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Quasi-periodic eruptions (QPEs) are luminous bursts of soft X-rays from the nuclei of galaxies, repeating on timescales of hours to weeks1-5. The mechanism behind these rare systems is uncertain, but most theories involve accretion disks around supermassive black holes (SMBHs) undergoing instabilities6-8 or interacting with a stellar object in a close orbit9-11. It has been suggested that this disk could be created when the SMBH disrupts a passing star8,11, implying that many QPEs should be preceded by observable tidal disruption events (TDEs). Two known QPE sources show long-term decays in quiescent luminosity consistent with TDEs4,12 and two observed TDEs have exhibited X-ray flares consistent with individual eruptions13,14. TDEs and QPEs also occur preferentially in similar galaxies15. However, no confirmed repeating QPEs have been associated with a spectroscopically confirmed TDE or an optical TDE observed at peak brightness. Here we report the detection of nine X-ray QPEs with a mean recurrence time of approximately 48 h from AT2019qiz, a nearby and extensively studied optically selected TDE16. We detect and model the X-ray, ultraviolet (UV) and optical emission from the accretion disk and show that an orbiting body colliding with this disk provides a plausible explanation for the QPEs.

Critical thinking ability and character education seem to be interesting educational topics that are being discussed in the digital era of 21st century. It is necessary to optimize the character education in the learning process earlier using various learning media. The aim of this study is to investigate the influence learning process of legend story the theme of "obligation and right me" using the a character-based media of "wayang beber" (the legend of "Wasis Joyokusumo") on the students' critical thinking ability. This study is quasi experimental research using post-test only non-equivalent. The samples or participants are two classes in Pati city, namely SD Ngepungrejo 01 Pati as the control class with 36 students and SD Payang 2 Pati as the experimental class with 38 students. Cluster sampling is a technique used to determine the research subject. The data then collected using several techniques, namely observations, interviews, tests, and document analysis. In analyzing the data, descriptive and inferential statistical analysis methods are implemented. In this case, the content validity and construct validity are utilized to test the internal validity. The external validity is tested using try out test of instruments on the sample of study. The validity and reliability tests are implemented. After that, the questions are eligible to be used to obtain the data. The conclusion of study is that the implementation of "wayang beber" as a character-based learning media influences the students' critical thinking ability because the significance value is less than 0,01.

Environmental monitoring (EM) is the cornerstone for the assurance of sterility during aseptic manufacturing. In this study, the EM quality aspects in the radiopharmaceutical cleanrooms of the University Medical Center Groningen (UMCG), The Netherlands, were evaluated. Hereto, data obtained from EM over the period 2010–2022 were analyzed. The data were sorted according to the Good Manufacturing Practice (GMP) classification of the respective premises with their corresponding limits, and frequencies of excursions were determined per location. The frequency of conducted measurements gradually increased between the start and end of the assessed period. There was a trend of increased action limit excursions observed between 2010–2022. We found that EM in grade A areas appeared to be significantly less compliant with GMP specifications than the combined data from all sampled premises at the facility (p < 0.00001; two-sided Fisher’s exact test). A trend was found for reduced action limit excursions for passive air sampling and particle counting, suggesting improved GMP compliance over time for this specific type of EM. The contamination recovery rate (CRR) found for cleanroom conditions, around 10%, was considered sufficient. From this comprehensive data analysis, we learn that, in order to be fully compliant with the requirements set in the recent revision of EU (European Union)-GMP Annex 1 ‘Manufacture of sterile medicinal products’ (in force as of 25 August 2023), strategies to further improve product protection are justified. For example, improved cleaning and disinfection procedures, more efficient working methods as well as optimization of the conditions under which aseptic manufacturing is performed are to be considered.

