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Teratoma kistik matur merupakan tumor ovarium yang paling sering terjadi pada wanita usia reproduktif. Transformasi keganasan pada teratoma kistik matur jarang terjadi. Transformasi keganasan yang paling umum pada teratoma kistik matur adalah karsinoma sel skuamosa, sedangkan karsinoma tiroid papiler merupakan kejadian yang sangat langka. Kami melaporkan satu kasus Karsinoma Papiler Tiroid Varian Folikular yang timbul dari teratoma kistik matur di ovarium kanan, pada wanita berusia 34 tahun dengan teratoma kistik matur bilateral. Pasien menjalani tindakan salpingo-ooforektomi bilateral. Pemeriksaan mikroskopis ovarium kanan dan kiri menunjukkan gambaran kista dilapisi epitel skuamosa kompleks dengan adneksa kulit berupa folikel rambut dan kelenjar sebacea serta dijumpai tulang rawan matur. Pada ovarium kanan ditemukan komponen jaringan tiroid, membentuk struktur folikular padat, sedikit struktur papiler, dilapisi epitel kuboid hingga kolumner, selapis hingga pseudostratifikasi, inti Sebagian overlapping, bulat-ovoid, pleomorfik, gambaran inti menunjukkan nuclear groove, nuclear clearing, Orphan Annie eyes, dan nuclear pseudo- inclusi, sitoplasma eosinofilik. Jumlah mitosis sedikit. Pengecatan IHK TTF-1 menunjukkan hasil positif. Ahli patologi harus melaporkan transformasi keganasan pada teratoma kistik matur agar klinisi dapat memberikan terapi yang spesifik dan adekuat pada pasien

Technology has greatly influenced education in the twenty-first century. Multimodal teaching is one of many classroom methods brought by technology. However, only a few studies have been conducted on how to create a multimodal pedagogy to assist EFL students in enhancing their language skills. Therefore, the purpose of this study was to investigate the perceptions of high school English students regarding the integration of multimodality into English classroom practices. Participation in this study was determined using a random sample. Data was gathered from 100 high school students in SMA Panjura, Malang. These students have experienced using multimodal in their learning process for six weeks. In this research, a quantitative method with a survey research design was chosen. The data were analyzed using SPSS 24 and the data was presented descriptively. The study revealed that the majority of students had a positive attitude toward the implementation of multimodality in their learning process in response to the characteristics of current students.

Positive behavior support (PBS) is an evidence-based framework for improving quality of life and preventing challenging behavior that is often implemented in combination with person-centered practices in the intellectual and developmental disability (IDD) field. Recently, state agencies and organizations supporting people with IDD have adopted a system-wide approach to PBS, much like multi-tiered school-wide PBS for youth in educational settings (e.g., SW-PBIS). Fidelity tools for guiding team implementation and action planning are essential throughout every phase of implementation in any innovation. Although such tools exist for SW-PBIS, no widely used measure currently exists for assessing the implementation of organization-wide PBS in the adult IDD field. This article describes the initial development of a fidelity of implementation tool used to evaluate organization-wide implementation of PBS and person-centered practices in community settings. A Midwestern state Department of Human Services and a university Center on Developmental Disabilities (UCEDD) in the United States partnered to complete this project. The authors discuss the exploratory and descriptive evaluation process involved in the initial development of the tool and share data for 10 provider organizations over a 6-year period of implementation. A descriptive case study using mixed measures is used to provide more details about the implementation of PBS in one agency to show the types of changes captured by the fidelity tool.

