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This study changed the low critical thinking skills of students caused by students not being accustomed to being trained with indicators in students' critical thinking. To overcome this problem, researchers developed interactive animated video media in Civics learning to improve students' critical thinking skills. This study aims to develop valid and practical interactive animated video media to improve critical thinking skills of grade IV elementary school students. This research uses the Research and Development (R&D) method with the ADDIE model. The data collection techniques used in this study were validation sheets, and practicality questionnaires. The subjects of this study were 23 fourth grade students of Pelandakan 2 State Elementary School in Cirebon City. The results showed a media expert score of 97.22% with the category "very valid", linguists 97.08% with the category "very valid" and material experts 91.39% with the category "very valid". For the practicality of interactive animated video media, the student's practicality score of 90% is categorized as very practical. The trial use of interactive animated videos in Civics learning resulted in a significant increase in critical thinking of grade IV students by obtaining an average N-Gain score of 0.77 with a high classification, so interactive animated video media for Civics learning is effectively used to improve the critical thinking skills of grade IV students in learning.

Q fever, caused by infection with the bacterium Coxeilla burnetii, is an endemic disease in Israel. In 2021, a total of 341 cases of Q fever were reported to the [...]

Abstract Recently, significant efforts have been exerted to replace mineral oil with environmentally friendly oils due to safety and environmental issues. However, there is a need to clarify the physical mechanisms behind the ageing impact of these oils. The authors use advanced optical spectroscopy techniques in correlation with dielectric measurements to understand the ageing processes in environmentally friendly oils as well as mineral oil. Firstly, different samples of environmentally friendly oils and mineral oil were utilised to investigate the ageing mechanism. The samples were subjected to different ageing periods using a thermal accelerated ageing process. Secondly, the severity of the produced byproducts due to the oil degradation is examined based on several measured properties representing macroscopic and microscopic categories. The macroscopic category was evaluated through dielectric properties, including breakdown voltage, dielectric permittivity, and dissipation factor. The microscopic category, on the other hand, was assessed using techniques such as ultraviolet–visible absorption spectroscopy and photoluminescence spectroscopy. These techniques enabled a deep understanding of the molecular‐level changes occurring in the oil under ageing conditions, thereby getting new insights into oil ageing mechanisms. It is worth mentioning that natural ester oil demonstrated the most favourable performance across various properties under ageing conditions.

Statin use can lead to various muscle-related issues, including benign creatine kinase (CK) elevations, myalgias, toxic myopathies, rhabdomyolysis, and immune-mediated necrotizing myositis (IMNM), which primarily affects older males. IMNM presents with proximal muscle weakness, elevated CK levels, and specific antibodies.

A burgeoning body of research shows that children who have stronger oral narrative, or storytelling, skills become better readers and writers later on, suggesting that these complex discourse skills play a pivotal role in literacy acquisition. There is evidence, however, that teachers rarely, if ever, implement oral narrative instruction. Understanding teachers' beliefs about children's oral narrative skills and the instructional practices they perceive as supporting oral narrative development is crucial for informing efforts to promote the development of these foundational oral language skills. This study used qualitative data from semi-structured interviews with 11 elementary school teachers to examine the significance that teachers attribute to children's oral narrative skills, the factors they perceive as contributing to oral narrative development, and the practices they report using to support children's development as storytellers. Results showed that teachers believed that oral narratives matter for children's social-emotional functioning and literacy achievement and placed responsibility for children's oral narrative development on the quality of home language and literacy experiences that children have with their families. Teachers reported using instructional practices that were primarily unplanned or aimed at accomplishing other goals, such as assessing children's reading comprehension. Implications for future research, teacher preparation, and professional learning opportunities for teachers are discussed.

