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The COVID-19 pandemic has caused a shift from on-campus to remote online examinations, which are usually difficult to invigilate. Meanwhile, closed-ended question formats, such as true–false (TF), are particularly suited to these examination conditions, as they allow automatic marking by computer software. While previous studies have reported the score characteristics in TF questions in conventional supervised examinations, this study investigates the efficacy of using TF questions in online, unsupervised examinations at the undergraduate level of Biomedical Engineering. We examine the TF and other question-type scores of 57 students across three examinations held in 2020 under online, unsupervised conditions. Our analysis shows significantly larger coefficient of variance (CV) in scores in TF questions (42.7%) than other question types (22.3%). The high CV in TF questions may be explained by different answering strategies among students, with 13.3 ± 17.2% of TF questions left unanswered (zero marks) and 16.4 ± 11.5% of TF questions guessed incorrectly (negative marks awarded). In unsupervised, open-book examination where sharing of answers among students is a potential risk; questions that induce a larger variation in responses may be desirable to differentiate among students. We also observed a significant relationship (r = 0.64, p

The article revisits the collaborative project of two early missionaries to China, Robert Morrison and William Milne, who overcame the ‘practical impossibility’ of translating the Protestant Bible into Chinese in 1823. The issues of the doctrinal constraints, the influence of the contemporary English translations, faithfulness to the Hebrew text and cultural sensitivity to the target language will be raised with reference to concrete examples cited from their joint translation version. The creation account of Genesis and passages on the rendering of the biblical ‘sea monsters’ into Chinese will be selected for focused study in order to show how Morrison and Milne were influenced by the KJV but at times departed from it in their reading of the original Hebrew text. Furthermore, it is also noted that they have shown a certain degree of sensitivity to the Chinese cultural context in their choice of terminology in translating the biblical text into Chinese.

Objective: To compare neurological functioning of neonates born to mothers with and without malaria in pregnancy. Methods: Pregnant women presenting at Korle Bu Teaching Hospital, Ghana were recruited into this prospective observational study. Malaria exposure was determined by clinically documented antenatal malaria infection; parasitemia in maternal, placental, or umbilical cord blood; or placental histology. Neurological functioning was assessed using the Hammersmith Neonatal Neurological Examination within 48 hours of birth. Performance was classified as ''optimal'' or ''suboptimal'' by subdomain and overall. Results: Between November 21, 2018 and February 10, 2019, a total of 211 term-born neonates, of whom 27 (13%) were exposed to malaria in pregnancy, were included. In the reflexes subdomain, exposed neonates tended to score lower (adjusted mean difference -0.34, 95% confidence interval -0.70 to 0.03), with an increased risk (adjusted risk ratio 1.63, 95% confidence interval 1.09 to 2.44) of suboptimal performance compared with unexposed neonates. There were no significant between-group differences in scores or optimality classification for the remaining subdomains and overall. Conclusions: Malaria-exposed neonates had similar neurological functioning relative to unexposed neonates, with differences confined to the reflexes subdomain, suggesting potential underlying neurological immaturity or injury. Further studies are needed to confirm these findings and determine the significance of malaria in pregnancy on long-term neurological outcomes.

Background: Empty nose syndrome (ENS) is characterized by paradoxical nasal obstruction that usually occurs after turbinate surgery. Patients with ENS may also experience significant psychiatric symptoms and sleep dysfunction, which negatively affect the quality of life of affected subjects. This study aimed to evaluate sleep impairment and sleepiness in patients with ENS. Methods: Patients with ENS and control participants were recruited prospectively. The Sino-Nasal Outcome Test-25 (SNOT-25), Empty Nose Syndrome 6-item Questionnaire (ENS6Q), Epworth Sleepiness Scale (EpSS), and modified sleep quality index (MSQI) were used to evaluate the participants before and after nasal surgery. Results: Forty-eight patients with ENS and forty-eight age- and sex-matched control subjects were enrolled. The SNOT-25, ENS6Q, EpSS, and MSQI scores in the ENS group were all significantly higher than those in the control group before and after surgery. After surgery, ENS patients all exhibited significant improvements in SNOT-25, ENS6Q, EpSS, and MSQI scores. Regression analysis revealed that SNOT-25 score was a significant predictor of EpSS and MSQI in preoperative evaluations. ENS patients experiencing daytime sleepiness suffered from significantly more “dryness of nose” and “suffocation” than those not experiencing daytime sleepiness. Conclusions: Patients with ENS experienced significantly impaired sleep quality and sleepiness. Nasal reconstruction surgery improved the sleep quality of ENS patients. The severity of sleep dysfunction is associated with the severity of ENS symptoms. Recognizing individuals with significant sleep impairment and sleepiness and providing appropriate management are critical issues for ENS patients.

