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Abstract Host-directed therapies aiming to strengthen the body’s immune system, represent an underexplored opportunity to improve treatment of tuberculosis (TB). We have previously shown in Mycobacterium tuberculosis (Mtb)-infection models and clinical trials that treatment with the histone deacetylase (HDAC) inhibitor, phenylbutyrate (PBA), can restore Mtb-induced impairment of antimicrobial responses and improve clinical outcomes in pulmonary TB. In this study, we evaluated the efficacy of different groups of HDAC inhibitors to reduce Mtb growth in human immune cells. A panel of 21 selected HDAC inhibitors with different specificities that are known to modulate infection or inflammation was tested using high-content live-cell imaging and analysis. Monocyte-derived macrophages or bulk peripheral blood cells (PBMCs) were infected with the green fluorescent protein (GFP)-expressing Mtb strains H37Ra or H37Rv and treated with HDAC inhibitors in the micromolar range in parallel with a combination of the first-line antibiotics, rifampicin, and isoniazid. Host cell viability in HDAC inhibitor treated cell cultures was monitored with Cytotox-red. Seven HDAC inhibitors were identified that reduced Mtb growth in macrophages > 45–75% compared to average 40% for PBA. The most effective compounds were inhibitors of the class III HDAC proteins, the sirtuins. While these compounds may exhibit their effects by improving macrophage function, one of the sirtuin inhibitors, tenovin, was also highly effective in extracellular killing of Mtb bacilli. Antimicrobial synergy testing using checkerboard assays revealed additive effects between selected sirtuin inhibitors and subinhibitory concentrations of rifampicin or isoniazid. A customized macrophage RNA array including 23 genes associated with cytokines, chemokines and inflammation, suggested that Mtb-infected macrophages are differentially modulated by the sirtuin inhibitors as compared to PBA. Altogether, these results demonstrated that sirtuin inhibitors may be further explored as promising host-directed compounds to support immune functions and reduce intracellular growth of Mtb in human cells.

Abstract There are millions of river barriers worldwide, ranging from wooden locks to concrete dams, many of which form associated impoundments to store water in small ponds or large reservoirs. Besides their benefits, there is growing recognition of important environmental and social trade-offs related to these artificial structures. However, global datasets describing their characteristics and geographical distribution are often biased towards particular regions or specific applications, such as hydropower dams affecting fish migration, and are thus not globally consistent. Here, we present a new river barrier and reservoir database developed by the Global Dam Watch (GDW) consortium that integrates, harmonizes, and augments existing global datasets to support large-scale analyses. Data curation involved extensive quality control processes to create a single, globally consistent data repository of instream barriers and reservoirs that are co-registered to a digital river network. Version 1.0 of the GDW database contains 41,145 barrier locations and 35,295 associated reservoir polygons representing a cumulative storage capacity of 7,420 km3 and an artificial terrestrial surface water area of 304,600 km2.

Ghada H Naguib,1,2 Gamal S Abd El-Aziz,3 Abdulghani Mira,1 Rayyan A Kayal,4 Lulwa Al-Turki,5 Hisham Mously,5 Abeer Alnowaiser,6 Jumana Mazhar,7 Mohamed T Hamed5,8 1Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Oral Biology, Cairo University School of Dentistry, Cairo, Egypt; 3Department of Clinical Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Oral and Maxillofacial Prosthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; ‬6Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 7King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Fixed Prosthodontics, Cairo University School of Dentistry, Cairo, EgyptCorrespondence: Ghada H Naguib, Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, P.O Box 80209, Jeddah, 21589, Saudi Arabia, Tel +966558190589, Email gnagieb@kau.edu.saBackground: Polymeric denture materials can be susceptible to colonization by oral microorganisms. Zein-coated magnesium oxide nanoparticles (zMgO NPs) demonstrate antimicrobial activity. The aim of this study was to investigate the antimicrobial effect and adherence of different oral microorganisms on hybrid polymeric denture materials incorporated with zMgO NPs.Methods: Five types of polymeric denture materials were used. A total of 480 disc-shaped specimens were divided by material type (n=96/grp), then subdivided by zMgO NPs concentration: control with no nanoparticles and other groups with zMgO NPs concentrations of 0.3%, 0.5% and 1% by weight. Characterization of the polymeric denture materials incorporating zMgO NPs was done, and the antimicrobial activity of all groups was tested against four types of microorganisms: 1) Streptococcus mutans, 2) Staphylococcus aureus, 3) Enterococcus faecalis and 4) Candida albicans. The samples underwent an adherence test and an agar diffusion test. Experiments were done in triplicates.Results: The characterization of the hybrid samples revealed variation in the molecular composition, as well as a uniform distribution of the zMgO NPs in the polymeric denture materials. All hybrid polymeric denture materials groups induced a statistically significant antimicrobial activity, while the control groups showed the least antimicrobial activity. The agar diffusion test revealed no release of the zMgO NPs from the hybrid samples, indicating the NPs did not seep out of the matrix.Conclusion: The zMgO NPs were effective in reducing the adherence of the tested microorganisms and enhancing the antimicrobial activity of the polymeric denture materials. This antimicrobial effect with the polymeric dentures could aid in resisting microbial issues such as denture stomatitis.Keywords: antimicrobial, nanoparticles, denture, magnesium oxide, biomaterial