Objective To develop predictive models for healthcare workforce transition success under decentralization using Support Vector Machine (SVM) analysis and identify key determinants across organizational support domains. Methods A cross-sectional study was conducted among healthcare personnel (n=430) who transferred from Ministry of Public Health facilities to Provincial Administrative Organizations in Thailand during 2023-2024. The SVM model evaluated 37 predictor variables spanning demographic characteristics, benefits, and welfare domains. Four kernel functions were compared to identify optimal model performance, and feature importance analysis was conducted to determine key predictors. Results The linear kernel demonstrated superior performance (accuracy: 71.43%, sensitivity: 49.02%, specificity: 85.37%) compared to other kernel functions. Analysis revealed five key predictors (feature weights >0.25): competitive compensation (0.427), career development opportunities (0.358), fair promotion processes (0.336), hazardous work compensation (0.285), and educational leave opportunities (0.252). While employee qualifications (0.236) emerged as a significant demographic predictor, organizational support factors, particularly financial incentives and professional development opportunities, showed stronger predictive power for transition success. Conclusions This study represents the first application of machine learning techniques to predict healthcare personnel transition success in decentralization contexts. The SVM model effectively identified critical factors influencing workforce transitions, emphasizing the importance of balanced organizational support mechanisms. These findings provide evidence-based guidance for healthcare administrators implementing decentralization policies, offering generalizable insights for workforce management during health system reforms.

Since the importance of truncated distributions has increased in many scientific fields in recent years and they provide valuable insights when dealing with censored or truncated data, this paper presents the Right Truncated Shanker Distribution as a new statistical distribution developed for modelling right truncated data. The distribution is defined by specifying its probability density function and cumulative distribution function under the truncation condition, the survival function and the hazard function. In addition, some properties of the right truncated Shanker distribution are derived, such as the moments around the origin, the variance, the coefficients of skewness and kurtosis, the moment generating function, and the mean time to failure. Our statistical properties show that the new distribution has the utility and flexibility to effectively model truncated data scenarios.

AIM: This study analyzes existing data on the efficacy and safety of adjunctive nebulized tobramycin (ANT) for treating ventilator-associated pneumonia (VAP). Background: VAP presents a significant management challenge in intensive care units, affecting up to 40% of patients, and is often caused by multidrug-resistant bacteria. Given the high cost and limited availability of newer antibiotics, nebulization of conventional antibiotics, including tobramycin, has emerged as a potential treatment strategy. METHODS: A systematic search was conducted in PubMed, Ovid SP, and ScienceDirect up to February 2024. Studies comparing ANT with intravenous antibiotics alone for VAP treatment were included. The combined effect estimates from these studies were assessed using random-effects models. RESULTS: Of the 63 screened studies, 8 underwent full evaluation, and 5 (2 observational and 3 randomized controlled studies) were included. 117 patients were recruited with a mean age of 61.4 years, and males predominate (82, 70%). The main ANT regimen was 300 mg tobramycin administered twice daily. Pseudomonas aeruginosa was the most common etiology for VAP, followed by Escherichia coli. Please refer to Table 1 for more details.ANT improved treatment success (RR 1.59, 95% CI, 1.11–2.27) but did not significantly reduce mortality (RR 0.54, 95% CI, 0.27–1.08) compared to intravenous antibiotics without tobramycin. It also did not increase the nephrotoxicity rate or significantly impact ICU stay, ventilation-free days, or reinfection rates. Overall, the quality of the study's outcomes ranged from low to very low certainty. CONCLUSIONS: Adjunctive nebulized tobramycin may improve VAP treatment success but does not provide additional benefits.

