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The effectiveness of an air conditioner does not only depend on the design of the air-conditioner solely. Several factors affect the effectiveness of the cooling process of a room. One of the main factors in obtaining optimal results in the cooling process of a room is the rate of heat flow that enters a conditioned space. The amount of heat flow that enters a conditioned room affects the final temperature of the room. The ceiling is a part of the room that has a immense heat-flow rate. That is because the air temperature above the plafond is relatively high, and the thickness of the room plafond is relatively compact. It is necessary to analyze the room plafond material thermal resistance in increasing the heat absorbtion efficiency of household air conditioners. The thermal resistance of the material effect on the average room temperature, room temperature map, and the energy consumption is examined experimentally. The result shows that by occupying the plafond with a Styrofoam layer, the average room temperature decreases by 1.3⁰C, the air conditioner cooling capacity decreases by 0.402 kW, electric current decreases by 0.006 A compared to the existing room condition.

The purpose of this paper is to determine and discuss the factors that influence the learning outcomes of preservice teacher students in a blended learning environment. This quantitative study used a structured online questionnaire to collect responses from preservice teacher students (n=602) from five universities in Indonesia. Measurement analysis was used to validate the instrument, and the structural equation model was used to test the relationship between constructs. The model had four constructs: support system, learning strategy, digital literacy, and learning outcome. This study integrates three factors, namely support systems, learning strategies, and digital literacy, to identify the determinants of student-teacher learning outcomes in a blended learning environment. The research revealed that support systems and learning strategies have an effect on digital literacy and that digital literacy has a direct effect on learning outcomes. This research provides important insights regarding the contribution of support systems, learning strategies, and digital literacy to improve student learning outcomes in a blended learning environment.

The potential of coal in Indonesia approximately 151 billion tons, there are 61% of Low-rank coal (LRC), which has a Higher Heating Value (HHV) of 5,100-6,100 kcal/kg and Moisture content of 30-40%. Combustion of the LRC contributes to global warming due to its CO2 emission. The LRC has also a low igl (CNS). The combustion performance of LRC mixed with CNS was investigated by determining its combustion efficiency and the impact on combustion gas emission including Carbon Dioxide (CO2), Carbon Monoxide (CO), Nitrogen Oxide (NOx), and Sulfur Dioxide (SOx). This study was conducted by adding CNS into LRC of 10%, 30%, 50%, 70%, and 90%, respectively. The characteristic of the specimen is obtained from proximate and ultimate analysis based on ASTM standard. The combustion performance of mixing LRC and CNS was investigated in the electric furnace combustors with the burn-out temperature of 500, 625, 750, and 875 oC respectively. The combustion oxidant used oxygen which was supplied constantly. The combustion gas emissions were measured by using Thermoline MRU Air Fair VARIO plus test apparatus. The result shows that the addition of CNS into the LRC improves combustion performance significantly. The results show that the addition of 10% of CNS into the LRC yield the combustion efficiency varies in the range of 0.92 – 14.42%. The addition of CNS into the LRC has a significant impact on reducing CO2, CO, NOx and SOx emissions. For example, adding 10% CNS into the LRC can reduce SOx emission of 16.80%, and adding 90% CNS of 80.67% with combustion temperature of 500 oC. Improving the combustion performance by increasing combustion efficiency and reducing gas emissions will reduce global warming and also decrease slagging and fouling of combustion apparatus due to decrease of Sulfur content in the CNS and LRC mixtures.

BACKGROUND: Cutaneous melanoma (CM) can be molecularly classified into four groups: BRAF mutant, NRAS mutant, NF1 mutant and triple wild-type (TWT) tumors lacking any of these three alterations. In the era of immune checkpoint inhibition (ICI) and targeted molecular therapy, the clinical significance of these groups remains unclear. Here, we integrate targeted DNA sequencing with comprehensive clinical follow-up in CM patients. METHODS: This was a retrospective cohort study that assessed clinical and molecular features from patients with localized or metastatic CM who underwent targeted next-generation sequencing as part of routine clinical care. A total of 254 patients with CM who had a CLIA-certified targeted sequencing assay performed on their tumor tissue were included. RESULTS: Of the 254 patients with cutaneous melanoma, 77 were BRAF mutant (30.3%), 77 were NRAS mutant (30.3%), 47 were NF1 mutant (18.5%), 33 were TWT (13.0%) and the remaining 20 (7.9%) carried mutations in multiple driver genes (BRAF/NRAS/NF1 co-mutated). The majority of this co-mutation group carried mutations in NF1 (n = 19 or 90%) with co-occurring mutations in BRAF or NRAS, often with a weaker oncogenic variant. Consistently, NF1 mutant tumors harbored numerous significantly co-altered genes compared to BRAF or NRAS mutant tumors. The majority of TWT tumors (n = 29, 87.9%) harbor a pathogenic mutation within a known Ras/MAPK signaling pathway component. Of the 154 cases with available TMB data, the median TMB was 20 (range 0.7-266 mutations/Mb). A total of 14 cases (9.1%) were classified as having a low TMB (≤5 mutations/Mb), 64 of 154 (41.6%) had an intermediate TMB (>5 and ≤20 mutations/Mb), 40 of 154 (26.0%) had a high TMB (>20 and ≤50 mutations/Mb) and 36 of 154 (23.4%) were classified as having a very high TMB (>50 mutations/Mb). NRAS mutant melanoma demonstrated significantly decreased overall survival on multivariable analysis (HR for death 2.95, 95% CI 1.13-7.69, p = 0.027, log-rank test) compared with other TCGA molecular subgroups. Of the 116 patients in our cohort with available treatment data, 36 received a combination of dual ICI with anti-CTLA4 and anti-PD1 inhibition as first-line therapy. Elevated TMB was associated with significantly longer progression-free survival following dual-agent ICI (HR 0.26, 95% CI 0.07-0.90, p = 0.033, log-rank test). CONCLUSIONS: NRAS mutation in CMs correlated with significantly worse overall survival. Elevated TMB was associated with increased progression-free survival for patients treated with a combination of dual ICI, supporting the potential utility of TMB as a predictive biomarker for ICI response in melanoma.

