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Music education is a subject that is generally thought to have much physical activity involved. However, virtual learning has been mandatary applied to most schools worldwide due to the COVID-19 pandemic. The landscape of music learning has had to be switched to online distance learning (ODL), where students learn music virtually using technological tools. Gifted students are among those affected by the implementation of music ODL throughout 2020. Thus, the purpose of this study is to identify the effectiveness of music ODL on gifted students' motivation. The researchers framed this quantitative study by involving 81 secondary gifted students, aged 13 years, from 13 states in Malaysia. The sample was selected through random sampling, and a preexperimental design was applied to conduct the study. Respondents had been exposed to the music ODL intervention for a month. Data were collected through an adapted questionnaire, namely, the MUSIC Inventory, with a five-point scale. Data were further analysed by descriptive and inferential statistics, integrating two-way MANOVA, using SPSS Statistics version 23. Results reveal that an ODL approach to music classes is significantly effective to enhance gifted students' motivation domains of empowerment, usefulness, success, interest, and caring. Yet, no significant difference was found in gifted students' genders and locations on the four domains. Different approaches in music teaching could be further explored for music ODL to gifted students in future studies.

Anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis is a prevalent autoimmune condition marked by diverse neuropsychiatric symptoms, primarily impacting young females. The exact mechanisms underlying the development of NMDAr encephalitis have not been fully elucidated. Nonetheless, studies have demonstrated that auto-antibodies targeting the NR1-NR2 subunits of the NMDAr can trigger receptor dysfunction within the central nervous system, thus giving rise to the associated symptoms. Notably, an association exists between NMDAr encephalitis and an underlying neoplastic condition, with approximately 38% of cases exhibiting this paraneoplastic relationship with ovarian teratomas being the most commonly associated malignancy.While the association between NMDAr encephalitis and renal cell carcinoma (RCC) is exceedingly rare. This case report presents the clinical scenario of a 20-year-old female patient diagnosed with NMDAr encephalitis in conjunction with RCC discovered incidentally on a CT abdomen and pelvis performed to rule out an ovarian teratoma. The presented case underscores the importance of adopting a multidisciplinary approach in the diagnosis and treatment of NMDAr encephalitis, particularly when it is linked to an underlying malignancy. Furthermore, it emphasizes the significance of expanding our understanding of the molecular pathogenesis of NMDAr encephalitis to enhance patient care and optimize clinical outcomes. Additionally, a comprehensive review of the existing literature is included, summarizing all reported malignancies associated with NMDAr encephalitis.

Purpose: Music class should function as a class that triggers joy and a platform for students to express their feelings. Based on observation, there are music teachers who teach singing and the playing of musical instruments based traditionally on a teacher-centered approach. This has caused music classes to become passive and dull, with unexcited students that would cause them to lose focus in the class. The purpose of this research is to investigate the application of rhythmic movements, using one of the components from Dalcroze's Eurhythmics as an activity to develop active and fun music classes, hence to improve students' music performance skills. Methodology: The study was carried out within the framework of a ten-week action-research design involving 35 primary school students at Putrajaya, Malaysia. Data collection was through group observation on students' musical behaviours. Researchers also conducted an in-depth interview with rhythmic movement experts. Findings: Result shows that there is a significant change of musical behaviours among primary students from week 8 to week 10. Experts agree that rhythmic movement can create a meaningful music class with the active participation of students. Three rhythmic procedures have been recommended by the experts to strengthen a music class pedagogy. Significance: Learning music through movements has turned music classes into active and fun places. Rhythmic movement activity has made music lessons to become more meaningful. This study has helped students to explore music through movements, creating an environment in which they have the chance to play, communicate with each other, learn through observation and express their creativity in their own way. This intervention helps students to grasp almost all the music concepts while doing activities. This study has also provided ideas for teachers to integrate rhythmic movements into the music instructional process.