Short stories have the advantage of teaching materials. Because of its short form, it is flexible to be used as teaching materials that do not take long to read. This study aims to describe the teachers' perception of the urgency of integrating tolerance education in the short story appreciation, the content of tolerance values in the short story appreciation learning instruments in high school, and the content of tolerance values in the short story appreciation teaching materials in textbooks. In order to achieve that, a descriptive qualitative method was employed in this study. The results are as follows: (1) All Indonesian teachers in senior high schools in Surakarta have the perception that the value of tolerance education is important to be integrated into learning, including in the short story appreciation learning. (2) The character of tolerance is always listed in the Syllabus document and the Core Competency component of the lesson plan. Apart from that component, the character of tolerance is implicitly included in the character of "caring" and "open to others' opinions" in 86% of the syllabus and lesson plans. (3) There are 9% of short story appreciation teaching materials that have tolerance education content. The potential for this tolerance content is found in a lot of teaching material topics in the form of learning activities and short stories.

Shani Reich,1 Maria Lopez,2,&ast; Jacqueline Leff,3,&ast; Jordan Herman1 1Clinical Research Center of Florida, Pompano Beach, FL, USA; 2New England Eye Center/Tufts Medical Center, Boston, MA, USA; 3Touro Osteopathic School of Medicine, Touro University, New York, NY, USA&ast;These authors contributed equally to this workCorrespondence: Shani Reich, Tel +1 305 984 7785, Fax + 1 305 570 2642, Email Shani.reich@gmail.comPurpose: To compare clinical outcomes and patient preference for the dexamethasone intracanalicular insert (DEX) versus topical loteprednol (LOT) or olopatadine (OLO) for the treatment of allergic conjunctivitis in a real-world model of allergen exposure.Methods: This was a prospective comparative trial. Adults with testing-confirmed bilateral allergic conjunctivitis received DEX in the more symptomatic eye and either LOT 2 times daily or OLO once daily for 30 days in the fellow eye. The primary outcome was patient preference for treatment. Clinical outcomes included ocular itching and hyperemia, lid swelling, and watering/tearing. Safety outcomes included intraocular pressure (IOP).Results: Thirty patients participated and completed the study. All received DEX in the eye with worse symptoms and 15 received LOT and the other 15 received OLO in the other eye. Patients preferred DEX (10/15; 66.7%) over LOT (4/15; 26.7%), with one patient having no preference (p = 0.0103). Patients had no preference between DEX (8/15; 53.3%) and OLO (6/15; 40%), with one patient having no preference (p = 0.1044). In the DEX/LOT cohort, ocular itching and hyperemia improved more with DEX than LOT (p ≤ 0.009), while in the DEX/OLO cohort, the DEX eyes showed greater improvement in conjunctival hyperemia (p < 0.0001) but not itching (p = 0.074). No between-group differences were seen in eyelid swelling or tearing/watering in either cohort. Mean change in IOP was similar between the DEX and LOT eyes (p = 0.4921), and mean IOP rose more in the DEX eyes than the OLO eyes (by < 1 mmHg; p = 0.0403).Conclusion: Overall, this real-world study demonstrated that the dexamethasone intracanalicular insert was as effective as a topical antihistamine/mast cell stabilizer and more effective than topical steroids in relieving the signs and symptoms of allergic conjunctivitis. This insert should be considered as an alternative to topical therapy for the treatment of allergic conjunctivitis.Keywords: dexamethasone, dextenza, allergic conjunctivitis

Samin is an Indonesian tribe at Mount Kendeng, exactly in the cities of Blora and Bojonegoro. Samin people reject school, fez, polygamy, long trousers, and trade. Although they look like out of date, they have 7 good characters i.e discipline, honesty, responsibility, cooperation, tolerance, social care, and environmental care. This research aimed at investigating the strategies for implementing local wisdom-based character education among Indonesian higher education students by focusing on the values sated in Jamuskalimasada book of Samin Community. The data of this phenomenological research were collected by observation, interview, questionnaire, and documentation. The findings demonstrated that teaching character education in the higher education based on local wisdom could be conducted by integrating values and aesthetics in the course, internalizing positive values to students, habituation and training, providing example and model, creating characterized-situation based on local wisdom, and civilizing. Value-based vision of study program or campus can be achieved through educational strategy formulation including value habituation, value role model, value internalization, value integration in learning, and cultural value. Teaching character education was related to both character actualization programmed in the lesson plan and good example provision in the classroom and daily campus activities.

