the expert opinion. Based on the criteria determined by Webb (1997) for the evaluation of learning outcomes, the opinions of field experts and experienced teachers were evaluated. In the second part of the study, a pilot application was made to 3.250 participants across Turkey on the e-platform created. Item analysis with the ITEMAN program showed that the test was valid to some degree. The KR-20 reliability coefficient was found to be 0.77, providing evidence of the reliability of the test. It is expected that the developed test will contribute to revealing basic skills in adults and be used in related research.

Emergency remote teaching has accelerated the search for alternative professional development practices that could meet the immediate needs of the teachers and be effectively implemented in times of the COVID-19 pandemic. This research aims to present the Remote Collaborative Reflection (RCR) Model a group of teacher educators (TEs) developed in a collaborative reflective endeavor originating from their own professional needs during emergency remote teaching in the fall term of 2020-2021. It also reveals TE's reflections on the RCR Model in developing and implementing the RCR consisting of several iterative steps. Findings revealed that the TEs reflected on their perceived cognitive, interpersonal, and intrapersonal gains from the RCR highlighting the challenges they faced while carrying out the model. Although the RCR was developed during the pandemic when social distancing was the norm, we believe it might also fit the face-to-face mode of professional development depending on the situational circumstances and needs of practitioners.

This study aimed to reveal the solutions of pre-service teachers to contextual problems related to number bases other than the base ten. Furthermore, it was intended to investigate which issues pre-service teachers discussed about their learning in the problem-solving process, including context, and about student learning in their future teaching practices. To achieve this, task-based interviews were held with 12 pre-service primary school teachers. During semi-structured one-on-one task-based interviews, some questions were asked to reveal preservice teachers' way of thinking about the problems and their reflection on the learning. In this context, data were obtained from the audio recordings and the students' written responses. Besides, researchers' notes are used as supporting documents for the validation of the data collection process. The main findings of the study revealed that context is a facilitator for preservice teachers in understanding number bases other than base ten. They gained insight and provided instructional explanations on how to teach the student by understanding the different number bases. Furthermore, context enabled preservice teachers to reflect on how to teach better by considering their own learning processes.

BACKGROUND: There are ≈5 million annual dizziness visits to US emergency departments, of which vestibular strokes account for over 250 000. The head impulse, nystagmus, and test of skew eye examination can accurately distinguish vestibular strokes from peripheral dizziness. However, the eye-movement signs are subtle, and lack of familiarity and difficulty with recognition of abnormal eye movements are significant barriers to widespread emergency department use. To break this barrier, we sought to assess the accuracy of EyePhone, our smartphone eye-tracking application, for quantifying nystagmus. METHODS AND RESULTS: We prospectively enrolled healthy volunteers and recorded the velocity of induced nystagmus using a smartphone eye-tracking application (EyePhone) and then compared the results with video oculography (VOG). Following a calibration protocol, the participants viewed optokinetic stimuli with incremental velocities (2-12 degrees/s) in 4 directions. We extracted slow phase velocities from EyePhone data in each direction and compared them with the corresponding slow phase velocities obtained by the VOG. Furthermore, we calculated the area under the receiver operating characteristic curve for nystagmus detection by EyePhone. We enrolled 10 volunteers (90% men) with an average age of 30.2±6 years. EyePhone-recorded slow phase velocities highly correlated with the VOG recordings (r=0.98 for horizontal and r=0.94 for vertical). The calibration significantly increased the slope of linear regression for horizontal and vertical slow phase velocities. Evaluating the EyePhones performance using VOG data with a 2 degrees/s threshold showed an area under the receiver operating characteristic curve of 0.87 for horizontal and vertical nystagmus detection. CONCLUSIONS: We demonstrated that EyePhone could accurately detect and quantify optokinetic nystagmus, similar to the VOG goggles.

Consciousness is thought to be regulated by bidirectional information transfer between the cortex and thalamus, but the nature of this bidirectional communication - and its possible disruption in unconsciousness - remains poorly understood. Here, we present two main findings elucidating mechanisms of corticothalamic information transfer during conscious states. First, we identify a highly preserved spectral channel of cortical-thalamic communication that is present during conscious states, but which is diminished during the loss of consciousness and enhanced during psychedelic states. Specifically, we show that in humans, mice, and rats, information sent from either the cortex or thalamus via δ/θ/α waves (∼1-13 Hz) is consistently encoded by the other brain region by high γ waves (52-104 Hz); moreover, unconsciousness induced by propofol anesthesia or generalized spike-and-wave seizures diminishes this cross-frequency communication, whereas the psychedelic 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) enhances this low-to-high frequency interregional communication. Second, we leverage numerical simulations and neural electrophysiology recordings from the thalamus and cortex of human patients, rats, and mice to show that these changes in cross-frequency cortical-thalamic information transfer may be mediated by excursions of low-frequency thalamocortical electrodynamics toward/away from edge-of-chaos criticality, or the phase transition from stability to chaos. Overall, our findings link thalamic-cortical communication to consciousness, and further offer a novel, mathematically well-defined framework to explain the disruption to thalamic-cortical information transfer during unconscious states.