Benevolent leadership is one of the leadership styles which provides a positive influence on employees. However, the current leadership literature has yet to investigate how benevolent leadership leads to job performance, the processes involved, the relationship between organizational culture and benevolent leadership, and the role of dark side of leaders in affecting this relationship. Using the leader-culture fit framework within an Eastern context, the current study first investigates the relationship between benevolent leadership and job performance through work engagement. The study then compares two contrasting organizational culture (i.e., market culture and clan culture) on benevolent leadership. Finally, the study investigates how leaders’ dark triad affects the relationship between organizational culture and benevolent leadership. 374 full-time white-collar employees (Males = 54.01%; Mean age: 32.7 years) from various private organizations within the service industry participated in this study. The results showed that work engagement mediated benevolent leadership and job performance. Market culture showed a negative relationship with benevolent leadership while clan culture showed a positive relationship with benevolent leadership. Benevolent leadership mediated clan culture (but not market culture) and work engagement. Under a high market culture with a high dark triad leader, benevolent leadership is at its lowest level. Under a high clan culture with a low dark triad leader, benevolent leadership is at its highest level. The findings suggest the importance of benevolent leadership within a clan culture (rather than market culture), in aligning with the leader-culture fit framework in increasing employees’ work engagement and job performance.

Summary: Background: We aimed to evaluate and improve the accuracy of the ultrasound scan in estimating gestational age in late pregnancy (ie, after 24 weeks' gestation) in low-income and middle-income countries (LMICs), where access to ultrasound in the first half of pregnancy is rare and where intrauterine growth restriction is prevalent. Methods: This prospective, population-based, cohort study was done in three LMICs (Bangladesh, Pakistan, and Tanzania) participating in the WHO Alliance for Maternal and Newborn Health Improvement study. Women carrying a live singleton fetus dated by crown-rump length (CRL) measurements between 8+0–14+6 weeks of gestation, who were willing to return for two additional ultrasound scans, and who planned on delivering in the study area were enrolled in the study. Participants underwent ultrasonography at 24+0–29+6 weeks and at 30+0–36+6 weeks' gestation. Birthweights were measured within 72 h of birth, and the proportions of infants who had a small-for-gestational-age birthweight (ie, a birthweight

PURPOSE: Staphylococcus aureus osteomyelitis remains a major clinical problem. Anti-glucosaminidase (Gmd) antibodies (1C11) are efficacious in prophylactic and therapeutic murine models. Towards clinical trials, we assess the feasibility, safety, and pharmacokinetics of 1C11 passive immunization in sheep, and quantified endogenous anti-Gmd levels in osteomyelitis patients. MAIN METHOD: Sheep (n=3) received a 500mg intravenous bolus of 1C11, and levels in sera over 52 days were determined by ELISA. A humanized anti-Gmd monoclonal antibody was made by grafting the Fab portion of 1C11 onto the Fc of human IgG1, which was used to make a standard curve of mean fluorescent intensity versus concentration of anti-Gmd via Luminex. Anti-Gmd serum levels were determined in 297 patients with culture-confirmed S. aureus osteomyelitis, and 40 healthy controls. MAIN RESULTS: There were no complications or adverse events associated with the 1C11 intravenous infusion of the sheep, and the estimated circulating half-life of 1C11 was 23.7 days. Endogenous anti-Gmd antibody levels in sera of osteomyelitis patients ranged from 8x endogenous anti-Gmd levels observed in osteomyelitis patients, and is predicted to have a half-life of >3-weeks. CLINICAL RELEVANCE: Anti-Gmd passive immunization has potential to prevent and treat S. aureus osteomyelitis. Further clinical development is warranted.