The objectives of this research are (1) revealing the lecturers and students' perception on the use of multicultural-based short story appreciation textbook in teaching prose-fiction appreciation course; and (2) evaluating the effectiveness of multicultural-based short story appreciation textbook in teaching prose-fiction appreciation course. This study employed a mixed-method approach by combining evaluative descriptive research design and experimental design to evaluate multicultural-based short story appreciation textbook in private universities in East Java, Indonesia. The data were gathered via interview, questionnaires, documentation, and test. While choosing the experimental and control group from each university, the sampling technique used was cluster random sampling. The results reveal that both the lecturers and the students showed their positive responses and attitudes towards the use of multicultural-based short story appreciation textbook in teaching prose-fiction appreciation course. They asserted that the textbook could motivate the students in learning prose-fiction appreciation course. It is inferred that the use of multicultural-based short story appreciation textbook is more effective than the use of previously common textbook used by the lecturers to teach prose-fiction appreciation.

John Lachs considers his major philosophical contributions to be his work on mediation, the love of life, and his explication of George Santayana's philosophical and literary outlooks. All three are undergirded by Lachs's effort to make philosophy relevant to people's lives. This article examines these three contributions with both a critical eye and an admiration for Lachs's efforts. The conclusion provides an assessment often missed in critiques of Lachs's work. Keywords: John Lachs, George Santayana, Wallace Stevens, Consciousness, Education, Immediacy, Living Well, Love of Life, Mediation, Naturalism, Neuroscience, Non-reductive Materialism, Preface John Lachs considers his major philosophical contributions to be his work on mediation, the love of life, and his explication of George Santayana's outlook. He notes that the foundation [...]

This study investigated whether and how medication reviews (MRs) conducted by pharmacists and general practitioners (GPs) with patient involvement can be performed on the island of Aruba (Dutch Caribbean). In this mixed-methods pilot study (both qualitative and quantitative), constructive and observational methodologies were combined. Healthcare providers’ and patients’ views on MRs and aspects of Aruban healthcare and culture relevant to MRs were examined. These insights were used to develop a protocol for conducting and implementing MRs in Aruba. Surveys were distributed and semi-structured interviews were held among Aruban community pharmacists and GPs, and a pilot program was created in which MRs were carried out with four Aruban patients and their GPs. According to the included healthcare providers, the main purpose of MRs is to optimize the patient experience and achieve concordance. Even though pharmacists and GPs consider their partnership equal, they have different views as to who should bear which responsibility in the MR process in matters regarding patient selection and follow-up. Common Aruban themes that were mentioned by the healthcare providers and deemed relevant for conducting MRs included behaviour/culture, healthcare, lifestyle, and therapy compliance. Anamnesis should be concise during the MR, and questions about medication storage, concerns, beliefs, and practical problems, as well as checks for limited health literacy, were considered important. In the pilot, at least three to, maximally, eight pharmacotherapy-related problems (PRPs) were detected per MR consultation, such as an incorrect dosage of acetylsalicylic acid, an inappropriate combination tablet for blood pressure regulation, and the absence of important laboratory values. All patients considered their consultation to be positive and of added value. In addition, it was observed that an MR can potentially generate cost savings. The information obtained from the healthcare providers and patients, together with the basic principles for MRs, as applied in the Netherlands, led to a definitive and promising MR format with practical recommendations for community pharmacists in Aruba: in comparison with the Dutch MR approach, GPs and pharmacists in Aruba could collaborate more on patient selection for MRs and their follow-up, because of their specific knowledge regarding the medications patients are taking chronically (pharmacists), and possible low levels of health literacy (GPs). Taking into account the Aruban culture, pharmacists could ask extra questions during MRs, referring to lifestyle (high prevalence of obesity), readability of medication labels (limited literacy), and herbal product use (Latin American culture). GPs and medical specialists sometimes experience miscommunication regarding the prescription of medication, which means that pharmacists must carefully take into account possible duplicate medications or interactions.