Introduction: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a significant health concern affecting a substantial population in India. This study outlines the limitations of current treatment options. Specifically, the toxicity of cyclophosphamide sets the stage for investigating the comparative effectiveness of rituximab in the context of RA-ILD. Methodology: This randomized, open-label study aimed to compare the efficacy and safety of rituximab and cyclophosphamide in treating severe or progressive RA-ILD. The inclusion and exclusion criteria, randomization process, and treatment protocols for each group are thoroughly described. The study’s ethical considerations, adherence to guidelines, and approval from the institutional ethics committee are highlighted. The comprehensive methodology encompasses patient recruitment, informed consent, treatment administration, and the rigorous assessment of clinical and spirometry parameters over a 48-week period. Results: The study enrolled 95 RA-ILD patients, randomly assigning them to rituximab and cyclophosphamide groups. The mean age, gender distribution, and baseline clinical parameters were comparable between the groups. Spirometry measurements, including forced vital capacity (FVC), were assessed at regular intervals up to 48 weeks. Results indicate that both rituximab and cyclophosphamide groups demonstrated improvement in FVC from baseline, with no statistically significant difference between the two groups at 24 and 48 weeks. Quality of life parameters, adverse effects, and other relevant clinical endpoints are thoroughly reported. Conclusion: Rituximab emerges as a comparable alternative to cyclophosphamide in increasing FVC and improving quality of life parameters in RA-ILD patients. Notably, rituximab demonstrated a superior safety profile with fewer adverse effects.

This explanatory sequential mixed-methods study investigates the factors influencing Thai fathers’ involvement in early childhood Childcare. In the quantitative phase ( n = 230), fathers’ involvement in Childcare was assessed using a Childcare involvement scale to identify key contributing factors. The qualitative phase ( n = 20) further elaborated on these quantitative findings through content analysis. Stepwise multiple regression analysis demonstrated that fathers’ perceived Childcare skills, division of Childcare responsibilities, and marital satisfaction explained 53% ( p

In this study, the photocatalytic degradation of tetracycline (TC), which is responsible for water pollution, was investigated in an aqueous solution by using two types of nanoparticles (NPs) based on green synthesis of ZnO NPs and CuO NPs as photocatalysts. Eucalyptus plant extract was chosen as a good reductant and capping agent because of its cost-effectiveness, nontoxic characteristics and ease of usage. Different molar ratios of Cu:Zn (1:3, 1:6, 1:9 and 1:12) were prepared, and then these ratios were evaluated to select the effective ratio for removing TC. The 1:6 ratio demonstrated the best photocatalytic performance, degrading 72.15% of TC at the ZnO/CuO nanocomposite (NC) dose of 0.5 g/L, an initial concentration of 10 mg/L, pH 7, an agitation speed of 300 rpm, a temperature of 25 °C, UV intensities of 15 W/m2 and a contact time of 180 min. The synthesis of NCs was characterised using different analysis methods. CuO/ZnO characteristics were investigated using several analytical techniques, including FTIR, FESEM, EDAX, AFM, BET and zeta potential analysis. The NP’s structure, morphology, thermal behaviour, chemical composition and optical properties were analysed. The FESEM images verified that the (1:6) CuO/ZnO NPs calcined and not calcined, with sizes of 13.92 and 26.73 nm, respectively, were crystalline and spherical. The quantity of TC degradation by metal oxide NCs was investigated using UV–Vis spectroscopy. This method is sustainable and environmentally benign because it synthesises both NPs from plant sources. These hybrid nanoparticles may be used to treat other pharmaceuticals that are hazardous to reduce pollution in water.