Abstract Camel health management has implications for public health and camel product trade. After liberalization of the veterinary service, current camel health management in the arid and semi-arid lands (ASALS) of Kenya and its implications for public health is not known. This study investigated camel health management and its implications on zoonoses and food safety in Isiolo County, Kenya. Semi-structured questionnaires were administered to 150 households, 15 agro-veterinary shops, 15 community-based animal health workers (CBAHWs) and 10 veterinary officers to collect information on camel health management. The main occupation and source of household income for the pastoral communities is camel-keeping (45.3%). Pastoralists self-medicate camels and other livestock (45.8%), which can lead to between over-dosing, under-dosing or wrong drug use. The CBAHWs, traditional animal health service providers (TAHSPs), government veterinary officers and private veterinary officers play a minimum role. Private veterinary services have not taken root in the ASALs. The sources of knowledge and information on the veterinary drug to use are experience (57.4%), non-governmental organizations (NGO) (41.1%) or CBAHWs (32.1%). The majority of pastoralists (72.5%) do not keep camel or other livestock treatment records. The constraints in purchasing veterinary drugs are expensive drugs, accessibility to drugs and availability of money. Pastoralists refer to veterinary drugs by their brand names but not by active ingredients. As reported by pastoralists, focus group discussion and key informant interviews, antibiotics used were adamycine (33.3%), ampicilline (26.7%), penicillin (14.4%), tetracycline (12.2%), amoxylin (11.1%) and penstrip (2.2%). The common camel diseases were trypanosomiasis, brucellosis, mastitis, diarrhoea, worm infestation, camel pox and tuberculosis. The public health risk factors were the presence of veterinary drug residues in camel products and development of resistant zoonotic organisms/diseases. It was concluded that current camel health management has serious implications for public health and food safety, and hence the camel product trade.

This study assessed the effects of vitamin D on blood pressure in individuals diagnosed with diabetes mellitus. Convenience sampling and a cross-sectional, analytical, quantitative approach were used. Blood samples were collected and analysed by a designated laboratory officer to measure vitamin D levels. Twenty-eight (70%) women, 18 (45%) housewives with a median age of 52 (36-60), median systole of 143.5 (102–180), and median diastole of 80 years (range, 59–110 years). Thirty-five (87.5%) had fasting blood glucose over 140 mg/dl, and 33 (82.5%) postprandial more than 100 mg/dl. The predictive validity test showed that a systole cut-off score of 160–179 yielded sensitivity, specificity, LR+, and LR– (81%, 67%, 2.4, and 0.3). Systole had a LR+ of 2.4 and was a moderate diagnostic test. Diastole cut-off score of 90–99 produced sensitivity, specificity, LR+, and LR– (84%, 67%, 2.5, and 0.2). The ROC for systole was AUC 0.65 (95% CI: 0.49–0.80) and diastole had AUC 0.67 (95% CI: 0.50–0.81). Patients with diabetes and hypertension were found to have vitamin D levels

Keragaman latar belakang dari peserta didik program paket C PKBM Sunan Drajat yang berbeda-beda membuat kesiapan belajar dan hasil belajar masing-masing peserta didik menjadi lebih variatif. Tujuan penelitian ini adalah untuk mengetahui tingkat kesiapan dan hasil belajar peserta didik, serta untuk mengetahui pengaruh kesiapan belajar terhadap hasil belajar peserta didik program paket C Di PKBM Sunan Drajat. Penelitian ini menggunakan metode deskriptif kuantitatif dengan jumlah sampel 67 peserta didik yang terdiri dari 35 peserta didik kelas XI dan 32 peserta didik kelas XII. Berdasarkan analisis deskriptif persentase diperoleh data secara keseluruhan kesiapan belajar peserta didik berada pada kualifikasi tinggi dengan jumlah persentase 67,16 % peserta didik di atas rata-rata. Pada variabel hasil belajar juga diperoleh hasil yang sama dengan persentase 68,66 % peserta didik berada pada kualifikasi di atas rata-rata. Pada analisis regresi sederhana diperoleh hasil yaitu skor = 45,247 lebih besar dari = 3,99 pada taraf signifikansi 0,05, sehingga hipotesis nol ( ) ditolak dengan kata lain ada pengaruh kesiapan belajar terhadap hasil belajar. Sedangkan pada tabel R square diperoleh skor 0,410 yang artinya besaran pengaruh kesiapan belajar peserta didik terhadap hasil belajar adalah sebesar 41,00 %. The diversity of backgrounds of students program package C PKBM Sunan Drajat different makes learning readiness and learning outcomes of each student become more varied. The purpose of this study was to determine the level of readiness and learning outcomes of students, as well as to determine the effect of learning readiness to the learning outcomes of students program package C PKBM Sunan Drajat. This study used quantitative descriptive method with a sample of 67 students consisting of 35 students of class XI and XII grade 32 students. Based on the descriptive analysis of the data obtained by the percentage of the overall readiness of learners are at high qualification on the percentage of 67,16% of students above average. In learning outcome variables were also obtained similar results with the percentage of 68,66% of students are at the qualifications above average. In simple regression analysis obtained result is a score = 45,247 is greater than = 3, 99 at a significance level of 0,05. So that the nol hypothesis ( ) rejected. While the R square table obtained scores 0.410, which means the amount of influence the readiness of learners on learning outcomes is equal to 41.00%.