CLIL approach refers to Content and Language Integrated Learning. This paper discusses the self-efficacy of Malaysian Gifted Students (MGS) at GENIUS@Pintar Negara in understanding Arabic tasks in the classroom, for example, understanding the Arabic terms in the lesson of Haji. These terms are; a) dam tertib and takdir, b) dam tertib and ta'dil, c) dam takhyir and takdir, d) dam takhyir and ta'dil. Besides, by employing the CLIL, the MGS can improve themselves because the CLIL approach encourages their self-efficacy to completely deal with the language task. The present study employs; qualitative study by using an interview, verbal report, and observation. This method is an instrument to answer two research questions. a) How the individual of MGS adapts his/ her situation to understand the four Arabic terms of the dam in Haji after undergo the three principles stages of classroom task in CLIL? b) What is the best method to memorize the four Arabic terms of the dam in Haji? In this study, three participants took part in the pilot study, and seven participants took part in the actual study. The present study revealed that the MGS in the Pusat GENIUS@Pintar Negara prefer to be independent learners by using the internet to understand the four Arabic terms and memorize by using keywords related to the four Arabic terms in performing Haji.

The concept of gamification has spread widely in recent years supported by the development of technology, especially due to the plethora of computers and video games and game apps for other devices. Gamification is the use of game thinking and game mechanics in non-game contexts that support play to engage users in solving problems or created for teaching and learning purposes. Gamification does not mean creating games but making education more engaging and fun with play for learners, without undermining its credibility. In modern education, lessons delivery is associated with the lack of engagement and motivation of learners to participate actively in the learning process. Teachers are increasingly faced with the problem of how to integrate technology and to impart good language learning habits at the level of primary school in Malaysia. Hence, the aim of this study is to propose a conceptual model of analogue gamification to enhance primary school learners' motivation and attitude.

Planning a creative learning environment is not an easy task. Teachers prefer to teach traditionally in chalk-and-talk approach during language teaching. However, this does not fit learners of the 21st Century as they prefer game-like activities instead of pen-and-paper lessons. Hence, the introduction of gamification in classroom would result in immediate enthusiasm and curiosity, which leads to the learners' willingness to learn. Gamification prepares learners to be active and take responsibility upon their own learning. Lessons filled with fun games are believed to be more effective in producing a positive outcome as learners are motivated to play more although they do not realise the fact that they are learning subconsciously. This study aimed to explore views of 33 pre-service teachers in using gamification in language teaching during their 16-week internship at local primary schools around Selangor, Malaysia. A quantitative survey research method was used by administering a set of questionnaires at the end of their internship. The data collected was then analysed and presented in the form of tables. The results showed that integrating gamification into language learning improved learners' creative, critical and problem-solving skills. Thus, interesting and engaging activities spark learners' interest in language learning subconsciously.

Summary:. Lower extremity reconstruction with free flaps in patients with only peroneal artery runoff remains a challenge. Here, we present a novel technique for reconstruction of medial defects in the distal leg using a medial approach to the peroneal artery and a short interposition vein graft anastomosed end to side to the peroneal artery. A retrospective, single-center study was performed including all patients who underwent lower extremity reconstruction with free flaps anastomosed to the peroneal artery using a mini vein graft from November 2020 to March 2022. The primary outcome measure was limb salvage. Secondary endpoints were flap survival and postoperative complications. Seven patients received lower extremity free flap reconstruction with a mini vein graft to the peroneal artery. Flap loss rate was 0%. Limb salvage was achieved in five patients (71%). At 6-month follow-up, all patients were ambulatory. One patient died 1 month after surgery due to heart failure. Mini vein graft to the peroneal artery allows reliable and safe free flap reconstruction of distal leg defects in patients with only peroneal artery runoff.

Mycotic aneurysms (MA) are a rare but severe complication of systemic infections, carrying a high risk of rupture, hemorrhage, sepsis, and potential multiple organ failure. Intracranial arteries are often affected and present a significant mortality risk due to cerebral bleeding and ischemic strokes. In this paper we describe the case of a 23-year-old female patient who presented with a sudden onset of right hemiparesis, followed by loss of consciousness. Cerebral imaging revealed multiple infarcts in both hemispheres and intracranial hemorrhage secondary to ruptured pseudoaneurysms. On transthoracic echocardiogram, she was found to have a left ventricular cardiac cyst with mobile vegetations potentially responsible for mycotic aneurysms and cerebral strokes. The patient underwent endovascular embolization for the mycotic aneurysms and cardiac surgery for the left ventricular cyst with satisfying clinical outcomes. Postsurgical analysis revealed the cyst to be of hydatid (Echinococcus) origin.