Background: Patients with early-stage lung tumors that are highly suspicious for malignancy typically undergo a preoperative diagnostic workup, primarily through bronchoscopy or transthoracic biopsy. Those without a preoperative diagnosis may alternatively be treated with upfront surgery, contingent upon the potential for intraoperative diagnosis. Previous studies have yielded conflicting results regarding the impact of upfront surgery on the survival of these patients. Our study aimed to elucidate the effect of upfront surgery on the survival outcomes of patients undergoing surgery for early-stage lung cancer without a preoperative diagnosis. Methods: We analyzed the survival rate of 158 consecutive patients who underwent pulmonary resection for stage I lung cancer, either with or without a preoperative diagnosis. Results: A total of 86 patients (54%) underwent upfront surgery. This approach positively impacted both disease-free survival (p=0.031) and overall survival (p=0.017). However, no significant differences were observed across subgroups based on sex, smoking status, forced expiratory volume in 1 second, histologic tumor size, or histologic subtype. Univariate analysis identified upfront surgery (p=0.020), age (p=0.002), maximum standardized uptake value (SUVmax) exceeding 7 (p=0.001), and histological tumor size greater than 20 mm (p=0.009) as independent predictors. However, multivariate analysis indicated that only SUVmax greater than 7 (p=0.011) was a significant predictor of unfavorable survival. Conclusion: Upfront surgery does not appear to confer a survival advantage in patients with stage I lung cancer undergoing surgical intervention.

Classrooms are a learning environment for teachers as well as students. Teachers can improve their teaching practices by monitoring and reviewing their practices. An important tool of this development is the reflective thinking of teachers. For teachers, reflection is an opportunity to look into the classroom from the outside, to examine the learning process, and to make inferences for pedagogical development. Video recordings of teachers' lessons can be used to stimulate self-reflection by capturing the details of the teaching process and by examining the classroom atmosphere. This study aims to investigate teachers' opinions about using video-based self-reflection for their pedagogical development. Seven teachers participated in the research. Data were collected through a Pre-interview Protocol, Teachers' Reflection Reports written for twelve weeks about one recorded lesson per week, and a Post-interview Protocol after the 12-week video-based self-reflection period. The main findings show that the teachers' video-based self-reflections constitute nine categories and two weeks video-based self-reflection process resulted in changes in teachers' opinions in terms of reflection on video recording, professional development and teaching and learning process.

Purpose: The C-reactive protein (CRP) velocity (CRPv) is an indicator of the change in CRP over time. In individuals with sepsis, the second values of CRP and CRPv have been shown to have more importance than the first CRP value measured at admission. This study examined the importance of CRPv for mortality among individuals who were hospitalized in the intensive care unit (ICU). Methods: The study was conducted between January 2021 and December 2022. CRPv was calculated according to the change in the second CRP value compared to the first. Results: The median age of the patients was 79 years (interquartile range (IQR), 69–85 years), and 53.2 % were male. The in-hospital mortality rate was 45.5 %. The presence of diabetes increased the odds of mortality by 2.17 times (confidence interval (CI): 1.06–4.4, p=0.032). Each increase in CRPv by 1 mg/dl/hour increased the odds of mortality by 1.07 times (CI: 1.01–1.14, p=0.015), while each one-point increase in the Sequential Organ Failure Assessment (SOFA) score increased the odds of mortality by 1.21 times (CI: 1.07–1.35, p=0.002). The SOFA score had the highest area under the curve (AUC) value for in-hospital mortality (AUC = 0.699 p=7, its sensitivity in predicting mortality was 46.7 %, and its specificity was 85.1 %. The AUC value of CRPv in predicting mortality was 0.629 (p=0.006). When CRPv was >0.75, its sensitivity in predicting mortality was 68.2 %, and its specificity was 57 %. Conclusion: CRPv performed well in predicting mortality and had satisfactory discriminative ability. Additionally, diabetes, SOFA score, and CRPv elevation were significant risk factors for mortality.

Hypertension is present in almost a third of Türkiye’s adult population. The Ministry of Health of the Republic of Türkiye in conjunction with the World Health Organization, rolled out a pilot primary health care model from February 2019 to 2020 to improve hypertension screening, management, and follow-up across the provinces of Erzincan, Çankırı and Uşak. The model was conducted in selected family health centers for one year and included multiple interventions – training of multidisciplinary primary care teams, implementation of evidence-based, standardised clinical guidelines related to monitoring and treatment of hypertension, clinical supervision and performance monitoring, and provision of health education to hypertensive individuals. Repeat surveys of population-based random samples of 975 patients were taken before (December 2018) and after (February 2020) model implementation to evaluate its effect on care delivery. There was an almost 6.5-fold increase in the measurement and subsequent recording of blood pressure compared to before model implementation (from 50 to 323). Blood pressure control improved to 58 % of measured individuals compared to 46 % of those measured at initial evaluation. The frequency of measuring risk factors and outcomes related to hypertension at least once a year increased for creatinine from 71 % to 79 %, fasting blood glucose from 70 % to 78 %, and tobacco use from 22 % to 31 %. Prescription of antihypertensive drugs increased from 49 % to 61 %. With improvements in hypertension-related care in all measures and across all regions, this primary healthcare model represents a potential paradigm for nationwide implementation.