BACKGROUND: Metastatic melanoma to the small bowel is an aggressive disease often accompanied by obstruction, abdominal pain, and gastrointestinal bleeding. With advancements in melanoma treatment, the role for metastasectomy continues to evolve. Inclusion of novel immunotherapeutic agents, such as checkpoint inhibitors, into standard treatment regimens presents potential survival benefits for patients receiving metastasectomy. CASE PRESENTATION: We report an institutional experience of 15 patients (12 male, 3 female) between 2014-2022 that underwent small bowel metastasectomy for metastatic melanoma and received perioperative systemic treatment. Median age of patients was 64 years (range: 35-83 years). No patients died within 30 days of their surgery, and the median hospital length of stay was 5 days. Median overall survival in these patients was 30.1 months (range: 2-115 months). Five patients died from disease (67 days, 252 days, 426 days, 572 days, 692 days postoperatively), one patient died of non-disease related causes (1312 days postoperatively), six patients are alive with disease, and three remain disease free. CONCLUSIONS: This case series presents an updated perspective of the utility of metastasectomy for small bowel metastasis in the age of novel immunotherapeutic agents as standard systemic treatment. Small bowel metastasectomy for advanced melanoma performed in conjunction with perioperative systemic therapy is safe and appears to promote long-term survival and enhanced quality of life.

This research aimed to examine the level of the implementation of authentic assessment by high school English teachers in a rural area of Siak district, Riau Province, Indonesia, and to explore their perception regarding authentic assessment. This research used a mixed method in which both quantitative and qualitative data were collected and analyzed. The research samples were 39 high school English teachers in the Siak region. The research instrument used is a questionnaire comprising 38 closed and three open questions, distributed online via Google Forms. The questionnaire was designed using Likert Scale with options ranging from 1-5 (very poor to very good) Data were also collected using semi-structured interviews to enrich data from the Google Form. This study found that the total average score of quantitative data is 4.1, classified as good. That means the implementation of authentic assessment by English teachers is at a good level. Then from the qualitative data analysis, it appeared that most teachers have a positive perception of authentic assessment as a tool for monitoring and evaluating student learning outcomes. However, there are still some problems faced by the teachers in implementing this assessment, such as the lack of time allotment for the English subject at school and the complexity of the assessment procedures. This implies that some policies are required to make the authentic assessment work well at school levels so teachers can benefit from the assessment for improving English learning at schools.

This study investigated student perceptions and preferences of Hybrid Flexible learning and equity. This research was conducted at fourteen universities with a research sample of 863 students. The cross-sectional survey design used online questionnaires and structured interviews for data collection. The collected data were then analyzed using the Jamovi program. The study examined students' positive perceptions of HyFlex learning modalities and equity. Students' positive perception of the face-to-face mode was the highest, followed by online asynchronous and synchronous modes. There was no gender relationship between face-to-face and equity modes, but there was a relationship between online synchronous and asynchronous modes. This study also found a positive perception of students toward equity, which explains the tendency of students to choose face-to-face and hybrid/blended modalities in the issue of equity or equity in HyFlex learning. This study also found that students' preferences for HyFlex learning modalities were mostly face-to-face and hybrid, followed by online synchronous and online asynchronous. This study also describes the qualitative reasons of students for choosing the HyFlex learning modality/mode.

All schools worldwide are rapidly entering the remote education process due to the COVID-19 outbreak. In this process, the math teacher becomes a remote math teaching partner. The teacher's experience in the remote teaching process of this mathematics subject, which is a compulsory subject in all senior secondary schools. This study aimed to see teachers' difficulties, such as problem-solving, class discussions, teaching aids, and appropriate learning methods. The participants of this study which was designed as a complex study were 15 experienced mathematics teachers in various schools in Banda Aceh. This research contributes to knowing the difficulties of mathematics teachers in teaching remotely to improve the quality of distance learning which the government is echoing in the present and future. The study results show that teachers have difficulties in remote math lessons. According to the findings of the research conducted by the participating teachers, mathematics classes should not be taught using applications for distance education; teachers have trouble interacting and communicating with students because there is limited interaction and a lack of direct feedback, and some students do not attend classes; there is a lack of information about the use of the internet and technological tools; there is a significant lack of sufficiency across the curriculum; there are some students who do not attend classes; there is a shortage of information about the use of technological tools.