Sonic pressure wave should be taken into consideration in all ballistic injury. We review a young gentleman with ballistic injury of his lateral chest wall. The bullet trajectory passed through the lateral chest wall. Chest radiograph shows a wedge-shaped consolidation adjacent to the wound with blunted right costophrenic angle. Subsequent CT scan confirms the consolidation adjacent to the bullet trajectory. This case report emphasizes on value of CT in ballistic chest trauma and indirect injury caused by the sonic pressure wave of the bullet.

الملخص: أهداف البحث: يعتقد بأن عملية الحمل تمثل إحدى التحديات التي تواجهها النساء اللاتي يقطن الأماكن شديدة الارتفاع عن سطح البحر، وذلك نظرا لصعوبة التأقلم مع معضلة نقص الأكسجين. من خلال هذا البحث تم دراسة مجموعة من الخصائص المرضية النسيجية (الباثولوجية) لبعض اضطرابات الحمل التي تتضمن فقدان الحمل (الإجهاض) بين النساء الحوامل اللائي يقطن منطقة مرتفعة عن سطح البحر بحوالي 2200 متر بالمملكة العربية السعودية. طرق البحث: دراسة مقطعية تم خلالها جمع البيانات بأثر رجعي من مستشفى واحد واقع في منطقة مرتفعة وذلك خلال عامي 2018-2020 . النتائج: أسفرت النتائج عن أن نسبة تقدر بحوالي 55% من النساء اللاتي حدث عندهن حمل غير مكتمل (إجهاض أو حمل العنقودي أو حمل خارج الرحم) كانت أعارهن تقل عن 35 عامًا. وقد دلت الإحصائية على أن نسبة الحمل خارج الرحم وصلت إلى 6.8% من تلك الاضطرابات. وقد بلغ معدل الإجهاض 19% من إجمالي عدد حالات الحمل التي تمت دراستها الاستنتاجات: توصي الدراسة الباحثين باستكمال وتواصل الدراسات في هذا الشأن وأن تشتمل دراساتهم المستقبلية على عدد أكبر من السيدات الحوامل في تلك المناطق شديدة الارتفاع عن سطح الأرض مستعينين بالتحليلات الجينية وغيرها من الوسائل التي تساعد على التوصل إلى نتائج أكثر دقة والتعرف على الأسباب وطرق الوقاية من تلك الاضطرابات، إضافة إلى الحاجة إلى المزيد من الدراسات المماثلة بمناطق تقع على مستوى سطح البحر. Abstract: Objectives: Pregnancy at high altitudes is relatively challenging because of hypobaric hypoxia, which is associated with a smaller uterine artery diameter and diminished blood flow. Here, we investigated the histopathological characteristics of early pregnancy disorders among pregnant women living in a high-altitude region (approximately 2200 m above sea level). Methods: This cross-sectional study used retrospective data collection from a single tertiary hospital in a high-altitude region in KSA. Age and histopathology were analyzed in 495 women diagnosed with early pregnancy disorders (mainly miscarriage) in 2018–2020. Results: Approximately one-fifth of pregnancies in this high-altitude region were lost before 24 weeks’ gestation, whereas 1150/6044 experienced miscarriage; 495 samples from those participants were sent for histopathological analysis. A total of 269 (54.34%) patients were younger than 35 years. Missed miscarriages accounted for 49.3% of miscarriages, followed by inevitable miscarriages (34.2%), which had a relatively higher frequency among mothers older than 35 years. The correlation between age and inevitable miscarriage was significant; ectopic pregnancy was diagnosed in 6.8%, molar pregnancy was detected in 6.26%, and blighted ovum was observed in 3.4%. Conclusion: The miscarriage rate in this high-altitude region was 19% of all pregnancies. Approximately half of the affected women were in their 30s. Missed miscarriage cases were relatively high in this region. The percentage of molar pregnancy was higher than those reported in prior studies, thus suggesting a need for monitoring and genetic workup practices. Furthermore, studies involving a larger population at high altitudes will be crucial for further risk assessment in addition to national studies on women living at sea level.

