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Letters of recommendation are increasingly important for the residency match. We assessed whether an artificial intelligence (AI) tool could help in writing letters of recommendation by analyzing recommendation letters written by 3 academic staff and AI duplicate versions for 13 applicants. The preferred letters were selected by 3 blinded orthopedic program directors based on a predetermined set of criteria. The first orthopedic program director selected the AI letter for 31% of applicants, and the 2 remaining program directors selected the AI letter for 38% of applicants, with the staff-written versions selected more often by all of the program directors (p < 0.05). The first program director recognized only 15% of the AI-written letters, the second was able to identify 92%, and the third director identified 77% of AI-written letters (p < 0.05)., Selecting qualified candidates for medical school or residency programs is a crucial and challenging undertaking that determines a person's career track and future. (1) Recent modifications in medical education and [...]

The ways teachers converse about their work in relation to information and communications technologies (ICTs) are worth studying. We analyse how a teacher converses about her local practices in relation to two spreadsheet algebra programs (SAPs) on variables. During the conversations we noticed that the teacher keeps different policy documents -- boundary objects -- firmly in view, in relation to the design of the two other boundary objects, namely the two SAPs. The policy documents provide details on the operative curricula which entail the intended, implemented and examined curricula. Of these curricula, the teacher regarded the examined curriculum and associated examinations as most important. Also, she conversed about how she intends to align the design features of the two SAPs with particular policy documents, especially in the context of the South African high-stakes National Senior Certificate examinations and the attendant examination pressure. Our results confirm current professional development (PD) literature suggestions that emphasise fostering coherence, for example between policy boundary objects details and what university-based PD providers do when they interact with school teachers. Contribution: The results provide guidelines for university-based PD providers to integrate SAPs or other ICTs related to algebra and variables by keeping teachers' local practices in view. These providers should note that different policy-related boundary objects shape the ways teachers understand and converse about their local practices, namely their work at the classroom level.

In engineering education, there is a prioritization of microethics and an omission of macroethics. Although macroethics is particularly significant for civil engineering, in which decision making directly influences the quality of civil infrastructure, current educational practices in civil engineering do not reflect this importance. This case study assessed the effectiveness of developing a three-credit course, entitled CIVE 491 Materials for Energy and Sustainability, to educate civil engineering majors on macroethics. A series of lectures was purposefully designed and implemented in the classes offered in Fall 2020 and Spring 2022 at the Department of Civil and Environmental Engineering, University of Nebraska-Lincoln. Instructor's observation, attendance rate, course performance, submitted assignments, and survey results were analyzed. The results suggested that several design principles should be applied when designing the course, which could significantly improve students' understanding of many macroethical issues that they may encounter in their professional careers as civil engineers.

Tropical ecosystems play an important role in the environment. Coastal areas are subjected to a wide range of impacts and pollution, which have drawn worldwide attention over the past few decades. Comprehensive studies of heavy metal content in soils worldwide are extremely important for assessing and predicting ecological risks. Very few studies have been devoted to a complete study of the physicochemical characteristics of soils, assessment of heavy metal accumulation in coastal zones along the Djibouti coast, and potential ecological risks. The study investigated the physico-chemical characteristics of soil, assessed the accumulation of heavy metals in coastal zones along the Djibouti coast, and analyzed the potential environmental risks associated with the presence of heavy metals in the studied soils. Analysis of heavy metals and trace elements in the soils of the coastal areas of Djibouti revealed that the levels of these elements are lower than in soils of the Red Sea coast and are in line with WHO and other international standards. All heavy metals in the soil of the studied area demonstrate low levels of potential ecological risk. The soils of the studied areas, overall, have not undergone significant heavy metal pollution and can be considered suitable for various types of use.

Abstract Regulating patients’ no-show behavior is critical from the standpoints of sustainable medical services and operational efficiencies. The purpose of this study was to evaluate the patients’ intention to make partial up-front payments at outpatient clinics. This was a cross-sectional study design introducing a self-administered questionnaire to 221 outpatients at a private health facility. The questionnaire measured the patient’s demographic characteristics, perceived usefulness (PU), trust in the health facility, and intention to make upfront partial payments. Out of the total respondents, 57.4% were female. There were 34.8% Malays, 40.6% Chinese and 24.6% Indians. The majority (66.5%) of the respondents attained tertiary education. Nearly a third of the respondents (30.5%) reported an income between 3000 and 5000 Malaysian Ringgit (RM). Regarding payment mode, just more than half (51.1%) made self-payment, and 21.8% by guaranteed letter. A quarter (24.9%) waited more than 3 h for consultation and 59.6% visited the health facility more than 2 times in a year. Initial analysis showed that PU, trust, age, education, number of visits, and hours of waiting were significantly associated with the intention to make a partial payment. Multiple linear regression showed that perceived usefulness (B = 0.517, p

