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Objective: Clinicians' fears of taking away patients' hope is one of the barriers to advance care planning (ACP). Research on how ACP supports hope is scarce. We have taken up the challenge to specify ways in which ACP conversations may potentially support hope. Methods: In an international qualitative study, we explored ACP experiences of patients with advanced cancer and their personal representatives (PRs) within the cluster-randomised control ACTION trial. Using deductive analysis of data obtained in interviews following the ACP conversations, this substudy reports on a theme of hope. A latent thematic analysis was performed on segments of text relevant to answer the research question. Results: Twenty patients with advanced cancer and 17 PRs from Italy, the Netherlands, Slovenia, and the United Kingdom were participating in post-ACP interviews. Three themes reflecting elements that provide grounds for hope were constructed. ACP potentially supports hope by being (I) a meaningful activity that embraces uncertainties and difficulties (II) an action towards an aware and empowered position (III) an act of mutual care anchored in commitments. Conclusion: Our findings on various potentially hope supporting elements of ACP conversations provide a constructive way of thinking about hope in relation to ACP that could inform practice.

Fasting Ramadan as worship has many benefits for health, so that these two goals can be achieved, it is necessary to regulate diet specifically, especially regulating nutritional intake during iftar and sahur. During fasting the diet will change, because it is only allowed to eat in the morning before dawn and at night. The stomach is left empty for about 13 hours. Generally, the body takes 3-5 days to adapt to a new diet. From the nutritional aspect, fasting will at least reduce nutritional intake, especially energy by around 20-30 percent. This community service activity is carried out using an action study method where mothers in Tonasa Village will practice cooking food according to the nutritional needs needed according to age, then increase knowledge and understanding of balanced nutrition during fasting for PKK mothers in RW 01 In addition, we as a service team will provide tips so that families can continue to do activities without feeling weak. The education provided is about balanced nutrition when fasting through Pre and Post Tests. The implementation time of the service is carried out for 4 months. The expected result of this service is that it can increase the knowledge and skills of mothers regarding a balanced nutritional menu during fasting.

Background Women whose pregnancies are affected by hypertensive disorders of pregnancy, in particular preterm pre-eclampsia, are at increased risk of long-term cardiovascular morbidity and mortality. Objectives To investigate the hypothesis that prolongation of a pregnancy affected by preterm pre-eclampsia managed by expectant management compared with planned early delivery would result in worse cardiovascular function 6 months postpartum. Design A randomised controlled trial. Setting 28 maternity hospitals in England and Wales. Participants Women who were eligible for the Pre-eclampsia in HOspital: Early iNductIon or eXpectant management (PHOENIX) study were approached and recruited for the PHOEBE study. The PHOENIX (Pre-eclampsia in HOspital: Early iNductIon or eXpectant management) study was a parallel-group, non-masked, multicentre, randomised controlled trial that was carried out in 46 maternity units across England and Wales. This study compared planned early delivery with expectant management (usual care) with individual randomisation in women with late preterm pre-eclampsia who were 34 weeks’ gestation to less than 37 weeks’ gestation and having a singleton or dichorionic diamniotic twin pregnancy. Interventions Postpartum follow-up included medical history, blood pressure assessment and echocardiography. All women had blood sampling performed on at least two time points from recruitment to the 6-month follow-up for assessment of cardiac necrosis markers. Main outcome measures Primary outcome was a composite of systolic and/or diastolic dysfunction (originally by 2009 guidelines then updated by 2016 guidelines, with an amended definition of diastolic dysfunction). Analyses were by intention to treat, together with a per-protocol analysis for the primary and secondary outcomes. Results Between 27 April 2016 and 30 November 2018, 623 women were found to be eligible, of whom 420 (67%) were recruited across 28 maternity units in England and Wales. A total of 133 women were allocated to planned delivery, 137 women were allocated to expectant management and a further 150 received non-randomised expectant management within usual care. The mean time from enrolment to delivery was 2.5 (standard deviation 1.9) days in the planned delivery group compared with 6.8 (standard deviation 5.3) days in the expectant management group. There were no differences in the primary outcome between women in the planned delivery group and those in the expectant management group using either the 2009 (risk ratio 1.06, 95% confidence interval 0.80 to 1.40) or the 2016 definition (risk ratio 0.78, 95% confidence interval 0.33 to 1.86). Overall, 10% (31/321) of women had a left ventricular ejection fraction 2, 95% confidence interval 1.12 to 1.59 per 5 kg/m2) and maternal age (adjusted odds ratio 2.16, 95% confidence interval 1.44 to 3.22 per 10 years). Limitations include changing definitions regarding systolic and/or diastolic dysfunction. Conclusions Preterm pre-eclampsia results in persistence of hypertension in the majority of women with late preterm pre-eclampsia at 6 months postpartum and systolic dysfunction in 10%. Pre-eclampsia should not be considered a self-limiting disease of pregnancy alone. Future work Interventions aimed at reducing cardiovascular dysfunction. Trial registration Current Controlled Trials ISRCTN01879376. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 12. See the NIHR Journals Library website for further project information.

Tjondronegoro's concept of sodality is gaining momentum to be applied in a broader context. Sodality is relevant to participatory approaches in community development, extension/empowerment, and development communication. This study aims to answer how the role of sodality is in the empowerment of peri-urban communities from communication and extension development sciences. This research method uses a participatory action study by placing the researcher to live with the community. Sodality can be interpreted as the life force of a unique community unit. However, without any family relationship, they are bound by a synergy of interest relations without eliminating the primary relationship. In the context of empowerment, the bonds in sodality are colored more with interest in achieving life necessities among community members. Thus, in peri-urban communities, sodality is closer to the meaning of social capital, which effectively strengthens the community's efforts to live a life together, both with internal and external parties. The Tjondronegoro version of the concept of sodality in the current era is not only for the smallest community unit in the community territory, but it can be strengthened by the meaning of a synergy of interests in meeting the needs of a community.

Pseudorabies virus (PRV), in the family Herpesviridae, is a pathogen of Aujeszky's disease, which causes great economic losses to the pig industry. Recent outbreaks of Pseudorabies imply that new control measures are urgently needed. The present study shows that kaempferol is a candidate drug for controlling PRV infection, as it possesses the ability to inhibit PRV replication in a dose-dependent manner in vitro. Kaempferol at a concentration of 52.40 µmol L−1 could decrease PRV-induced cell death by 90%. With an 50% inhibitory concentration (IC50) value of 25.57 µmol L−1 kaempferol was more effective than acyclovir (positive control) which has an IC50 value of 54.97 µmol L−1. A mode of action study indicated that kaempferol inhibited viral penetration and replication stages, decreasing viral loads by 4- and 30-fold, respectively. Addition of kaempferol within 16 h post infection (hpi) could significantly inhibit virus replication, and viral genome copies were decreased by almost 15-fold when kaempferol was added at 2 hpi. Kaempferol regulated the NF-κB and MAPKs signaling pathways involved in PRV infection and changed the levels of the target genes of the MAPKs (ATF-2 and c-Jun) and NF-κB (IL-1α, IL-1β and IL-2) signaling pathways. The findings of the current study suggest that kaempferol could be an alternative measure to control PRV infection.