In recent years, research on the epoxidation of fatty acids has attracted considerable attention due to the growing demand for eco-friendly epoxides generated from vegetable oils. Commercially available epoxides are primarily derived from petroleum and animal fats, which are non-environmentally friendly sources. Epoxide is a crucial chemical precursor for the manufacture of alcohols, glycols, and polymers such as polyesters and epoxy resin. The optimal process parameters were determined using the one factor at a time (OFAT) technique. This study's purpose is to identify the optimal process parameter for agitation speed in relation to the oxirane ring opening of epoxidized oleic acid. The result at 100 rpm and sulfuric acid as catalyst are the optimal process setting for achieving maximal relative oxirane conversion (93 %). Then, the ring opening formation's identity was validated using Fourier Transform Infrared (FTIR).

Purpose: This study examined academic motives to enter university-industry collaboration (UIC) and how they affect collaboration performance. Given that UIC performance is context-dependent, we also explored the moderating role of relationship governance. Design/methodology/approach: The study population was academics working at a public research university while collaborating with industry. Data were collected through a cross-sectional survey. The measurement items were adapted from previous studies. Exploratory factor analysis and confirmatory factor analysis were conducted using IBM SPSS statistics 26 (SPSS 26). This study utilized a hierarchical moderated regression analysis to examine the research model. Findings: The results indicated that government and institutional policies and knowledge generation and dissemination are critical indicators of necessity that motivate academics to enter UIC and positively influence performance outcomes. Different governance mechanisms also play varying roles in the relationship between motivation and UIC performance. Practical implications: Institutional programs designed to encourage academics to collaborate with industry should consider the types of academic motivation and carefully manage collaboration efficiency using various kinds of relationship governance. Originality/value: This study contributes to existing knowledge by determining how different relationship governance mechanisms moderate the relationship between academic motivation and collaboration performance.

Background:. The demand for augmentation-mastopexy surgery without using implants has significantly increased over the years. Fat transfer offers an alternative method, but some patients do not favor this procedure either. The purpose of this study was to evaluate the versatility of using a lateral-based mammary flap as an “auto-implant” for enhancing the breast mound for patients undergoing primary mastopexy. Method:. This retrospective study was performed between February 2016 and April 2019, including 36 female patients (72 breasts). Our technique involves using the inferior breast tissue by elevating the lateral-based dermoglandular flap that was moved cranially with a 90 degree rotation in a conical shape within the created pocket to refill the superior and central mound. Result:. The mean nipple projection was 11.2 after 36 months postoperative compared with 5.2 before surgery. The mean ± SD of pre- and postoperative measurements for the lower pole zone were 80.2 ± 10.5 and 50.1 ± 6.4, and those for the upper pole zone were 40.3 ± 9.5 and 63.9 ± 6.5, respectively. The distance of breast mound elevation after the surgical procedure ranged from 5.30 to 9.55 cm, with a mean of 7.90 cm. Conclusions:. The lateral-based mammary flap acts like an implant that helps shape and augment the breast, enhances the mammary projection, and restores the breast contour without requiring a synthetic implant or fat grafting. It is a reliable technique with high patient satisfaction but is unsuitable for patients with insufficient breast volume.

Objectives . To evaluate carotid artery intima-media thickness (CIMT) and lipid profile in children with epilepsy on long-term antiepileptic drug (AED) monotherapy. Methods . We included 60 children with epilepsy receiving valproate, carbamazepine, or levetiracetam monotherapy and 60 controls. A high-resolution B-mode ultrasound was used to measure (CIMT). Measurement of serum lipids was done. Results . Patients on valproate (0.44 ± 0.03, P ≤ .001), carbamazepine (0.43 ± 0.03with P ≤ .001), and levetiracetam (0.44 ± 0.02 with P ≤ .001) monotherapy showed significantly higher CIMT compared to controls. CIMT was correlated with age ( P = .041, r = .112) AEDs{valproate ( P = .005, r = .731), carbamazepine ( P = .038, r = .365), and levetiracetam ( P = .036, r = .155)}, duration of treatment ( P = .001, r = .313), TC( P = .001, r = .192), TG ( P = .014, r = .018), and LDL ( P = .001, r = .219). HDL ( P = .003, r = −.126). Seizure severity and Apo A1 were insignificantly involved. Conclusion . Long-term monotherapy with valproate, carbamazepine, and levetiracetam in epileptic children was associated with significant abnormalities in CIMT.