Abstract Background There is a higher risk for nematode infections associated with outdoor-reared pigs. Next to Ascaris suum, Oesophagostomum dentatum and Trichuris suis, there is the potential of infections with other nodular worm species, Hyostrongylus rubidus, Stongyloides ransomi and Metastrongylus spp. lungworms. Next-generation sequencing methods describing the nemabiome have not yet been established for porcine nematodes. Methods FLOTAC was used for faecal egg counts of porcine gastrointestinal nematodes and lungworms in piglets, fatteners and adults individually. A nemabiome analyses based on ITS-2 gene region metabarcoding was used to differentiate strongyle species. Additionally, questionnaire data was analysed using mixed-effect regression to identify potential risk factors associated with parasite occurrences and egg shedding intensity. Results On 15 of 17 farms nematode eggs were detected. Ascaris suum, strongyles and T. suis were detected on 82%, 70% and 35% of the 17 farms, respectively. Lungworms were detected on one out of four farms with access to pasture. Strongyloides ransomi was not detected. 32% (CI 28–36%), 27% (24–31%), 5% (4–7%) and 3% (0.9–8%) of the samples where tested positive for strongyles, A. suum, T. suis and lungworms, respectively. The nemabiome analysis revealed three different strongyle species, with O. dentatum being the most common (mean 93.9%), followed by O. quadrispinulatum (5.9%) and the hookworm Globocephalus urosubulatus (0.1%). The bivariate and multivariate risk factor analyses showed among others that cleaning once a week compared to twice a week increased the odds significantly for being infected with A. suum (OR 78.60) and strongyles (2077.59). Access to pasture was associated with higher odds for A. suum (43.83) and strongyles (14.21). Compared to shallow litter systems, deep litter and free range systems resulted in significant higher odds for strongyles (85.74, 215.59, respectively) and T. suis (200.33, 623.08). Conclusions Infections with A. suum, O. dentatum, O. quadrispinulatum, T. suis, Metastrongylus spp. and G. urosubulatus are present in German outdoor-reared pigs. This is the first report of G. urosubulatus in domestic pigs in Europe. Metabarcoding based on the ITS-2 region is a suitable tool to analyse the porcine nemabiome. Furthermore, management practices have the potential of reducing the risk of parasite infections.

Analyzing digital video recordings (DVRs) is an effective instructional strategy for professionally preparing and developing prospective teachers. This study examines the impact of using DVRs among prospective teachers at Al-Qasimi College on their technological pedagogical content knowledge (TPACK) and its seven domains (TK, PK, CK, PCK, TCK, TPK, TPACK). The study was based on a mixed methodology approach, and the study sample included 70 prospective teachers who were distributed into an experimental group and a control group. Data were collected using the TPACK questionnaire and semi-structured interviews with 10 participants. The quantitative and qualitative results showed that prospective teachers in the experimental group significantly and positively impacted TPACK and its seven domains. The results of the study indicated that digital video recordings allowed prospective teachers to reflect and ponder on their teaching skills, content delivery, and the appropriate use of technology and its relevant tools in the educational process to identify strengths for development and weaknesses for improvement. Therefore, the results of the current study provide concrete evidence for the need to use DVRs as a promising educational approach in future professional preparation and to develop prospective teachers’ technological pedagogical content knowledge (TPACK).

Abstract Background Fatty acid oxidation defects are rare autosomal recessive disorders with variable clinical manifestations and outcome. Early detection by systematic neonatal screening may improve their prognosis. Long-term outcome studies of these disorders in the Middle East and North Africa region are limited. The purpose of this study is to report the diagnostic challenges and outcome of fatty acid oxidation defects in a major tertiary care center in Lebanon, a resource-constrained country in the Middle East. Methods A retrospective review of charts of all fatty acid oxidation defects sequential patients diagnosed and followed at our center was conducted. Collected data included: parental consanguinity, age at diagnosis, clinical presentation, biochemical profile, confirmatory diagnosis, treatment and outcome. A genotype–phenotype correlation was also performed, when available. Results Seven types of fatty acid oxidation defects were identified in a total of 34 patients from 21 families. Most families (79%) were consanguineous (first-degree cousins). The majority were diagnosed when clinically symptomatic (78%), at various ages between 10 days and 19 years (average: 2 years). Follow-up duration spanned between 2 months and 15 years (average: 5 years). The remainder of the patients were detected while still asymptomatic by systematic neonatal screening (9%) or due to positive family history (9%). The most common defect was carnitine transporter deficiency (50%) with an exclusive cardiac presentation related to a founder variant c.981C > T, (p.Arg254*) in the SLC22A5 gene. Medium chain acyl-CoA dehydrogenase deficiency was found in 13% only, which could be explained by the absence of systematic neonatal screening. Rare gene variants were detected in very long chain and multiple acyl-CoA dehydrogenase deficiency. The worse prognosis was observed in very long chain acyl-CoA dehydrogenase deficiency. The overall survival at last follow-up reached 75% with a complete reversal of symptoms with treatment in most patients (63%), despite their late diagnosis. Conclusions Our experience highlights the diagnostic challenges and outcome of fatty acid oxidation defects in a resource-constrained country with high consanguinity rates. Physicians’ awareness and systematic neonatal screening are key for diagnosis. Larger genotype–phenotype studies are still needed to understand the natural history of these rare diseases and possibly improve their outcome.