Background: Whether endoscopic surgery for sellar/parasellar disease causes significant deficits in olfactory function remains unclear. We aimed to systematically review the olfactory outcomes in such settings based on the evidence up to date. Methods: PubMed, EMBASE, and CENTRAL were searched through February 1, 2021. Included studies were limited to endoscopic surgery for sellar/parasellar disease with follow-up olfactory function measured by standardized olfactory testing methods or subjective assessment. The primary outcome was the change in olfactory function after surgery assessed by standardized olfactory testing methods. The secondary outcome was the change in subjective olfactory function. Random-effects model was used in obtaining combine effects. Study quality was assessed using the Newcastle–Ottawa scale. Sensitivity analysis was carried out using the leave-one-out approach, and publication bias was assessed using Egger’s test. Results: The results show no significant difference in olfaction assessed by standardized olfactory testing methods at 1–3 months post-surgery (880 patients in 16 studies) or at 6–12 months post-surgery (1320 patients in 16 studies) compared to pre-surgery, whereas a significantly lower subjective olfaction at 3 months was observed. In addition, the lack of significant change in olfaction as assessed by standardized olfactory testing methods was observed regardless of whether patients were treated with or without the nasoseptal flap (NSF) harvesting. Heterogeneity and publication bias were observed, whereas sensitivity analysis showed the meta-analysis results are robust. Conclusion: The findings of this updated systematic review and meta-analysis support the conclusion that endoscopic surgery for sellar and parasellar pathology may pose no greater risk of olfactory dysfunction. In addition, the current evidence does not support there is an increased risk of diminished olfaction among patients treated with NSF during surgery.

In low- and middle-income countries (LMIC), measurement of symphysis fundal height (SFH) is often the only available method of estimating gestational age (GA) in pregnancy. This systematic review aims to summarize methods of SFH measurement and assess the accuracy of SFH for the purpose of GA estimation. We searched PubMed, EMBASE, Cochrane, Web of Science, POPLINE, and WHO Global Health Libraries from January 1980 through November 2021. For SFH accuracy, we pooled the variance of the mean difference between GA confirmed by ultrasound versus SFH. Of 1,003 studies identified, 37 studies were included. Nineteen different SFH measurement techniques and 13 SFH-to-GA conversion methods were identified. In pooled analysis of five studies (n = 5838 pregnancies), 71% (95% CI: 66–77%) of pregnancies dated by SFH were within ±14 days of ultrasound confirmed dating. Using the 1 cm SFH = 1wk assumption, SFH underestimated GA compared with ultrasound-confirmed GA (mean bias: -14.0 days) with poor accuracy (95% limits of agreement [LOA]: ±42.8 days; n = 3 studies, 2447 pregnancies). Statistical modeling of three serial SFH measurements performed better, but accuracy was still poor (95% LOA ±33 days; n = 4 studies, 4391 pregnancies). In conclusion, there is wide variation in SFH measurement and SFH-to-GA conversion techniques. SFH is inaccurate for estimating GA and should not be used for GA dating. Increasing access to quality ultrasonography early in pregnancy should be prioritized to improve gestational age assessment in LMIC.

ObjectivesTo describe the feeding profile of low birthweight (LBW) infants in the first half of infancy; and to examine growth patterns and early risk factors of poor 6-month growth outcomes.DesignProspective observational cohort study.Setting and participantsStable, moderately LBW (1.50 to Variables of interestKey variables of interest included birth weight, LBW type (combination of preterm/term status and size-for-gestational age at birth), lactation practices and support, feeding profile, birthweight regain by 2 weeks of age and poor 6-month growth outcomes.ResultsBetween 13 September 2019 and 27 January 2021, 1114 infants were enrolled, comprising 4 LBW types. 363 (37.3%) infants initiated early breast feeding and 425 (43.8%) were exclusively breastfed to 6 months. 231 (22.3%) did not regain birthweight by 2 weeks; at 6 months, 280 (32.6%) were stunted, 222 (25.8%) underweight and 88 (10.2%) wasted. Preterm-small-for-gestational age (SGA) infants had 1.89 (95% CI 1.37 to 2.62) and 2.32 (95% CI 1.48 to 3.62) times greater risks of being stunted and underweight at 6 months compared with preterm-appropriate-for-gestational age (AGA) infants. Term-SGA infants had 2.33 (95% CI 1.77 to 3.08), 2.89 (95% CI 1.97 to 4.24) and 1.99 (95% CI 1.13 to 3.51) times higher risks of being stunted, underweight and wasted compared with preterm-AGA infants. Those not regaining their birthweight by 2 weeks had 1.51 (95% CI 1.23 to 1.85) and 1.55 (95% CI 1.21 to 1.99) times greater risks of being stunted and underweight compared with infants regaining.ConclusionLBW type, particularly SGA regardless of preterm or term status, and lack of birthweight regain by 2 weeks are important risk identification parameters. Early interventions are needed that include optimal feeding support, action-oriented growth monitoring and understanding of the needs and growth patterns of SGA infants to enable appropriate weight gain and proactive management of vulnerable infants.Trial registration numberNCT04002908.