Pelawad Village is one of the villages in the Ciruas sub-district, Serang Regency, where the majority of the population is Muslim. Pelawad Village has eight mosques. In the management of mosque finances, based on preliminary information received from the BKPM (Mosque Youth Communication Board) it has not been carried out properly. Almost all mosques do not yet have a good bookkeeping system. This activity aims to provide simple financial bookkeeping training with the theme Financial Management Training for Empowerment of Mosque Youth. The method used in this community service activity is an action study through a training approach for youth and adolescents in the Pelawad-Ciruas village environment. To make this happen, BKPM has collaborated with several Bina Bangsa University lecturers. The partnership cooperation between BKPM and Abdimas team at Bina Bangsa University is carried out with the following agreements: BKPM is responsible for providing training facilities and infrastructure as well as coordinating training participants. The community service team served as resource persons and provided training materials. This activity has an outcome that must be achieved, namely increasing the ability of mosque-based financial management. The activity was carried out by after isha considering that the participants were mosque administrators and BKPM members who were caretakers of the mosque, and lasted for 3 days while still observing strict health protocols.

Many school administrators in the Department of Education faced a big problem in the form of student dropouts. The aim of the study was to look at the demographic data and reasons for student dropouts in the school year 2018–2019, as well as establish an intervention program to help students avoid dropping out. The mixed method design was used in this action study. The research study used a purposive sampling method, with students who dropped out during the 2018-2019 school year as participants. In addition, random sampling was used to select focus-group discussions (FGD) in order to obtain in-depth information on the subject of this research. For this study, simple statistics such as ranking and percentage were used as statistical tools. The majority of dropouts cited personal reasons for leaving school, especially a lack of interest due to poverty, while others were affected by peers. The results were used to improve the guidance program at the school in order to keep students from dropping out. Teachers, particularly those with advisory classes, were given training on how poverty can lead to students dropping out. Muchos administradores escolares del Departamento de Educación enfrentaron un gran problema en forma de deserción de estudiantes. El objetivo del estudio fue analizar los datos demográficos y las razones de la deserción de los estudiantes en el año escolar 2018-2019, así como establecer un programa de intervención para ayudar a los estudiantes a evitar la deserción. En este estudio de acción se utilizó el diseño de método mixto. El estudio de investigación utilizó un método de muestreo intencional, con estudiantes que abandonaron durante el año escolar 2018-2019 como participantes. Además, se utilizó un muestreo aleatorio para seleccionar discusiones de grupos focales (FGD) con el fin de obtener información en profundidad sobre el tema de esta investigación. Para este estudio, se utilizaron estadísticas simples como la clasificación y el porcentaje como herramientas estadísticas. La mayoría de los que abandonaron la escuela citaron razones personales para dejar la escuela, especialmente la falta de interés debido a la pobreza, mientras que otros se vieron afectados por sus compañeros. Los resultados se utilizaron para mejorar el programa de orientación en la escuela con el fin de evitar que los estudiantes abandonen la escuela. Los maestros, en particular los que tienen clases de asesoramiento, recibieron capacitación sobre cómo la pobreza puede llevar a la deserción de los estudiantes. Muitos administradores escolares no Departamento de Educação enfrentaram um grande problema na forma de evasão de alunos. O objetivo do estudo foi analisar os dados demográficos e as razões para a evasão de alunos no ano letivo de 2018–2019, bem como estabelecer um programa de intervenção para ajudar os alunos a evitar o abandono. O desenho do método misto foi usado neste estudo de ação. A pesquisa utilizou um método de amostragem proposital, com alunos que abandonaram o estudo durante o ano letivo de 2018-2019 como participantes. Além disso, a amostragem aleatória foi utilizada para selecionar discussões de grupos focais (FGD), a fim de obter informações aprofundadas sobre o tema desta pesquisa. Para este estudo, estatísticas simples como classificação e porcentagem foram usadas como ferramentas estatísticas. A maioria dos desistentes citou motivos pessoais para abandonar a escola, especialmente a falta de interesse devido à pobreza, enquanto outros foram afetados por colegas. Os resultados foram usados ​​para aprimorar o programa de orientação na escola, a fim de evitar o abandono escolar. Os professores, especialmente aqueles com aulas de aconselhamento, receberam treinamento sobre como a pobreza pode levar ao abandono escolar.

We studied the barriers to and enablers of the diffusion of a new working practice. We used the diffusion of innovations theory as the the­oretical framework for this participatory action study. The data included interviews, memos, notes from workshops and descriptions of the environment in which the new practice was applied. The data were analyzed using induc­tive content analysis. In general, the enablers and barriers were related to factors pertaining to both individuals and structures. The main barriers were lack of digital skills, incompatible data systems and characteristics related to the environment of use or the practice itself. The en­abling factors related to the users’ competence and the operating environment.

This research aims to improve the competence of MI teacher Muhammadiyah Grubug in compiling syllabus and RPP. This research is an action study through academic supervision activities. The subject of the study was MI teacher Muhammadiyah Grubug. The research was conducted in two cycles covering observation and discussion activities. The results showed that in cycle I the improvement in teacher competency reached 22% and increased to 67% in cycle II. Academic supervision activities can significantly improve the ability of MI Muhammadiyah Grubug teachers in compiling syllabuses and RPP.

In general, the purpose of this study is to obtain data about the spiritual intelligence of children aged 5-6 years in the center of al Islam KB TK Bunga Bangsa Islamic School through role play. This research was conducted at KB TK Bunga Bangsa Islamic School Bekasi which is located on Jl. Kh. Agus Salim Number 206, Kelurahan Margahayu, District of East Bekasi, Kota Bekasi, West Java Province. Specifically this research will see how big role play can improve every aspect that exist in spiritual intelligence for children aged 5-6 years at KB TK Bunga Bangsa Islamic School Bekasi. This research was conducted in second semester of academic year 2016/2017. This action study was conducted using a cycle model from Stephen Kemmis and Mc Taggart. Action research is carried out through planning, implementation, observation and reflection. This research was conducted in two cycles and started with pre-research activities. The average praintervensi result is 57%, in cycle 1 the result is 65,5% and cycle 2 reaches 80% on average. From the data there is a significant increase in each cycle. Improvement is seen in every aspect that depicts children's spiritual intelligence such as self-awareness, spontaneity, internally motivated, seeing life from vision and based on fundamental, holistic values, seeing system and universality, compassion (sense of community, sense of following the flow of life) diversity, independent, firm against the majority, fundamentally questioning, rearranging in the big picture, and steadfast in difficulty.Thus, the learning process through the role play to improve spiritual intelligence is said to have been achieved because most of the indicators in the competence of the ability of spiritual intelligence has increased. The implication of this research is that role playing can be one strategy to improve spiritual intelligence.