Objective: To assess whether baseline pulmonary artery diameter (PAD), obtained from noncontrast nongated computed tomography (NCCT), can be associated with coronavirus disease 2019 (COVID-19) outcomes. Patients and Methods: This is a retrospective study of patients hospitalized with COVID-19 admitted to Hôtel-Dieu de France university hospital (Beirut, Lebanon) between March 1, 2020 and March 1, 2021. Pulmonary artery diameter was measured at baseline NCCT. Various outcomes were assessed, including hospital length of stay, intensive care unit admission, invasive mechanical ventilation, mortality, and Post–COVID-19 Functional Status scale at discharge and at 2-month follow-up. Results: Four hundred sixty-five patients underwent baseline NCCT, including 315 men (67.7%) with a mean age of 63.7±16 years. Baseline PAD was higher in critically ill patients admitted to the intensive care unit (mean difference, 0.8 mm; 95% CI, 0.4-1.59 mm) and those receiving invasive mechanical ventilation (mean difference, 1.1 mm; 95% CI, 0.11-2.04 mm). Pulmonary artery diameter at baseline correlated significantly with hospital length of stay (r=0.130; P=.005), discharge status (r=0.117; P=.023), and with Post–COVID-19 Functional Status scale at 2-month follow-up (r=0.121; P=.021). Moreover, multivariable logistic regression showed that a PAD of 24.5 mm and above independently predicted in-hospital all-cause mortality remained unaffected in patients with COVID-19 (odds ratio, 2.07; 95% CI, 1.05-4.09). Conclusion: Baseline PAD measurement using NCCT can be a useful prognostic parameter. Its measurement can help to identify early severe cases and adapt the initial management of patients hospitalized with COVID-19.

Learning is the act of acquiring new, or reinforcing existing knowledge, characters, skills, and values, affecting a potential change of the learners towards nurturing creativity and innovation. The 21st-century learning framework from the 21st-Century Partnership, 2002 and the component of the Four-Dimensional Education written by Fadel, Bialik & Trilling 2015, have in common in the aspect of designing instructions for the implementation of the 21st-century learning. It is a challenge for the teachers to design the instruction in fulfilling the requirements. Thus, this concept paper introduces The Collaborative Instructional Design System (CIDS) 2017, developed as a solution towards the challenges. CIDS comprises of the Integral ASIE Instructional Design Model developed by Ismail, & Balakrishnan 2016 (the transformational ID Model), and special features on the Professional Learning Community (PLC). PLC is a "global hub" for connecting teachers meeting with members of various communities around the world virtually that foster and build high-quality human capital for future prosperity. Information about the development and issues of job opportunities in the world and the successes and challenges faced by the industries especially relating to the Fourth Industrial Revolution--IR4.0, can create awareness which further motivates learners to commit themselves with confidence in pursuing their goals. CIDS is a constructive process in designing the instructions, which provides practitioners in education a valuable tool and perspective in enhancing the quality of instructions and training towards visualizing the 21st-century learning requirements for all learners. CIDS is accessible at https://asiemodel.net.

Design of instruction is an important feature in teacher education at fulfilling the needs of 4Cs ("critical thinker," "communicator," "collaborator," "creator") developing "a globally competitive learners". As Instructional design models (ID) need to move from adopting a standard approach to developing models that have an impact on learners profiles, creating a much better learning experience, skills and knowledge both in classroom and online. Traditional ID models will have to be re-modelled and re-designed to deliver instructions which are more learner-centered than process-centered. An Integral ASIE Instructional Design Model (Analyze, Strategize, Implement and Evaluate) is an online planning ID Model which serves as alternative to the existing traditional ID models which support experiential and collaborative learning for learners in gaining and re-producing information. It is interactive to the user, integrative in planning the content, prescriptive in the planning procedures and constructive in the organization of the components. Instructors/teachers plan their instruction in the planning mechanism known as Multiple Integration Worksheet (MIW) by interacting within and between components in the "Reflection Cycle" of the model and it allows sharing of information among teachers across nations. This unique features provides flexibility in customisation of items and guide instructors/ teachers in formulating & integrating the best possible designing practices giving opportunities for learners to explore their potential establishing a more participative, communicative and innovative learning environment. It is accessible at www.asiemodel.com.