Background:. The most common reason for lower-extremity amputations remains the management of complications of diabetes mellitus (DM) and/or peripheral vascular disease. Traditional socket prostheses remain the rehabilitation standard, although transcutaneous osseointegration for amputees (TOFA) is proving a viable alternative. Limited studies of TOFA for vascular amputees have been published, but no study has focused on TOFA for patients with DM, neglecting this important patient population. The primary aim of the present study exploring this potential care option was to report the frequencies and types of adverse events following TOFA for patients with well-controlled DM. The secondary aims were to report their mobility and quality-of-life changes. Methods:. A retrospective review was performed of 17 consecutive patients with well-controlled DM who had undergone unilateral transfemoral TOFA from 2013 to 2019 and had been followed for at least 2 years. Outcomes were perioperative complications, additional surgery (soft-tissue refashioning, debridement, implant removal, periprosthetic fracture treatment), mobility (daily prosthesis wear hours, K-level, Timed Up and Go Test, 6-Minute Walk Test), and patient-reported outcomes (Questionnaire for Persons with a Transfemoral Amputation, Short Form-36). Results:. There were no perioperative systemic complications, deaths, or proximal amputations. Two patients (12%) sustained a periprosthetic fracture following a fall, managed by internal fixation with implant retention, and regained independent ambulation. Eight patients (47%) had additional surgery or surgeries for non-traumatic complications: 4 (24%) had soft-tissue refashioning, 3 (18%) had debridement, and 3 others had implant removal with subsequent revision osseointegration for aseptic loosening (1) or infection (2). The proportion of patients wearing their prosthesis at least 8 hours daily improved from 5 (36%) to 11 (79%) of 14 (p = 0.054). The proportion of patients who achieved at least K-level 2 improved from 6% to 94% (p < 0.001). Other changes were not significant. Conclusions:. Contraindicating TOFA for all patients with DM seems draconian. Patients with well-controlled DM experienced significant mobility improvements, although additional surgery was somewhat common. Improvements in selection criteria or surgical technique to reduce risks are needed so that TOFA can be routinely considered for amputees with well-controlled DM. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Understanding how the outdoor environment shapes the community mobility of people with visual disabilities is key to designing an accessible public realm and facilitating their rights to use outdoor spaces. A scoping review was conducted to explore 1) What aspects of the built environment affect the community mobility of persons with visual disabilities? and 2) How does the built environment affect the community mobility of persons with visual disabilities? Forty-three peer-reviewed publications from 2000 to 2022 were included after conducting database searches, screening of articles, and data charting. Studies focused on micro-environmental features related to sidewalks and crosswalks (e.g. landmarks, curbs, curb ramps, tactile warning/guiding surfaces, and accessible pedestrian signals), and broad environmental factors (e.g. neighbourhood amenities and street layout) and their influence on orientation, wayfinding, and safety. The paper discusses the role of the built environment in 1) posing barriers to outdoor mobility (e.g. potholes, poorly designed curb cuts, obstacles at waist-height or eye-level, poor lighting, inadequate pedestrian signal, complicated street layout), and 2) offering cues (e.g. visual, tactile, auditory, olfactory, kinaesthetic) for spatial perception and navigation. Focusing on how the built environment shapes community mobility is necessary to enhance accessibility through urban planning and design and assistive technology.

The historical and political emergence of STEM has changed the educational paradigm. Researchers, educators, and frontline professionals consider STEM as their savior. However, the ambiguity surrounding STEM and its successors, Integrated STEM education, and STEAM has created confusion for educators and frontline workers about which framework and concept they have to adapt to support their nation in the global financial crisis. Unfortunately, limited research offers insight into the historical, political, and educational development of STEM, iSTEM, and STEAM. This literature review fills this gap by addressing the historical, political, and educational development and uncertainty surrounding STEM, iSTEM, and STEAM. Also, the study explores the purpose, significance, and limitations of STEM, iSTEM, and STEAM individually and current pedagogical practices in this domain. Moreover, this literature review exposes the historical and current Canadian perspective of STEM, iSTEM and STEAM, and Canada's position and response to current global needs. Finding from the study reveal that there is a need for curriculum reform that involves adding STEM, iSTEM, STEAM domain and pedagogical practices in national/provincial curricula; professional development for teachers; support for the teachers and post-secondary institutions to increase STEM, iSTEM, STEAM-proficiency and their career interest among students to survive in the global economic race. Furthermore, the study highlights a need for further research and discussion about the STEM, iSTEM, STEAM domain and consensus among scholars on one platform. Moving forward, after STEM [right arrow] iSTEM [right arrow] STEAM, What's next?

A 24-year-old Black woman from South Africa sought care at a local primary-level clinic in Soweto, Johannesburg, South Africa, reporting a painless nasal mass of 3 years duration that caused [...]