When the pandemic COVID -19 led to school closures, many of us had no idea that this disruption would last months and perhaps more than a year. Curriculum-based assessment (CBA) is an assessment process that uses academic knowledge picked directly from the material taught in the classroom. This form of criterion-referenced assessment connects evaluation with instructional programs by informing teachers of student progress and learning challenges. In this study a nationwide exam called Transition to Secondary School Exam TEOG Exam was used as a curriculum based tool since TEOG Exam is also second or third exam for semester. The data showed a one and a half year learning loss in both Turkish and mathematics based on Woesmann's (2016) criteria. The difference in the scores for math exam between 2016 and 2020 was 10.32 points which accounts for half of exam standard deviation. Also, the difference in the scores for Turkish exam 2016 and 2020 was 10.91 points which is also around half of the standard deviation. Additionally, based on gender there was a statistically significant decrease of 12.04 points in the mathematics scores of girls and 8.43 points for boys showing a 15-month learning loss for girls. and a year of learning loss for boys. These results showed that girls had more learning losses due to COVID-19 pandemic. According to the mother's education level; the decrease for mathematics scores were between 9.73 (elementary school degree) and 22.02 points (associate degree). This finding shows that the learning loss in math based on mother educational level is between 15-months and 2.5 years. Similar findings showed up for Turkish scores as well. Turkish scores decreased between 10.43 (elementary school degree) and 22.24 points (associate degree). This finding shows that the learning loss in Turkish based on mother educational level is between 15-months and 2.5 years. These results show that some students did not learn new material after the outbreak and even slipped backwards. Ministry of National Education should take important steps to prevent the effects of COVID-19 pandemic and minimize and resolve the learning losses emphasized in this study.

Intercropping is an agricultural technique where many crops are grown together on the same field, and it is becoming more widely acknowledged for its ability to improve productivity in food and forage production. This farming method allows for the strategic integration of a profitable crop with cover or non-profitable crops to achieve reciprocal benefits, while also spreading advantages across different agricultural systems. Intercropping designs differ to attain greater crop yields, reduce the use of chemicals and fertilizers, and enhance water-use efficiency, especially in the demanding circumstances of arid and semi-arid countries. This study examines new mechanisms via which intercropping enhances sustainable agriculture, including recent progress in ecological, genetic, and microbial interactions that enhance plant growth and resilience. The adaptability of the Mediterranean region, for varied agricultural methods is also assessed, with a particular focus on the possibilities for implementing intercropping systems. This study provides a thorough analysis of existing research, emphasizing the many advantages of intercropping and its contribution to the progress of sustainable agriculture.

Introduction: Amyotrophic lateral sclerosis (ALS) can affect various eye movements, making eye tracking a potential means for disease monitoring. In this study, we evaluated the feasibility of ALS patients self-recording their eye movements using the “EyePhone,” a smartphone eye-tracking application. Methods: We prospectively enrolled ten participants and provided them with an iPhone equipped with the EyePhone app and a PowerPoint presentation with step-by-step recording instructions. The goal was for the participants to record their eye movements (saccades and smooth pursuit) without the help of the study team. Afterward, a trained physician administered the same tests using video-oculography (VOG) goggles and asked the participants to complete a questionnaire regarding their self-recording experience. Results: All participants successfully completed the self-recording process without assistance from the study team. Questionnaire data indicated that participants viewed self-recording with EyePhone favorably, considering it easy and comfortable. Moreover, 70% indicated that they prefer self-recording to being recorded by VOG goggles. Conclusion: With proper instruction, ALS patients can effectively use the EyePhone to record their eye movements, potentially even in a home environment. These results demonstrate the potential for smartphone eye-tracking technology as a viable and self-administered tool for monitoring disease progression in ALS, reducing the need for frequent clinic visits.

Objectives: To evaluate results of sutured repair for slipping rib syndrome (SRS), identify failure points, and discuss technique modifications to improve outcomes through costal margin reconstruction (CMR). Methods: Patients undergoing repair of SRS between February 2019 and February 2024 at an academic referral institution were retrospectively analyzed. Pain scores, quality of life, pain medication use, and reoperations were evaluated pre- and postoperatively at 1 and 6 months. In patients failing sutured repair we identified specific failure points and devised a new CMR technique to overcome them. Subsequent CMR patients were followed at 1, 6, 12, 18, and 24 months using the same outcome measures. Results: Four hundred forty-nine patients underwent repair. Two hundred forty-one patients underwent sutured repair with revision required in 66. Median time to revision was 14 months. CMR was developed and performed in 247 patients. In CMR patients, preoperative mean pain score of 7.5 out of 10 dropped postoperatively to 4.0, 2.5, 1.9, 1.3, and 0.9 at 1, 6, 12, 18, and 24 months, respectively (P