This action research is conducted to examine the factors in MSMD Resources (M) Sdn Bhd influencing job performance among employees. The study objective was (a) to determine the factors that influence job performance of employees in MSMD Resources (M) Sdn Bhd;(b) to identify the improvement process for job performance in MSMD Resources (M) Sdn Bhd and; (c) to examine whether the monthly appraisal or quarterly performance review can help on job performance improvement in MSMD Resources (M) Sdn. Bhd. For the purpose of this action study, 35 employees out of 60 were selected via a stratified random sampling technique from MSMD Resources (M) Sdn Bhd. Data were collected via a questionnaire and interviews to attain the research objectives. The expected results of this study will also contribute to the MSMD Resources (M) Sdn Bhd company and future researchers on managing employees towards job performance excellence.

Background Numbers of people with an intellectual disability and dementia present a global health and social challenge with associated need to reduce stress or agitation and improve quality of life in affected individuals. This study aimed to identify effectiveness of psychosocial interventions in social care settings and, uniquely, explore use of photovoice methodology to develop dialogue about dementia. Methods This mixed-method participatory action study used individualised goal-setting theory with 16 participants with intellectual disability and dementia, and 22 social care staff across 11 sites. Five co-researchers with intellectual disability were part of an inclusive research team collecting data using existing and bespoke tools including photovoice. Analysis used descriptive and inferential statistics and framework analysis. Results Seventy four percentage of individual goals met or exceeded expectations with reduction in some "as required" medication. Qualitative findings include themes of enabling care and interventions as tools for practice. Photovoice provided insight into previously unreported fears about dementia. Conclusions Individualized psychosocial interventions have potential to reduce distress or agitation.

Favorable efficacy and safety profiles have been demonstrated for abatacept in patients with rheumatoid arthritis (RA) in randomized controlled trials, but these data require validation during long-term follow-ups in routine clinical practice. This study explored long-term safety and retention rates in RA patients treated with intravenous abatacept in the Belgian cohort of the international AbataCepT In rOutiNe clinical practice (ACTION) study (NCT02109666). This non-interventional, observational, longitudinal study included Belgian patients aged ≥ 18 years with moderate-to-severe RA who started intravenous abatacept treatment as first- or second/further-line biologic therapy in routine clinical practice. Between October 2010 and December 2012, 141 patients were enrolled in this cohort, of whom 135 evaluable patients (6 biologic-naïve; 129 previously exposed to ≥ 1 prior biologic disease modifying anti-rheumatic drugs) were eligible for the descriptive analysis; 131/135 were included in the effectiveness analysis. Mean disease duration was 10.5 years (standard deviation 9.7) before abatacept initiation. RA patients presented with high disease activity and comorbidity rate, having failed multiple previous treatment options. In this cohort, the 5-year abatacept retention rate was 34% (95% confidence interval, 23-45%) per protocol, and 51% (95% confidence interval, 40-61%) when temporary discontinuations of abatacept > 84 days (n = 24) were not considered as treatment discontinuations. After 5 years of abatacept treatment, clinical outcomes were favorable [good/moderate European League Against Rheumatism (EULAR) responses in 91.7% patients]. No new safety signals were detected for abatacept in routine clinical practice. In this difficult-to-treat Belgian RA population, high retention rates, good clinical outcomes and favorable safety profile were observed with abatacept., SCOPUS: ar.j, info:eu-repo/semantics/published

Aim To determine the health facility‐based perinatal mortality rate, its causes and avoidable factors using the perinatal mortality surveillance and response guidelines. Design This was an action study conducted in one of the districts in Western Uganda from 1 January–31 December 2019. Methods A total of 20 perinatal death cases were recruited consecutively. Data were collected using a Ministry of Health Perinatal Death Surveillance and Response (PDSR) questionnaire containing questions on pregnancy, delivery and immediate postnatal care. We used descriptive statistics to describe key data elements. Results We found a health facility‐based perinatal mortality rate of 17.3 deaths per 1,000 live births. Birth asphyxia was the most common cause of perinatal deaths. Seven, three and ten mothers delayed seeking, reaching and receiving appropriate health care, respectively.

Our goal was to apply an action study on flipped learning in anundergraduate blended course. The student views were collected through asemi-structured interview form. Participants were 143 sophomore teachercandidates (96 female and 47 male) in a mid-size public university in Turkey,registered in a statistics course on MOODLE. There were six main analyses (dataprocessing, t tests, ANOVA, regression, Chi Square and factor analysis) thatwere assigned as a project in the course. There were ppt slides for each topic,sample data and detailed explanations of the projects as well as sampleanalyses in the form of screenshots from SPSS. The semi-structured interviewitems were focused on students’ overall views, the views on videos, the cons ofvideo use, to what extent the expectations from the course were fulfilled, andstudents’ satisfaction levels. The results indicated that students favoredflipped classroom environment over other activities that took place in thecourse. According to their statements, videos were much usedand liked. The cons of flipped classroom application for students were nothaving a computer/smart phone or proper internet connection to access to LMS.According to students' statements, the course offered a lot more than theyexpected, they used to consider statistics challenging and were very satisfiedwith their resulting performance in the course. Finally, they regarded thecourse useful, suggested sparing more time for application, having less topicsfor the project, more visual representations of the topics and videos on theanalyses in SPSS., Amacımız, ters yüz öğrenme üzerine lisansdüzeyindeki istatistik dersinde bir eylem araştırması yapmaktır. Öğrencigörüşleri yarı yapılandırılmış bir görüşme formu ile toplanmıştır.Katılımcılar, Türkiye'deki orta büyüklükte bir kamu üniversitesindeöğrenimlerine devam eden, MOODLEüzerinden istatistik dersine kayıtlı 143 3. sınıf öğretmen adayından (96 kadınve 47 erkek) oluşmaktadır. Ders kapsamında altı temel veri analizi uygulaması(veri işleme, t testi, ANOVA, regresyon, Ki Kare ve faktör analizi) öğretmenadaylarına proje ödevi olarak verilmiştir. Her bir analiz için açıklayıcıslaytlar, örnek veriler ve projelerin ayrıntılı açıklamasının yanı sıraSPSS'den ekran görüntüsü alınarak oluşturulmuş örnek analizler dersinMOODLE'ında bulunmaktaydı. Yarı yapılandırılmış görüşme soruları öğrencilerinders hakkındaki genel görüşlerini, ders videoları hakkındaki olumlu ve olumsuzdüşüncelerini, dersten beklentilerinin ne derece karşılandığına dairdüşüncelerini ve öğrencilerin dersten memnuniyet düzeylerini belirlemeyeyönelik sorulardan oluşmaktadır. Sonuçolarak öğrencilerin ters yüz öğrenme aktivitelerini, dersin içeriğindeki diğer aktiviteleregöre daha çok sevdikleri görülmüştür. Görüşmelerde belirttikleri üzereanalizlerin videolarını beğenerek ve proje ödevlerini yaparken kullanmışlardır. Ters yüz öğrenmeninolumsuz yönü olarak da her zaman LMS'ye erişmek için bilgisayar / akıllıtelefon veya uygun internet bağlantısı bulamama problemlerindenbahsetmişlerdir. Öğrencilere göre, ders beklediklerinden içerik olarak dahazengindi. Dersin başında istatistiği zor bir ders olarak görmelerine rağmendersteki performanslarından memnun olduklarını belirmişlerdir. Dersin kendileriiçin genel olarak yararlı olduğunu ancak uygulamalar için daha fazla zamanverilmesini, proje ödevindeki konu sayısının azaltılmasını, dersin konularıhakkında daha fazla görsel sunumların olmasını ve SPSS'deki analizler için daha fazla videoolmasını önermişlerdir.