Monkeypox is a highly infectious disease and spreads very easily, hence posing several health concerns or risks as it may lead to outbreak. This article proposes a new mathematical model to simulate the transmission rate of the monkeypox virus-infected fractional-order differential equations using the Caputo–Fabrizio derivative. The existence, uniqueness, and stability under contraction mapping of the fixed point of the model are discussed using Krasnoselskii’s and Banach’s fixed point theorems. To verify the model proposed, we employ data that record the actual dynamics, and based on these data, the model can capture the observed transmission patterns in Ghana. Also, the analytic algorithm is used to find the result applying the Laplace Adomian decomposition method (LADM). Performance analysis of LADM is made regarding Runge-Kutta fourth order, which is the most commonly employed method for solving second-order ordinary differential equations. This comparison therefore offers information on the truth and reliability of the two techniques toward modeling the transmission pattern of the monkey pox virus. The information obtained through this study provides a better understanding of the antibodies linked to monkeypox virus spreading and provides effective strategies to doctors and politicians. This article helps shape better strategies about combating the impact of monkeypox virus in public health since it makes it easy to predict and prevent the occurrence of the disease.

Abstract Background With the increasing number of protracted refugee crises globally, it is essential to ensure strong national health information systems (HIS) in displacement settings that include refugee-sensitive data and disaggregation by refugee status. This multi-country study aims to assess the degree of integration of refugee health data into national HIS in Jordan, Lebanon, and Uganda and identify the strengths and weaknesses of their national HIS in terms of collecting and reporting on refugee-related health indicators. Methods The study employs a comparative country analysis approach using a three-phase framework. The first phase involved reviewing 4120 indicators compiled from global health organizations, followed by a multi-stage refinement process, resulting in 45 indicators distributed across five themes. The second phase consisted of selecting relevant criteria from the literature, including data sources, annual reporting, disaggregation by refugee status, refugee population adjustments, accuracy, and consistency. The third phase involved assessing data availability and quality of the selected indicators against these criteria. Results Our analysis uncovered significant challenges in assessing the health status of refugees in Jordan, Lebanon, and Uganda, primarily stemming from limitations in the available health data and indicators. Specifically, we identified significant issues including incomplete local data collection with reliance on international data sources, fragmented data collection from various entities leading to discrepancies, and a lack of distinction between refugees and host populations in most indicators. These limitations hinder accurate comparisons and analyses. In light of these findings, a set of actionable recommendations was proposed to guide policymakers in the three countries to improve the integration of refugee health data into their national HIS ultimately enhancing refugees’ well-being and access to healthcare services. Conclusion The current status of refugee-related health data in Jordan, Lebanon, and Uganda indicates the need for improved data collection and reporting practices, disaggregation by refugee status and better integration of refugee health data into national HIS to capture the health status and needs of refugees in host countries. Key improvement strategies include establishing a centralized authority for consistent and efficient data management, fostering transparent and inclusive data governance, and strengthening workforce capacity to manage refugee health data effectively.