To determine the cause of acute febrile illnesses other than malaria in the North Eastern Province, Kenya, we investigated rickettsial infection among patients from Garissa Provincial Hospital for 23 months during 2006–2008. Nucleic acid preparations of serum from 6 (3.7%) of 163 patients were positive for rickettsial DNA as determined by a genus-specific quantitative real-time PCR and were subsequently confirmed by molecular sequencing to be positive for Rickettsia felis. The 6 febrile patients’ symptoms included headache; nausea; and muscle, back, and joint pain. None of the patients had a skin rash.

Climate change poses a significant threat to Somalia’s food security and stability. This review examines the complex interplay between climate change impacts, food insecurity, and conflict in Somalia. Recent climate data and forecasts paint a concerning picture: the rainfall probabilistic forecast for April- June 2024 indicates a high likelihood of above-normal rainfall across much of Somalia, thus increasing the flood risks. Concurrently, temperature forecasts project above-normal temperatures, potentially exacerbating drought conditions between the rainy seasons. Historical climatology data reveal Somalia’s vulnerability, with average temperatures ranging from 25°C to 30°C and significant seasonal variations affecting agriculture and water resources. These climate trends, combined with ongoing political instability and weak governance, have created a storm of challenges. This perspective explores how recurrent droughts and floods disrupt agricultural production, decimate livestock, and displace vulnerable populations, particularly those affecting rural and nomadic communities. It also examines how environmental stress exacerbates poverty and conflict, thereby creating a vicious cycle of vulnerability. This analysis draws on recent data on poverty rates, food expenditure patterns, and climate-related displacement, to illustrate the multifaceted nature of the crisis. Finally, this perspective proposed recommendations for building climate resilience, enhancing food security, and promoting sustainable development in Somalia, emphasizing the need for integrated approaches that combine immediate humanitarian assistance with long-term adaptation strategies.

The significance of the current research lies in studying the impact of the Guidance Technique (Stopping Negative Thinking) to reduce psychological reluctance in swimming lessons among female students of Physical Education and Sports Sciences highlighting the concept of psychological reluctance and how to confront it in the swimming lessons. The research provides a comprehensive and integrated theoretical framework that benefits the guiding process, contributing to the development of guiding programs that help reduce or eliminate psychological reluctance. Additionally, this research offers a psychological reluctance scale, aiding in the evaluation and diagnosis of students for the purpose of guiding them. The research addressed an important segment represented by female students of the College of Physical Education and Sports Sciences, so the aim of the current research is to identify the impact of the guidance program according to the method (stopping negative thinking) to reduce psychological reluctance in the swimming lesson among female students of Physical Education and Sports Sciences, and achieving the research goal required the construction of two tools, namely: Firstly, a psychological reluctance scale in swimming lessons for female students of Physical Education and Sports Sciences. Secondly, a guiding program using the (Stopping Negative Thinking) method, consisting of 12 guiding sessions for female students of the College of Physical Education and Sports Sciences at the University of Baghdad, who exhibited high scores on the psychological reluctance scale in swimming lessons. To achieve this objective, the researchers employed the descriptive survey approach in developing the psychological reluctance scale and used the experimental method, with a pre-test and post-test design, for both the experimental and control groups, aligning with the research problem. The results indicated that the guiding method (Stopping Negative Thinking) had a significant effect in reducing psychological reluctance among female students of Physical Education and Sports Sciences, with a statistically significant difference compared to the control group.