Occlusion of exposed dentin tubules may eliminate or reduce dentin hypersensitivity by hindering fluid movements within the tubules. In this study, the mode of action of spherical particles of amorphous calcium magnesium phosphate (180-440 nm in diameter) was studied. A degradation study of the particles in Tris-HCl buffer showed that the particles continuously released Ca2+, Mg2+, and phosphate, and XRD analysis revealed the formation of hydroxyapatite (HA) after 1 week. The occluding effect and efficacy of the spherical particles as an occluding agent were evaluated in an in vitro study. The ACMP particles were incorporated in a gel intended for at-home use and tested on extracted human molars. Application of the particles followed by incubation in artificial saliva resulted in occlusion of exposed tubules, and examination with SEM showed that the particles could penetrate the tubules down to 100 μm from the dentin surface. Transformation of the particles into nanocrystalline HA-structures (nanoHA) was initiated at the dentin surface within 12 h of application, and tubule penetration of the particles, accompanied by further ion release and diffusion of ions, resulted in deep intratubular occlusion in the majority of the tubules within 3 days from application. NanoHA was tightly adhered to the tubule walls, filling the entire tubule volume after 7 days. The results of this study demonstrate the mode of action of the amorphous calcium magnesium phosphate particles in occluding exposed dentin tubules. Interaction with saliva and transformation of the particles within the tubules inducing further mineralization indicate that the particles may be used as an effective treatment to reduce dentin hypersensitivity.

PurposeThe purpose of this paper is primarily to identify factors that accounted for the differences in course evaluation and course performance in two sections of the same course taught by the same instructor. Potential contributors to these differences included critical thinking, grade point average (GPA) and homework time in the course. Secondarily, the authors also examined whether season of the year and academic status of students (1st year through 3rd year) might have contributed to differences in course ratings and exam performance. The data in the study included some strictly quantitative variables and some qualitative judgments subsequently converted to quantitative measures.Design/methodology/approachThe outcome variables included student objective exam scores and course ratings on the University’s eight-item rating form. Variables that may have contributed to performance and course evaluation differences between the two groups included student effort in the course, GPA and critical thinking.FindingsThe higher-performing section obtained significantly higher scores on course exams than the lower-preforming group and also rated the course significantly higher (average of 4.15 across the evaluation items) than the lower performing section (3.64 average in item ratings). The two performance groups did not differ on critical thinking and GPA, but did differ significantly in hours spent per week outside of class in studying for the course.Originality/valueAlthough many studies have examined the predictive validity of course ratings, instructors are typically held responsible for both high and low student ratings. This particular action study suggests that it may be student effort rather than instructor behavior that has the stronger impact on both student performance and course evaluations.

Background: People with advanced cancer often suffer from various symptoms, which can arise from the cancer itself and its treatment, the illness experience, and/or co-morbid conditions. Important patient-reported outcomes such as functional status, symptom severity, and quality of life (QoL) might differ between countries, as countries vary with regard to contextual factors such as their healthcare system. Purpose: To assess self-reported emotional functioning, physical functioning, symptoms, and overall QoL in patients with advanced lung or colorectal cancer from six European countries, particularly in relation to their country of residence. Methods: We used baseline patient data from the ACTION trial, including socio-demographic and clinical data as well as patient-reported data regarding functioning, symptoms, and overall QoL (EORTC QLQ-C15-PAL). Results: Data from 1117 patients (55% lung cancer stage III/IV, 45% colorectal cancer stage IV) were used. The highest (worst) average symptom score was found for fatigue. We found similarities but also important differences in the outcomes across countries. The best scores (the highest for emotional functioning and QoL, the lowest for symptoms) were reported by Dutch and Danish patients. Belgian patients reported relatively low emotional functioning. Conclusion: The optimization of functioning, symptom relief, and overall QoL should be important objectives of healthcare professionals who take care of patients with advanced cancer. There are similarities, but also substantial differences across countries in functional status, symptoms, and overall QoL. Policymakers should take these differences into account and invest in offering health care catered to the needs of their population.

Background Preterm infants have high rates of morbidity, especially from late-onset sepsis and necrotising enterocolitis. Lactoferrin is an anti-infective milk protein that may act through effects on gut bacteria, metabolites and epithelial cell function. The impact of supplemental lactoferrin in reducing late-onset sepsis was explored in the Enteral LactoFerrin In Neonates (ELFIN) trial. Objectives The Mechanisms Affecting the Gut of Preterm Infants in Enteral feeding (MAGPIE) study was nested within the ELFIN trial and aimed to determine the impact of lactoferrin on gut microbiota and bacterial function, and changes preceding disease onset. We aimed to explore impacts on the stool bacteria and faecal/urinary metabolome using gas and liquid chromatography–mass spectrometry, and explore immunohistological pathways in resected tissue. Methods Preterm infants from 12 NHS hospitals were enrolled in the study, and daily stool and urine samples were collected. Local sample collection data were combined with ELFIN trial data from the National Perinatal Epidemiology Unit, Oxford. The longitudinal impact of lactoferrin in healthy infants was determined, and samples that were collected before disease onset were matched with samples from healthy control infants. Established, quality-controlled 16S ribonucleic acid, gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry analyses were conducted. Validated databases and standardised workflows were used to identify bacteria and metabolites. Tissue samples from infants undergoing surgery and matched controls were analysed. Results We recruited 479 preterm infants (mean gestation of 28.4 ± 2.3 weeks) and collected > 33,000 usable samples from 467 infants. 16S ribonucleic acid bacterial analysis was conducted on samples from 201 infants, of whom 20 had necrotising enterocolitis and 51 had late-onset sepsis, along with samples from healthy matched controls to explore longitudinal changes. The greatest change in relative bacterial abundance over time was observed in Staphylococcus, which decreased from 42% at aged 7–9 days to only 2% at aged 30–60 days (p R 2 = 0.005; p = 0.04). Staphylococcus (p Haemophilus (p Lactobacillus (p = 0.01) showed greater mean relative abundance in the placebo group than in the lactoferrin group. Gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry analyses showed that lactoferrin had limited impact on the metabolome. Liquid chromatography–mass spectrometry showed significant metabolite differences between necrotising enterocolitis or late-onset sepsis infants and healthy controls. The resected gut tissue analysis revealed 82 differentially expressed genes between healthy and necrotic tissue. Limitations Although we recruited a large number of infants, collecting daily samples from every infant is challenging, especially in the few days immediately preceding disease onset. Conclusion We conducted a large mechanistic study across multiple hospital sites and showed that, although lactoferrin significantly decreased the level of Staphylococcus and other key pathogens, the impact was smaller than those of other clinical variables. Immunohistochemistry identified multiple inflammatory pathways leading to necrotising enterocolitis and showed that the use of NHS pathology archive tissue is feasible in the context of a randomised controlled trial. Future work We observed significant changes in the stool and urinary metabolome in cases preceding late-onset sepsis or necrotising enterocolitis, which provide metabolic targets for a future mechanistic and biomarker study. Trial registration Current Controlled Trials ISRCTN12554594. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.