The study aims to find out the effectiveness of poetry appreciation textbook for the implementation of character education values at the Higher Education institution. It was set in four universities, two of which are located in Central Java, including University of Sebelas Maret Surakarta and University of Muhammadiyah Purworejo meanwhile, the other two are in Special Region of Yogyakarta, including University of Ahmad Dahlan, and University of Sarjanawiyata Taman Siswa. It utilized an experimental method with Independent Sample T-Test based on the mean difference of pre-test and post-test results from the control and experimental group. The finding confirms that the experimental group obtained the average score that equals 15.68, meanwhile the control group obtained 10.86. The T-Test shows tcalc = 5.087 (p = 0.000<0.05), that rejects the Null Hypothesis. It concludes that there is a significant difference between the experimental and control group in the use poetry appreciation textbook for character education implementation at the Higher Education institution. The study expects further exploration concerning character education implementation through literature works in a wider range for the sake of research and development. The uniqueness of the textbook in combining the values of personal development and literature is recommended as the dominant feature to introduce a complex gradual learning system for the innovation of teaching and learning method.

Even though, nowadays, most medicines are manufactured industrially, patients may have medical needs that can only be met by a tailor-made approach. This requires the availability of pharmacy preparations made under Good Manufacturing Practice (GMP) conditions. An efficient hand hygiene practice is essential herewith, especially if sterile products that are prepared in a cleanroom are concerned. The effectiveness of hand washing and hand disinfection procedures greatly relies on adequate training. We carried out an observational cross-sectional pilot study aimed at optimizing hand hygiene training with objective and measurable quality assessments using an ultraviolet (UV) dye. Practical acceptance criteria for qualifying personnel through this method were set and evaluated. In total, 25 GMP-qualified cleanroom operators washed and disinfected their hands with UV dye hand wash lotion and UV dye hand alcohol, respectively. To obtain a proof-of-concept, the results were judged based on adherence to the WHO six-step protocol and associated acceptance criteria. Commonly missed areas were brought to light, and the influence of procedure duration was investigated. UV-dye-based assessments appeared to be more valuable in hand disinfection than in hand washing. In both procedures, the back of the hands and the thumbs were frequently missed. This underpins the need for enhanced and repeated education on hand washing and disinfection. Additionally, a dry skin gave rise to extra cleaning challenges. From this pharmacy practice pilot study with a focus on pharmaceutical product care, it may be concluded that the application of UV-dye-based assessments offers valuable insights for pharmacists to optimize hand hygiene, thereby increasing the safety of tailor-made medicines and on-site preparations.

Conventional therapy is commonly used for the treatment of inflammatory skin conditions, but undesirable effects, such as erythema, dryness, skin thinning, and resistance to treatment, may cause poor patient compliance. Therefore, patients may seek complementary treatment with herbal plant products including essential oils (EOs). This scoping review aims to generate a broad overview of the EOs used to treat inflammatory skin conditions, namely, acne vulgaris, dermatitis and eczema, psoriasis, and rosacea, in a clinical setting. The quality, efficacy, and safety of various EOs, as well as the way in which they are prepared, are reviewed, and the potential, as well as the limitations, of EOs for the treatment of inflammatory skin conditions are discussed. Twenty-nine eligible studies (case studies, uncontrolled clinical studies, and randomized clinical studies) on the applications of EOs for inflammatory skin conditions were retrieved from scientific electronic databases (PubMed, Embase, Scopus, and the Cochrane Library). As an initial result, tea tree (Melaleuca alternifolia) oil emerged as the most studied EO. The clinical studies with tea tree oil gel for acne treatment showed an efficacy with fewer adverse reactions compared to conventional treatments. The uncontrolled studies indicated the potential efficacy of ajwain (Trachyspermum ammi) oil, eucalyptus (Eucalyptus globulus) oil, and cedarwood (Cedrus libani) oil in the treatment of acne, but further research is required to reach conclusive evidence. The placebo-controlled studies revealed the positive effects of kānuka (Kunzea ericoides) oil and frankincense (Boswellia spp.) oil in the treatment of psoriasis and eczema. The quality verification of the EO products was inconsistent, with some studies lacking analyses and transparency. The quality limitations of some studies included a small sample size, a short duration, and the absence of a control group. This present review underscores the need for extended, well-designed clinical studies to further assess the efficacy and safety of EOs for treating inflammatory skin conditions with products of assured quality and to further elucidate the mechanisms of action involved.