Finding effective therapeutic targets to treat NRAS-mutated melanoma remains a challenge. Long non-coding RNAs (lncRNAs) recently emerged as essential regulators of tumorigenesis. Using a discovery approach combining experimental models and unbiased computational analysis complemented by validation in patient biospecimens, we identified a nuclear-enriched lncRNA (AC004540.4) that is upregulated in NRAS/MAPK-dependent melanoma, and that we named T-RECS. Considering potential innovative treatment strategies, we designed antisense oligonucleotides (ASOs) to target T-RECS. T-RECS ASOs reduced the growth of melanoma cells and induced apoptotic cell death, while having minimal impact on normal primary melanocytes. Mechanistically, treatment with T-RECS ASOs downregulated the activity of pro-survival kinases and reduced the protein stability of hnRNPA2/B1, a pro-oncogenic regulator of MAPK signaling. Using patient- and cell line- derived tumor xenograft mouse models, we demonstrated that systemic treatment with T-RECS ASOs significantly suppressed the growth of melanoma tumors, with no noticeable toxicity. ASO-mediated T-RECS inhibition represents a promising RNA-targeting approach to improve the outcome of MAPK pathway-activated melanoma.

Various blended learning models have been developed, but none of them have focused on support systems to improve the digital literacy of preservice teachers. This study aims to produce a prototype of a blended learning support system that can improve the digital literacy of preservice teachers. This type of research is research and development using a 4D model. This research was conducted at Universitas Negeri Padang and started with a needs analysis of 168 students to develop a blended learning prototype. The prototype was tested on six experts, six lecturers, and six students in the limited test and 50 students at the dissemination stage. The data collection instrument used observation and questionnaires. The data were analyzed using descriptive statistical analysis. The results show that the validity of the blended learning support system to improve the digital literacy of preservice teachers was in the very valid category. All indicators from the experts were higher than indicators from the lecturers. Although each support system was assessed differently by the experts and the lecturers, overall the digital literacy components in each support system were declared valid. The results of this study contribute to the development of digital literacy for preservice teachers by integrating digital literacy skills into a blended learning support system that includes lesson plans, content, and activities on the LMS as well as digital literacy-based assessments.

Purpose: This paper aims to investigate the effect of learning styles on HyFlex learning towards equity of learning in higher education. Design/methodology/approach: A quantitative approach was used, with data collection through a structured online questionnaire. The study participants were undergraduate students (n = 451) studying at various public and private universities in Indonesia. Measurement analysis is used to test the validity of the instrument used. Analysis of structural equations is used to test the relationships between the constructs under study. Findings: Survey instruments have satisfactory internal validity and consistency. The learning style of students in higher education positively influences the use of HyFlex's three learning modalities. All three modalities of HyFlex learning positively affect learning equity, especially the asynchronous online modality. However, the synchronous online effect is insignificant. Active/reflective learning styles only affect face-to-face mode but do not significantly affect the two online modalities, synchronous and asynchronous. Some of the learning style dimensions have an indirect effect on equity through three HyFlex learning modalities. Face-to-face and online asynchronous mediate well the indirect relationship between learning style and equity. The impact of gender and higher education status was not shown to strengthen the relationship between learning styles, HyFlex learning modalities and equity. Research limitations/implications: This study will provide valuable understanding for lecturers, educators and developers to adapt and develop HyFlex learning strategies based on the positive dimensions of the Felder-Silverman learning style that can support equitable and inclusive learning. The study forms a foundation for researchers to investigate more constructs that could improve HyFlex learning in future studies. Originality/value: This research is a pioneer in using learning styles to investigate trends in using three HyFlex learning modalities, particularly emphasising modalities that can provide equitable learning.

Changes in antenatal gut microbiota (GM) have been associated with gestational diabetes and obesity which are influenced by diet and lifestyle. Gamification can be used as an interactive health education tool to convey this concept to the public. Thus, we designed an interactive story titled 'MoM: Microbiome of Maternity' highlighting the importance of diet and lifestyle during pregnancy. Using the 'RPG Maker MV' software, a branching narrative emphasizing flavour texts with a local flair was developed. The choice-based game narrative revolves around daily diet and lifestyle preferences in an engaging story throughout pregnancy. A graphical report is provided at predetermined intervals, highlighting the relevant details on their health and GM. A pilot evaluation was conducted using feedback surveys: Part A evaluated the knowledge on GDM, healthy diet and GM (13 items, score [more than or equal to]8 ([more than or equal to]60%) depicts adequate knowledge) and Part B evaluated the satisfaction on the game design and structure (24 items, score [more than or equal to]38 depicts satisfaction and pleasant experience). We found that the initial knowledge on the introduced health concept were inadequate (Part A score 7.67 ± 2.97). After playing 'MoM', their understanding was improved and were satisfied with the design (Part B score 42.3 ± 6.49). In conclusion, 'MoM' is an effective educational game in promoting health awareness among women.