Students' speaking skills always require practice and also the right encouragement by the teacher. This is where the teacher as a person who has maturity in thinking should build a replication of activities and learning in the classroom as needed by students. This research is an action study of classroom action. The subjects of this study were fifth grade students at MI Muhammadiyah Sinduraja. The sociodrama method was carried out, the researchers obtained data on the percentage of good progress to improve students' speaking skills. The percentage which was originally shown at 60% had an increase to 75% when the action test was carried out in the second cycle.

When children require hospital admission, many receive medications with nephrotoxic potential. As such, this can translate into an increased risk of acute kidney injury. In this context, acute kidney injury is hospital acquired, often iatrogenic, and portends risk of adverse outcomes. The Nephrotoxic Injury Negated by Just-in-Time Action study implemented a multicenter hospital-wide quality improvement initiative to detect and reduce nephrotoxin exposure in children aimed at decreasing the rates of potentially avoidable acute kidney injury. This commentary explores the findings and implications of the Nephrotoxic Injury Negated by Just-in-Time Action study.

In the present investigation, male and female clones/strains/species of Populus deltoides procured from State Forest Department, Haldwani and Shyampur, Haridwar Forest Division and maintained in the germplasm block of Naganji nursery from which 11 male and 13 female clones were included in the reproductive study and the selected plant material of 4 females (G-48, S 1, S 7 C 8 and L-62/84) and 4 males (S 7 C 11, L-17/92, L-124/86 and S 7 C 1) clones were crossed using Line × Tester (4 × 4) mating design. Control crossing was done and seedlings were raised in the nursery at stage-1 and were evaluated for morphological characters. In stage-2 clonal cuttings of selected individuals were raised in RBD and were evaluated for morphological, physiological and wood characters. The gene action study revealed that dominance variance was observed more than the additive variance for all the parameters studied. The proportional contribution of lines was higher than individual contribution of testers or line × tester interaction except for plant height, collar diameter, internodal length, leaf area, maximum width of leaf, angle between the mid rib and 2 nd lower lateral mid rib, shoot bark thickness, root bark thickness, fresh shoot weight, dry shoot weight, dry root weight, dry root shoot ratio, root length, total fresh weight, total dry weight, stomatal conductance and fibre length. Among 18 SSR markers, fifteen markers showed monomorphic allelic pattern, the remaining three markers (PMGC-2060, PMGC-2020 and PMGC-451) showed polymorphic pattern. A close appraisal of the SSR banding pattern obtained after the amplification of genomic DNA of both the parents and their hybrids revealed that, all the hybrids were similar to their parents.

The advancement of technology requires higher skill in obtaining information due to the rapid flows of information in this recent globalization era. Consequently, reading comprehension becomes an important language skill for students to nurture. In classroom practices, Indonesian students still encounter problems in English reading comprehension. The present classroom action study dealt with improving reading comprehension through collaborative learning. This is due to some studies revealed that collaborative learning is an effective learning strategy to improve students' learning achievement. The data were collected by administering a pre-test in reading comprehension prior to the teaching cycle and two post-tests at the end of every teaching cycle. The results showed that collaborative learning is significantly effective to improve students' reading comprehension and critical thinking. This study implies that teachers should consider the integration of collaborative learning in teaching reading comprehension.

Successful hotel branding requires the management of both external and internal branding. External branding has been widely studied to understand how hotel brands connect with customers; however, internal branding targets internal employees, and the practice is not well understood by hoteliers. For that reason, this study proposes a framework for implementing internal branding in hotel organizations. We analyzed an internal branding project for three consecutive years using a participatory action study. The findings of this study support a six dimensions framework for implementing internal branding strategies: (1) corporate support; (2) leadership of managers; (3) reciprocal learning; (4) being proactive at the personal level; (5) characteristics of departments; and (6) performance evaluation. In the proposed framework, we applied a combined social identity and social exchange approach to identify how these approaches function in different paths which contributes new theoretical insights to the understanding of internal branding.

Lack of both awareness and application of evidence-based principles for obesity care for people with obesity (PwO) limit employers' role in supporting effective obesity management among employees with obesity (EwO). The aim of the ACTION (Awareness, Care, and Treatment In Obesity maNagement) study was to explore the current state of employer wellness programs related to obesity management, evaluate the impact of obesity in the workplace, assess attitudes regarding the role of employers in managing obesity, and identify challenges in implementing workplace wellness programs as perceived by employer representatives (ERs) and EwO. An online survey was conducted among ERs and adult PwO (BMI ≥30 by self-reported height and weight) using a cross-sectional, US-based stratified sample design. There were 153 ER respondents and 3008 adult PwO respondents; 1478 PwO were employed full-time, part-time, or were self-employed. ERs recognize the seriousness of obesity and its negative impact on work productivity; however, wellness programs tend to fall short of addressing specific needs of EwO, evidenced by low participation and success rates reported by EwO. This study highlights the need for programs that address the complexities of obesity and the specific needs of EwO, which currently are inadequately addressed according to EwO.