Background The overall poor prognosis in pancreatic cancer is related to late clinical detection. Early diagnosis remains a considerable challenge in pancreatic cancer. Unfortunately, the onset of clinical symptoms in patients usually indicate advanced disease or presence of metastasis. Analysis and Results Currently, there are no designated diagnostic or screening tests for pancreatic cancer in clinical use. Thus, identifying risk groups, preclinical risk factors or surveillance strategies to facilitate early detection is a target for ongoing research. Hereditary genetic syndromes are a obvious, but small group at risk, and warrants close surveillance as suggested by society guidelines. Screening for pancreatic cancer in asymptomatic individuals is currently associated with the risk of false positive tests and, thus, risk of harms that outweigh benefits. The promise of cancer biomarkers and use of ‘omics’ technology (genomic, transcriptomics, metabolomics etc.) has yet to see a clinical breakthrough. Several proposed biomarker studies for early cancer detection lack external validation or, when externally validated, have shown considerably lower accuracy than in the original data. Biopsies or tissues are often taken at the time of diagnosis in research studies, hence invalidating the value of a time-dependent lag of the biomarker to detect a pre-clinical, asymptomatic yet operable cancer. New technologies will be essential for early diagnosis, with emerging data from image-based radiomics approaches, artificial intelligence and machine learning suggesting avenues for improved detection. Conclusions Early detection may come from analytics of various body fluids (eg ‘liquid biopsies’ from blood or urine). In this review we present some the technological platforms that are explored for their ability to detect pancreatic cancer, some of which may eventually change the prospects and outcomes of patients with pancreatic cancer.

OBJECTIVES:. Antipsychotic medications are frequently prescribed to critically ill patients leading to their continuation at transitions of care thereafter. The aim of this study was to generate evidence-informed consensus statements with key stakeholders on antipsychotic minimization and deprescribing for ICU patients. DESIGN:. We completed three rounds of surveys in a National modified Delphi consensus process. During rounds 1 and 2, participants used a 9-point Likert scale (1—strongly disagree, 9—strongly agree) to rate perceptions related to antipsychotic prescribing (i.e., experiences regarding delivery of patient care), knowledge and frequency of antipsychotic use, knowledge surrounding antipsychotic guideline recommendations, and strategies (i.e., interventions addressing current antipsychotic prescribing practices) for antipsychotic minimization and deprescribing. Consensus was defined as a median score of 1–3 or 7–9. During round 3, participants ranked statements on antipsychotic minimization and deprescribing strategies that achieved consensus (median score 7–9) using a weighted ranking scale (0–100 points) to determine priority. SETTING:. Online surveys distributed across Canada. SUBJECTS:. Fifty-seven stakeholders (physicians, nurses, pharmacists) who work with ICU patients. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Participants prioritized six consensus statements on strategies for consideration when developing and implementing interventions to guide antipsychotic minimization and deprescribing. Statements focused on limiting antipsychotic prescribing to patients: 1) with hyperactive delirium, 2) at risk to themselves, their family, and/or staff due to agitation, and 3) whose care and treatment are being impacted due to agitation or delirium, and prioritizing 4) communication among staff about antipsychotic effectiveness, 5) direct and efficient communication tools on antipsychotic deprescribing at transitions of care, and 6) medication reconciliation at transitions of care. CONCLUSIONS:. We engaged diverse stakeholders to generate evidence-informed consensus statements regarding antipsychotic prescribing perceptions and practices that can be used to implement interventions to promote antipsychotic minimization and deprescribing strategies for ICU patients with and following critical illness.