The article is devoted to studying the importance of increasing customer loyalty for successful business development in the digital era. The author identifies brand equity, customer trust and satisfaction as key factors influencing the level of customer loyalty. The article identifies the complexities of the modern market and the need to use digital tools to form and maintain consumer loyalty.The study aims to identify methods for building customer loyalty, including analyzing the importance of various factors, market segmentation and the use of digital technologies. The results of the study will be useful for companies aimed at strengthening their base of loyal customers.It is worth not only satisfying the needs of customers, but also building emotional connections with them, taking into account their individual preferences. The author draws attention to the importance of service quality, brand reputation, pricing and personalization in creating and maintaining customer loyalty.The study also highlights the importance of moving from product loyalty to brand loyalty to increase customer retention and ensure sustainable business growth. Particular attention is paid to the emotional connection with clients and the importance of quality of service in establishing long–term relationships.

This study aimed to investigate the impact of a group counseling program on reducing parental stress and depression among mothers of Jordanian children with autism. A purposive sample comprising 40 mothers of children with autism was selected from three autism centers in Zarqa and Rusaifa in Jordan; these participants were then randomly assigned to either an experimental group (N = 20) or control group (N = 20). Participants were asked to complete both the Parental Stress Index--Short Form (PSI--SF; including its three sub-scales) and an amended Arabic version of the Depression, Anxiety and Stress Scale (DASS): pre- and posttest by both groups, and a six-week follow-up test by the experimental group. A CBT-based group counseling program was designed and 14 sessions were held three times per week over a four-week period. The difference between the pre- and posttest scores for the two groups revealed that the experimental group was significantly more likely to have lower levels of parental stress and depression. Furthermore, there was a significant difference in scores between the experimental group's posttest and follow-up assessment: Total Stress (Total PSI), Parental Distress (PD), and depression had all decreased significantly; Parent-Child Dysfunctional Interaction (PCDI) had also decreased, but not significantly; however, although not significantly, stress levels associated with a Difficult Child (DC) had increased.

In fuzzy decision-making, incomplete information always leads to uncertain and partially reliable judgements. The emergence of fuzzy set theory helps decision-makers in handling uncertainty and vagueness when making judgements. Intuitionistic Fuzzy Numbers (IFN) measure the degree of uncertainty better than classical fuzzy numbers, while Z-numbers help to highlight the reliability of the judgements. Combining these two fuzzy numbers produces Intuitionistic Z-Numbers (IZN). Both restriction and reliability components are characterized by the membership and non-membership functions, exhibiting a degree of uncertainties that arise due to the lack of information when decision-makers are making preferences. Decision information in the form of IZN needs to be defuzzified during the decision-making process before the final preferences can be determined. This paper proposes an Intuitive Multiple Centroid (IMC) defuzzification of IZN. A novel Multi-Criteria Decision-Making (MCDM) model based on IZN is developed. The proposed MCDM model is implemented in a supplier selection problem for an automobile manufacturing company. An arithmetic averaging operator is used to aggregate the preferences of all decision-makers, and a ranking function based on centroid is used to rank the alternatives. The IZN play the role of representing the uncertainty of decision-makers, which finally determine the ranking of alternatives.