AbataCepT In rOutiNe clinical practice (ACTION; NCT02109666) was an observational study of patients with rheumatoid arthritis who initiated intravenous abatacept in clinical practice. We aimed to compare abatacept retention rates and clinical outcomes in patients from Germany versus other countries. Baseline characteristics, crude retention rates, and clinical outcomes were compared by treatment line in the German cohort at 2 years. In addition, biologic-naive patients were compared with biologic-naive patients pooled from other participating countries. In the German cohort, 677/680 (99.6%) patients enrolled were evaluable and 171/677 (25.3%) were biologic naive. At baseline, abatacept monotherapy was received by a similar proportion of biologic-naive and biologic-failure patients in the German cohort, but by a greater proportion of biologic-naive patients in German versus other countries cohort (27.5 vs. 12.9%). The overall crude abatacept retention rate at 2 years in the German cohort was 39.9%; retention rate did not differ significantly by treatment line, but among biologic-naive patients it was lower in Germany than in the other countries cohort (42.1 vs. 58.7%; log-rank test p

From the aDivision of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy; b3rd Medical Department, Cardiology and Intensive Care Medicine and Sigmund Freud University, Medical Faculty, Vienna, Austria; cCardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; dLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; eAalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; fBrigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts; gDuke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; hDepartment of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, and faculty of Medicine and Life Sciences at the University of Hasselt, Hasselt, Belgium; iCardiology Department, Nimes University Hospital, ACTION Study Group, Montpellier University, Nimes, France; jDepartment of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; kMayo Clinic College of Medicine, Rochester, Minnesota; and the lDivision of Cardiology, University of Florida College of Medicine, Jacksonville, Florida. Dr. Capodanno has received speakers honoraria from Bayer, AstraZeneca, Daiichi-Sankyo, Pfizer, and Boehringer Ingelheim; and has received consulting fees from Abbott Vascular, Bayer, and Daiichi-Sankyo. Dr. Huber has received lecture fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, Portola, Sanofi, and The Medicines Company. Dr. Mehran has received institutional research funding from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol-Myers Squibb/Sanofi, CSL Behring, Eli Lilly/Daiichi-Sankyo, Medtronic, Novartis, and OrbusNeich; has served as a consultant to Boston Scientific, Abbott Vascular, Medscape, Siemens Medical Solutions, Regeneron Pharmaceuticals (no fees), Roivant Sciences, and Sanofi; has served as an institutional consultant (payment to institution) for Abbott Vascular and Spectranetics/Phillips/Volcano Corporation; has served on the Executive Committee for Janssen Pharmaceuticals and Bristol-Myers Squibb; has received institutional (payment to institution) Advisory Board funding from Bristol-Myers Squibb and Novartis; has received Data and Safety Monitoring Board membership funding to his institution from Watermark Research; and has < 1% equity with Claret Medical and Elixir Medical. Dr. Lip has served as a consultant for Bayer/Janssen, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo; and has received speaker's honoraria from Bayer, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. Dr. Faxon has received personal fees from Boston Scientific, Medtronic, and Baim. Dr. Granger has received personal fees from Janssen, Boston Scientific, and Medtronic; has received research grant support from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Daiichi-Sankyo, Janssen Pharmaceuticals, Bayer, Pfizer, Novartis, Population Health Research Institute, the U.S. Food and Drug Administration, and the National Heart, Lung, and Blood Institute; and has received consulting fees from Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Medtronic, Merck & Co., Novartis, Pfizer, Daiichi-Sankyo, Rho Pharmaceuticals, Verseon, and Janssen Pharmaceuticals. Dr. Vranckx has received personal fees from AstraZeneca, Bayer Health Care, CLS Behring, and Daiichi-Sankyo. Dr. Lopes has received consulting fees from Amgen, Bayer, Boehringer Ingelheim, BristolMyers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi; and has received institutional grants from Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi. Dr. Montalescot has received research grants to the institution or consulting/lecture fees from Abbott, Amgen, Actelion, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women's Hospital, Cardiovascular Research Foundation, Daiichi-Sankyo, Idorsia, Lilly, Europa, Elsevier, Federation Francaise de Cardiologie, ICAN, Medtronic, Journal of the American College of Cardiology, Lead-Up, Menarini, Merck Sharp & Dohme, Novo Nordisk, Pfizer, Sanofi, Servier, The Mount Sinai School, TIMI Study Group, and WebMD. Dr. Cannon has received institutional grants and personal fees from Boehringer Ingelheim and Bristol-Myers Squibb; institutional grants from Daiichi-Sankyo and Janssen; and honoraria from Amgen, Amarin, Merck, Alnylam, Kowa, Pfizer, Eisai Co., Ltd., Sanofi, and Regeneron. Dr. Ten Berg has received grant support, Advisory Board fees, consulting fees, and lecture fees from AstraZeneca; has received Advisory Board fees, consulting fees, and lectures fees from Eli Lilly, Daiichi-Sankyo, The Medicines Company, Accumetrics, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, and Bayer; and has received grant support from ZonMw and AstraZeneca. Dr. Gersh has received research contracts with Apple, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi-Sankyo, Janssen, Novartis, GlaxoSmithKline, Medtronic Foundation, Pfizer, the U.S. Food and Drug Administration, and the National Institutes of Health; and has a consulting relationship with Abbvie, AstraZeneca, Bayer, BristolMyers Squibb, Boehringer Ingelheim, Boston Scientific, Gilead, Pfizer, Daiichi-Sankyo, Novartis, Medtronic, Merck, Novo Nordisk, and Roche Diagnostics. Dr. Bhatt has served on the Advisory Board of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, and Regado Biosciences; has served on the Board of Directors of Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; has served as Chair of the American Heart Association Quality Oversight Committee, NCDR-ACTION Registry Steering Committee, and the VA CART Research and Publications Committee; has served on the Data Monitoring Committees of Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi-Sankyo), and the Population Health Research Institute; has received honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC. org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI Clinical Trial Steering Committee funded by Boehringer Ingelheim), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national coleader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME Steering Committees); has served as Deputy Editor of Clinical Cardiology; has received research funding from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); has served as site coinvestigator for Biotronik, Boston Scientific, St. Jude Medical (now Abbott), and Svelte; has served as a Trustee of the American College of Cardiology; and has performed unfunded research for FlowCo, Fractyl, Merck, Novo Nordisk, PLx Pharma, and Takeda. Dr. Angiolillo has received consulting fees or honoraria as an individual from Amgen, Aralez, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Daiichi-Sankyo, Eli Lilly, Haemonetics, Janssen, Merck, PhaseBio, PLx Pharma, Pfizer, Sanofi, and The Medicines Company; has participated in review activities for CeloNova and St. Jude Medical; and has received institutional grants from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Idorsia, Janssen, Matsutani Chemical Industry Co., Merck, Novartis, Osprey Medical, and Renal Guard Solutions. Stefan Hohnloser, MD, served as Guest Associate Editor for this paper.