Geetha Kandasamy,1 Dalia Almaghaslah,1 Mona Almanasef,1 Tahani Musleh Almeleebia,1 Khalid Orayj,1 Ayesha Siddiqua,1 Eman Shorog,1 Asma M Alshahrani,1 Kousalya Prabahar,2 Vinoth Prabhu Veeramani,2 Palanisamy Amirthalingam,2 Saleh Alqifari,2 Naif Alshahrani,3 Aram Hamad AlSaedi,4 Alhanouf A Alsaab,5 Fatimah Aljohani,6 M Yasmin Begum,7 Akhtar Atiya8 1Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia; 2Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Kingdom of Saudi Arabia; 3Department of Pharmacy, Ad Diriyah Hospital, Ministry of Health (MOH), Riyadh, 13717, Kingdom of Saudi Arabia; 4College of Medicine, Taibah University, Al Madinah, Al Munawwarah, Saudi Arabia; 5Pharmacist at Abha International Private Hospital, Abha, Saudi Arabia; 6Pharmacist at Prince Sultan Armed Forces Hospital, Almadenah, Almonwarah, Saudi Arabia; 7Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia; 8Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi ArabiaCorrespondence: Geetha Kandasamy, Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia, Email glakshmi@kku.edu.saBackground: Migraine is a disabling disease that poses a significant societal burden. Migraine is a major cause of disability. Migraine is the eighth leading disease-causing disability in the population.Objective: To study the clinical profile and measure the pain and migraine-related disability of patients with all types of migraine using the McGill pain assessment scale and Migraine Disability Assessment (MIDAS) before and after 3 months of effect on the medication.Methods: A Prospective-Cross sectional study was carried out in a multispecialty hospital with male and female patients between 18 and 65 years. The data were collected from the patients directly through the questionnaire of McGill pain assessment scale-short form (SF) and MIDAS, which was provided before and after the medication.&#x00A0Results: There were 165 subjects of which 52 were men and 113 were women. The mean age of all the subjects was 43 years. About 26.06% of the subjects had a family history of headaches. The scores of McGill pain and MIDAS assessment before and after medication were as follows: 0– 15 were 30.90% and 73.33%, Score 16– 30 were 54.54% and 18.18%, the score of 31– 45 were 14.54% and 7.87% of the subjects. MIDAS grade I was 17.57% and 50.90%, Grade II 33.93% and 21.81%, Grade III 30.30% and 15.75% Grade IV 18.18% and 11.51% of the subjects.Discussion: The calculated “t” value between the before and after medication values of McGill and MIDAS by paired ‘t-test was 13.85 and 17.49 respectively. As the calculated “t” value is more than the table value, the alternate hypothesis is accepted.Conclusion: This study confirms that there is a significant difference in disability levels before and after acute and preventative treatments when measured over 3 months. In addition, the preponderance of females was high, and the functional disability that affects work and social activity associated with migraine is moderate to severe.Keywords: migraine, pain, disability, loss of productivity, MIDAS

Over the last decade, our world exposed to many types of unpredictable disasters (recently Coronavirus). These disasters have clearly shown the uncertainty and vulnerability of supply chain systems. Also, it confirmed that adopting Just-in-Time (JIT) strategy to reduce the logistic chain cost may lead to inbuilt complexity and risks. Efficient tools are therefore needed to make complexity optimized supply chain decisions. Evolutionary algorithms, including genetic algorithms (GA), have proven effective in identifying optimal solutions that address the trade-offs between total supply chain cost and carbon emissions regulatory policy represented by carbon tax charges. These solutions pertain to the design challenges of supply networks exposed to potential disruption risks. However, GA have a set of parameters must be chosen for effective and robust performance of the algorithms. This paper aims to set the most suitable values of these parameters that used via GA – ased optimization cost and risk reduction model in firms using a JIT as a delivery system. The model has been conceptualized for addressing the design complexities of the supply chain, referred to as SCRRJITS (Simultaneous Cost and Risk Reduction in a Just-in-Time System). A complete analysis of the different parameters and operators of the algorithm is carried out using design of experiments approach. The algorithm performance measure used in this study is convergence of solutions. The results show the extent to which the quality of solution can be changed depending on selection of these parameters.