Teaching and learning speaking skills should be able to engage students in a creative process. Students have to be able to speak in front of the class, create a dialogue, tell a story, and produce the language creatively. The teaching and learning of the speaking skill focusing on story telling ability can work well when supported by the appropriate choice of teaching method. This study attempts to: 1) identify the list of things needed by teachers of primary schools to teach Bahasa Indonesia in fun and creative ways, 2) design a prototype of suggestopedia based storytelling learning model to teach Bahasa Indonesia in primary schools, 3) develop the prototype into a suggestopedia based storytelling learning model to teach Bahasa Indonesia in primary schools, 4) determine the effectiveness of the application of suggestopedia based storytelling learning model to teach Bahasa Indonesia in primary schools. This research is a model development study based on the procedures by Borg and Gall. This study demonstrated that a teaching model is created through the following steps: 1) identifying and analyzing the needs of the students and teachers, 2) designing and evaluating the model, 3) developing and testing the model. The effectiveness test showed a significant increase of 3.03 or 8.11% in the experimental group's mean score, from 18.94 in the pretest to 21.97 in the posttest. Meanwhile, the control group only experienced a 2.51 or 6.36% in the mean score, from 18.50 in the pretest to 21.05 in the posttest. Hence, it can be concluded that the students' story telling skill in the experiment class using the teaching method developed in this study was higher than in the control class. The result implied that the teaching model prototype can be further developed to increase the primary students' story telling skill in Salatiga.

In this study, a variety of ZnO-based heterojunctions with disparate wt.% doping of WO3 and BiOI have been prepared for the photodestruction of methyl orange (MO) dye in aqueous solution. The composites were analysed by scanning electron microscopy, energy-dispersive X-ray spectroscopy, X-ray diffraction, optical studies, and nitrogen adsorption-desorption isotherms. The SEM images revealed non-uniform surfaces of the ZnO–BiOI based composites while mostly nodular morphology was observed for all three samples of ZnO-WO3. As the WO3 loading increased, more clustering was detected. The analysed samples exhibited characteristic peaks representative of the triclinic phase of WO3 and the hexagonal wurtzite structure of ZnO, while the diffractogram observed from the materials displayed distinct peaks corresponding to the crystalline phases of both BiOI and ZnO in their pure forms. Further evidence of the samples' characteristics includes the presence of distinct crystalline patterns without any impurity peaks, a red shift in the absorption spectra of the heterostructure, the detection of only the reference elements, and mostly Type IV isotherm adsorption. This study identified the ZnO-[10%]BiOI and ZnO-[10%]WO3 heterojunctions as the best performing photocatalysts, as MO was completely destroyed in 120 and 90 min, respectively. Thus, confirming 10% wt. as the optimal doping concentration for the best photo-activity in this study. The impact of varying process parameters demonstrates that at an elevated photocatalyst mass of 40 mg, both heterojunctions effectively degraded MO. The photodegradation efficiency of MO was more pronounced in strong acidic conditions (pH 2) when compared to high alkaline conditions (pH 11) for the ZnO-[10%]BiOI heterostructure. However, a decrease in performance was observed for both strong acidic and high alkaline pH values when the ZnO-[10%]WO3 heterostructure was applied. The kinetic analysis of the photodegradation study reveals that all the photodegradation experiments can be represented by the pseudo-first-order kinetic model. The findings from this investigation propose that the ZnO-[10%]BiOI heterojunction photocatalyst holds significant potential for the effective treatment of dye-contaminated wastewater.