Aesthetic education is currently an educational issue receiving substantial attention, and to increase the accessibility of aesthetic education, working to implement aesthetic education programs should be for all age groups. The aesthetic education for senior citizens, providing the participants with positive aesthetic experiences not only increases sensory stimulation but also facilitates new connections to the world, are critical in maintenance of senior citizens’ physical and social functions. In the literature, few aesthetic education studies have targeted senior citizens, despite the increase in senior-activity-center-related projects and programs since 2015 in Taiwan. Most individuals who attend programs at senior activity centers are senior citizens from nearby communities. Systematic arrangement and planning of aesthetic courses at these centers may further community-based aesthetic education efforts. This study chose a Taipei City senior activity center for an action study exploring design approaches for aesthetic education community-based classes and activities for 25 senior citizens. The findings include understanding the initial experiences of senior citizens in collective art projects, adjustment of instruction method through reflection and conversation, senior citizens’ class participation and feedback enhanced aesthetic literacy and interpersonal interaction, future course improvement and enrichment. The researcher reviewed feasible approaches for promoting senior aesthetic education to provide useful information to community senior activity centers and their managers and senior aesthetic education promoters.

Simultaneous action of surfactant modified sugarcane bagasse (SBH) for dye adsorption and antibacterial activity were investigated. SBH was subjected for adsorption of cationic dye, methylene blue (MB) and anionic dye, methyl orange (MO). Antibacterial activity of SBH was tested against gram negative bacterium (Escherichia coli ATCC11229) and gram positive bacteria (Enterococcus faecalis ATCC 29212 and Staphylococcus aureus ATCC6538). SBH was prepared by reacting sugarcane bagasse (SB) with different concentrations of cationic surfactant, hexadecyltrimethylammonium bromide HDTMA-Br) (0.1, 1.0 and 4.0 mM). The adsorbed amount of HDTMA-Br onto SBH was determined after modification process. SB and SBH were structurally characterized by FTIR spectroscopy. Results from simultaneous action study demonstrated that SB showed adsorption affinity towards MB and MO while the antibacterial activity of SB increased after the surfactant modification reaction. SB modified with 4.0 mM of HDTMA-Br (SBH4.0) exhibited the highest adsorption capacity and antibacterial activity. SBH demonstrated excellent antibacterial activity against gram negative in comparison to gram positive bacteria. In conclusion, the modification of SB with high concentration of HDTMA-Br enhanced the simultaneous action of cationic and anionic dye adsorption and the antibacterial activity against gram negative bacteria.

The article describes the process of developing a practical guide rooted in a participatory action study conducted at the Compagnie des jeunes retraites du Plateau to promote the inclusion of membe...

Background Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu (Posyandu/Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia. Methods A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition. Results (1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs’ knowledge (p = 0.000) and skills (p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia. Conclusions The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs’ book. Hence, its implementation is promising for use at the national level.

Background The smoking of illicit drugs presents a serious social and economic burden in Canada. People who smoke drugs (PWSD) are at increased risk of contracting multiple infections through risky drug practices. Peer-led harm reduction activities, and the resulting social networks that form around them, can potentially minimize the dangers associated with the smoking illicit drugs. Goal The goals of this study were to pilot test the combined approaches of respondent driven sampling with community based participatory action research in these settings and compare the attributes and social networks of PWSD in two British Columbia cities with different harm reduction programs. Methods Using community-based participatory action research (CBPAR) and respondent-driven sampling (RDS), individuals with lived drug experiences were employed from communities in Abbotsford and Vancouver as peer researchers to interview ten contacts from their social networks. Contacts completed a questionnaire about their harm reduction behaviours and interactions. Results We found that PWSD residing in Abbotsford were more likely to report engaging in harm-promoting behaviours, such as sharing, reusing, or borrowing crack pipes. However, PWSD in the Downtown East side Community of Vancouver were more likely to report engaging in harm-reducing activities, such as being trained in naloxone use and CPR. We found no differences in network sizes between the two communities, despite the population differences and harm reduction programs Conclusion The high participation rates and interactions between researchers, and peer researchers enriched the study implementation and successfully informed our results. The fact that there were no differences in network size suggests that people have similar support in Vancouver as in Abbotsford, and that drug use practices differ mainly due to availability of harm reduction programming and resources.

BACKGROUND AND PURPOSE A prior study found a link between post-stroke blood-brain barrier disruption and functional outcomes. The current study aimed to replicate this finding in a cohort of patients recruited in the context of a randomized clinical trial. METHODS The ACTION trial was a study of natalizumab in acute stroke patients. Patients with MRI-perfusion weighted imaging (PWI) were included in this post-hoc analysis. Blood-brain permeability images (BBPI) were calculated from the PWI source images. Mean BBPI values from the 24 h time point were compared with modified Rankin scores (mRS) at 5, 30, and 90-day assessments using linear regression. Good functional outcome (mRS< = 1) was compared with mean BBPI using logistic regression. RESULTS One hundred and nineteen patients were included in the analysis (median age = 74, 43% female). Higher mean BBPI was associated with worse mRS at 5 days (p = 0.002; r2 = 0.078) and 30 days (p = 0.036; r2 = 0.039) but did not reach statistical significance at 90 days (p = 0.30; r2 = 0.010). When removing high-value outliers, all outcome measures showed a stronger relationship with mean BBPI. Logistic regression found that with every 1% increase in mean BBPI measured 24 h after the stroke, the likelihood of achieving a good functional outcome at 90 days is decreased by half (OR = 0.53; CI = 0.30:0.95; p = 0.032). CONCLUSIONS With sufficient image quality, elevated BBPI measured in the days after an ischemic event is predictive of worse functional outcome and may serve as a biomarker for post-stroke inflammation.

This study focuses on the loss of youth and talent as one of the most pressing social justice issues leading to unsustainable and inequitable development in rural communities. With the backdrop of the rapid decline in the young rural population and loss of local tacit knowledge, we question how to balance rural sustainability through place-based critical pedagogy by integrating rural societies, agri-economics, and cultural landscapes. To confront the crisis of a loss of young rural talent and local wisdom, interdisciplinary professors from the National Taiwan University initiated place-based pedagogical action research from winter 2011 to winter 2019. This interdisciplinary place-based pedagogy approach supported hundreds of students and educators by nurturing socio-cultural and economic networks that benefit both urban universities and rural communities. Using the curriculum outcomes of this study, we propose the concept of “Knowledge-Ties Youth Rural Sustainability” (KYRS). The KYRS framework addresses two questions: (1) how to bring young talent to rural everyday landscapes in order to sustain rural livelihoods, and (2) how to integrate rural tacit knowledge with contemporary sciences to create new technologies that sustain the environment. The KYRS framework serves as a pedagogical action research blueprint for university educators encountering similar rural challenges and opportunities to those faced by the National Taiwan University in Pinglin.

Health Lens Analysis (HLA) is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community-based participatory research (CBPR) and action study to mitigate the negative health effects of traffic-related air pollution TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus creating a shared language and understanding of the issue.