Abstract Background Dietary supplements (DS) are commonly used to improve overall health status and correct nutritional deficiencies. However, with the global rise in DS use, there is an increased risk of misuse and/or excessive use leading to toxicity and adverse events (AE). Research on DS use and DS-related AE is limited in Kuwait. This study aimed to explore the prevalence of DS use, its associated factors, and reported AE in a population of young adults. Methods A cross-sectional study was carried out using an online self-administered questionnaire. Non-probabilistic sampling was used via multiple social media platforms. Logistic regression analysis was performed to assess the association between sociodemographic, lifestyle characteristics and health status with DS use and AE. Results The prevalence of DS use was 68.24%. DS use was found to be associated with age (odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.03–1.13; p-value [p] =

Abstract The State University of North Fluminense Darcy Ribeiro (UENF) has been developing for fifteen years a breeding program that aims at the development of new cultivars of elephant grass due to its high potential and the low availability of cultivars developed by genetic breeding programs that meet the needs of producers in the State of Rio de Janeiro. In this sense, inbred families were also obtained as a way of fixing potential alleles for traits related to production, as the inbreeding process apparently does not strongly affect elephant grass in aspects related to inbreeding depression. This study aimed to estimate genetic diversity, variance components and prediction of genotypic values in 11 (S1) elephant grass families, and perform the truncation and simultaneous selection of traits using the selection index, by mixed models. The experimental design consisted of randomized blocks with 11 (S1) families, three replications, and six plants per plot. For variables dry matter production, percentage of dry matter, plant height, stem diameter, number of tillers and leaf blade width, was performed the estimation of genetic parameters and selection of the best genotypes based selection index using mixed model. The descriptors were subjected to correlation analysis, distance matrices were generated by the Mahalanobis method, and individuals were grouped by the UPGMA method. In the selection via mixed models (REML/BLUP), families 6, 11, 8, 1, 3, 7, and 9 contributed most of the genotypes selected for the evaluated traits, indicating their high potential to generate superior genotype. The selection indices via mixed models indicated that the multiplicative index presented a greater selection gain.The phenotypic correlations showed the possibility of performing an indirect selection from six evaluated traits.The genotypes were separated into 18 groups by the Mahalanobis distance, allowing the observation of a wide genetic diversity. The most divergent and productive genotypes were self-fertilized to obtain the second generation (S2), continuing the development program.

Background: The anatomic interplay and overlap between the cervical spine and the shoulder constitutes a challenge for shoulder and spine surgeons, as symptoms of spine and shoulder pathologies are often similar and may lead to entity misdiagnosis. Methods: PubMed, Cochrane, and Google Scholar (page 1-20) searches were updated to October 2023 in search of the qualified papers. Boolean Operators were used with a combination of the keywords “spine” OR “neck” And “Shoulder”. Furthermore, reference lists from papers were also searched to find literature. Results: It is of pivotal importance to conduct comprehensive preoperative clinical investigation to appropriately evaluate and assess the source of the pathology and the leading causes behind it. Certain markers can help guide surgeons towards etiologies, and these include areas of pain and physical exam findings with the arm squeeze test having the highest sensitivity and specificity for diagnosing cervical radiculopathy. As for the shoulder, despite its low sensitivity, the Yergason test had the highest specificity for diagnosing subacromial impingement. Local anesthetic injection can help as well in the diagnostic approach. Moreover, the interplay between these anatomic locations is not solely related to preoperative diagnosis. Studies have shown that previous surgery for cervical spine pathology may negatively affect the outcomes of shoulder procedures like arthroplasties. Conclusion: Shoulder and spine surgeons should be wary and vigilant of accurately diagnosing the etiology of the presenting symptoms to ensure proper management and optimize prognosis.

Researchers pointed at project-based science education encourages students' dialogic practices such as wondering about the scientific phenomenon and asking questions, which may positively affect positively students' democratic practices in the classroom. It is the goal of the present research to verify this issue. Sixty-six Grade 5 students participated in the research. Thirty-two students constituted the project-based science class and were engaged with project-based activities, while 34 students constituted the regular science class. The students in each class were requested to complete a questionnaire that assessed democratic practices (freedom, equality, engagement and justice). The data were analysed using SPSS 21.0. The research results indicate that project-based learning affected positively and significantly the democratic practices of equality, engagement and justice but not that of freedom. In addition, the interactions between project-based programme and gender or science-ability affected only engagement. The project-based class can empower elementary school teachers with. Specifically, the teacher needs to be aware of the constraints of freedom, so that she/he tries to encourage the freedom of the student for expression and decision taking, which are of special importance for carrying out of project-based activities.

Background Residual risk of cardiovascular events and plaque progression remains despite reduction in low-density lipoprotein cholesterol. Factors contributing to residual risk remain unclear. The authors examined the role of eicosapentaenoic acid and docosahexaenoic acid in coronary plaque regression and its predictors. Methods and Results A total of 240 patients with stable coronary artery disease were randomized to eicosapentaenoic acid plus docosahexaenoic acid (3.36 g/d) or none for 30 months. Patients were stratified by regression or progression of coronary fatty plaque measured by coronary computed tomographic angiography. Cardiac events were ascertained. The mean±SD age was 63.0±7.7 years, mean low-density lipoprotein cholesterol level was