Existing electrical and electronic laboratories in different industries have normally equipped with four types of basic electrical compliance testers (Hi-potential tester, leakage current tester, insulation resistance tester and earth continuity tester) that may be an old or a standard model. They operate separately and the operator has to record the test data one by one manually. In recent years, manufacturers have introduced new models to combine the four testers and provide Internet-of-Things (IoT) and data analysis software upgrades. However, it is not cost-effective to replace properly functioning equipment for these upgrades. Therefore, by upgrading these compliance testers with IoT capabilities, the test data from the four testers can be organized, thus correlating the four major electrical compliance tests. This paper reveals the feasibility on enhancing the efficiency of testing operations with a reasonable cost of less than USD 100.

Inflammation may adversely affect early human brain development. We aimed to assess the role of maternal nutrition and infections on cord blood inflammation. In a pregnancy cohort in Sylhet, Bangladesh, we enrolled 251 consecutive pregnancies resulting in a term livebirth from July 2016–March 2017. Stillbirths, preterm births, and cases of neonatal encephalopathy were excluded. We prospectively collected data on maternal diet (food frequency questionnaire) and morbidity, and analyzed umbilical cord blood for interleukin (IL)-1α, IL-1β, IL-6, IL-8 and C-reactive protein. We determined associations between nutrition and infection exposures and cord cytokine elevation (≥75% vs. &lt, 75%) using logistic regression, adjusting for confounders. One-third of mothers were underweight (BMI &lt, 18.5 kg/m2) at enrollment. Antenatal and intrapartum infections were observed among 4.8% and 15.9% of the sample, respectively. Low pregnancy intakes of B vitamins (B1, B2, B3, B6, B9 (folate)), fat-soluble vitamins (D, E), iron, zinc, and linoleic acid (lowest vs. middle tertile) were associated with higher risk of inflammation, particularly IL-8. There was a non-significant trend of increased risk of IL-8 and IL-6 elevation with history of ante-and intrapartum infections, respectively. In Bangladesh, improving micronutrient intake and preventing pregnancy infections are targets to reduce fetal systemic inflammation and associated adverse neurodevelopmental outcomes.

Background Low birthweight (LBW) ( Methods A comparative pre-post study was performed in selected rural health facilities located in West Gojjam and South Gondar zones. At baseline, a retrospective review of delivery records from February to May 2018 was performed in 14 health centers to collect birthweight data. A birthweight QI initiative was introduced in August 2019, which included provision of high-quality digital infant weight scales (precision 5 g), routine calibration, training in birth weighing and data recording, and routine field supervision. After the QI implementation, birthweight data were prospectively collected from late August to early September 2019, and December 2019 to June 2020. Data quality, as measured by heaping (weights at exact multiples of 500 g) and rounding to the nearest 100 g, and the prevalence of LBW were calculated before and after QI implementation. Results We retrospectively reviewed 1383 delivery records before the QI implementation and prospectively measured 1371 newborn weights after QI implementation. Heaping was most frequently observed at 3000 g and declined from 26% pre-initiative to 6.7% post-initiative. Heaping at 2500 g decreased from 5.4% pre-QI to 2.2% post-QI. The percentage of rounding to the nearest 100 g was reduced from 100% pre-initiative to 36.5% post-initiative. Before the QI initiative, the prevalence of recognized LBW was 2.2% (95% confidence interval [CI]: 1.5–3.1) and after the QI initiative increased to 11.7% (95% CI: 10.1–13.5). Conclusions A QI intervention can improve the quality of birthweight measurements, and data measurement quality may substantially affect estimates of LBW prevalence.