This action research examined the roles of writing instruction involving metacognitive and critical thinking strategy on the improvement of argumentative writing skills of college students in Indonesia. Argumentative writing is one of the pivotal topics among researchers investigating ways to improve college-level writing. This study involved 88 students of three parallel classes enrolled in the writing skill development course. Employing Kemmis and McTaggart’s (1988, 2014) model of action research, this study employed a three-cycle action study in one semester, covering four stages of learning tasks: understanding of the problem, monitoring of students’ learning activities, problem-solving, assessment, and conclusion drawing. Each cycle provided learning exercises of metacognitive and critical thinking to hone the students’ argumentative writing skills. Referring to critical skill criteria as a baseline, the analysis found that employing metacognitive and critical thinking processes in the instructional treatments enabled the students to improve their argumentative writing skills. The finding indicates a pivotal role of incorporating metacognition in writing instruction as a strategy to improve college-level writing skills.

Background/aims Serious adverse event reporting guidelines have largely been developed for pharmaceutical trials. There is evidence that serious adverse events, such as psychological distress, can also occur in non-pharmaceutical trials. Managing serious adverse event reporting and monitoring in palliative care non-pharmaceutical trials can be particularly challenging. This is because patients living with advanced malignant or non-malignant disease have a high risk of hospitalisation and/or death as a result of progression of their disease rather than due to the trial intervention or procedures. This paper presents a number of recommendations for managing serious adverse event reporting that are drawn from two palliative care non-pharmacological trials. Methods The recommendations were iteratively developed across a number of exemplar trials. This included examining national and international safety reporting guidance, reviewing serious adverse event reporting procedures from other pharmacological and non-pharmacological trials, a review of the literature and collaboration between the ACTION study team and Data Safety Monitoring Committee. These two groups included expertise in oncology, palliative care, statistics and medical ethics and this collaboration led to the development of serious adverse event reporting procedures. Results The recommendations included; allowing adequate time at the study planning stage to develop serious adverse event reporting procedures, especially in multi-national studies or research naïve settings; reviewing the level of trial oversight required; defining what a serious adverse event is in your trial based on your study population; development and implementation of standard operating procedures and training; refining the reporting procedures during the trial if necessary and publishing serious adverse events in findings papers. Conclusions There is a need for researchers to share their experiences of managing this challenging aspect of trial conduct. This will ensure that the processes for managing serious adverse event reporting are continually refined and improved so optimising patient safety. Trial registration ACTION trial registration number: ISRCTN63110516 (date of registration 03/10/2014). Namaste trial registration number: ISRCTN14948133 (date of registration 04/10/2017).

This project focused on emergency department (ED) care provided in a rural northern Canadian community. It studied how supported and meaningful dialogue between health authority providers and physicians whose work is associated with the ED, and providers who work with Indigenous people outside the health authority, helped inform culturally safe care in the ED. Guided by Indigenous and non-Indigenous advisory committee members, this participatory action study created a space for dialogue that allowed the perspectives of two worlds and multiple disciplines to emerge and develop solutions. The findings demonstrated what culturally safe and unsafe care in the ED look like, identified current culturally safe practices, and described factors that challenge culturally safe care. This project, although small, was unique because of the degree of collaboration in health care improvement between those inside and outside the health authority. Supportive dialogue that is mutually negotiated to include attention to culturally safe practice may be the starting place for the creation of the right space, the ethical space, which is so crucial in moving forward. From this foundation, there are six priority suggestions on how to enhance culturally safe care within an ED setting. These recommendations, built from dialogue within a locally generated ethical space, may extend beyond the local context and may be crucial for supporting cultural safety more broadly in the health care system. The findings presented here were the result of a research project undertaken as part of a master’s degree and do not reflect the views of any other body.

Background Missing data are common in end-of-life care studies, but there is still relatively little exploration of which is the best method to deal with them, and, in particular, if the missing at random (MAR) assumption is valid or missing not at random (MNAR) mechanisms should be assumed. In this paper we investigated this issue through a sensitivity analysis within the ACTION study, a multicenter cluster randomized controlled trial testing advance care planning in patients with advanced lung or colorectal cancer. Methods Multiple imputation procedures under MAR and MNAR assumptions were implemented. Possible violation of the MAR assumption was addressed with reference to variables measuring quality of life and symptoms. The MNAR model assumed that patients with worse health were more likely to have missing questionnaires, making a distinction between single missing items, which were assumed to satisfy the MAR assumption, and missing values due to completely missing questionnaire for which a MNAR mechanism was hypothesized. We explored the sensitivity to possible departures from MAR on gender differences between key indicators and on simple correlations. Results Up to 39% of follow-up data were missing. Results under MAR reflected that missingness was related to poorer health status. Correlations between variables, although very small, changed according to the imputation method, as well as the differences in scores by gender, indicating a certain sensitivity of the results to the violation of the MAR assumption. Conclusions The findings confirmed the importance of undertaking this kind of analysis in end-of-life care studies.

There are two approaches to health and wellness that are explored throughout this chapter. The first is a socio-ecological response, where the recreation system has been focused on changing individual behaviour at the programmatic level. There is the realization that if programs were the single answer, then all the world's problems would be solved by now. What is needed is a much larger systemic response. The second approach relates to the co-creation of authentic and customized health and wellness solutions. Typically, the notion of health and wellness is viewed through the lens of the “expert” and a prescription model that is grounded in “the expert knows what is best for you.” The emerging model is one where the citizen is at the centre of the solution process. People desire the ability to feel more in control and make informed decisions about their health for themselves and their families. In this chapter, the authors explore this topic by reviewing a Canadian health and wellness action study.

Rationality in decision making means choosing alternative actions to achieve goals through the best method. Rationalization of decision making is urgently needed in the 21st-century learning to create qualified human resources which can compete on the world stage in the era of rapid development of science and technology. This paper aims to scrutinize the profile of students’ rational thinking skills in decision making process on infusion analytical thinking skill’s framework in biology learning. Students’ rational thinking skills were gauged by 13 indicators namely probabilistic and statistical reasoning, practical numeracy, risk knowledge, knowledge of scientific reasoning, financial literacy and economic thinking, resistance to miserly information processing, absence of irrelevant context effects in decision making, sensitivity to expected value, proper knowledge calibration: avoiding overconfidence, avoidance of myside bias, openminded/objective reasoning styles, prudent attitude toward the future, and sensitivity to emotions. This research employed mixed-method research approach by conducting test and interview. There were 31 students intensively participated in this action study research. The findings revealed that students are having good results in all the rational thinking skills’s indicators except on resistance to miserly information processing and proper knowledge calibration: avoiding overconfidence indicators because of students’ low desire on expanding their knowledge individually without the teacher’s guidance. The final result of the research showed that there is an influence of analytical thinking infusion in biology learning towards the rationalization of student’s decision making. Therefore, the future learning should balance between the teaching of material and the thinking skill desired in the learning process.