Agrarian reform encompasses a series of government actions and policies designed to restructure the land system, aiming to enhance social justice, reduce land ownership inequality, increase agricultural productivity, and stimulate economic growth in the agricultural sector. These reforms typically involve transferring land from large owners to smaller farmers, improving the land ownership structure, and granting land to farmers. This study employs descriptive qualitative research. According to Lexi J. Moleong, qualitative research seeks to understand phenomena experienced by the subjects. Although agrarian reform in Indonesia began during Dutch colonialism, significant reforms were implemented during the Old Order and New Order eras, particularly through Law Number 5 of 1960, known as the Basic Agrarian Law (UUPA). This law established regulations related to agrarian principles during the Old Order period. The Old Order’s agrarian reform aimed to dismantle colonial capitalism and feudalism by nationalizing foreign companies and redistributing land. However, agrarian reform in Indonesia still faces numerous challenges that need to be addressed to ensure inclusive and sustainable economic growth.

Penelitian ini dilatarbelakangi oleh adanya kesulitan belajar matematika yang dialami oleh siswa, dengan salah satu aspek pendukungnya adalah motivasi belajar. Penelitian ini mendeskripsikan kesulitan belajar matematika yang dialami oleh 36 siswa kelas VIII di SMP Negeri 37 Kota Bekasi. Menggunakan metode penelitian kualitatif studi kasus, penelitian ini melibatkan populasi sebanyak 45 siswa dengan teknik purposive sampling. Data dikumpulkan melalui tes tulis, angket, dan wawancara. Hasil analisis data menunjukkan bahwa kesulitan belajar matematika terbagi menjadi tiga kategori utama: 83% siswa mengalami kesulitan dalam memahami konsep, 100% siswa mengalami kesulitan dalam menggunakan prinsip, dan 33% siswa mengalami kesulitan dalam menyelesaikan soal dalam bentuk verbal. Selain itu, motivasi belajar siswa berada pada tingkat sedang dengan nilai rata-rata sebesar 59,4%. Penelitian ini juga menemukan bahwa meskipun tingkat kesulitan belajar matematika bergantung pada masing-masing individu, motivasi belajar memiliki pengaruh positif dalam menurunkan tingkat kesulitan yang dialami siswa.

Summary: Background: Immunocompromised patients with primary and secondary immunodeficiencies have shown impaired responses to SARS-CoV-2 mRNA vaccines, necessitating recommendations for additional booster doses. However, longitudinal data reflecting the real-world impact of such recommendations remains limited. Methods: This study represents a two-year follow-up of the COVAXID clinical trial, where 364 of the original 539 subjects consented to participate. 355 individuals provided blood samples for evaluation of binding antibody (Ab) titers and pseudo-neutralisation capacity against both the ancestral SARS-CoV-2 strain and prevalent Omicron variants. T cell responses were assessed in a subset of these individuals. A multivariate analysis determined the correlation between Ab responses and the number of vaccine doses received, documented infection events, immunoglobulin replacement therapy (IGRT), and specific immunosuppressive drugs. The original COVAXID clinical trial was registered in EudraCT (2021-000175-37) and clinicaltrials.gov (NCT04780659). Findings: Several of the patient groups that responded poorly to the initial primary vaccine schedule and early booster doses presented with stronger immunogenicity-related responses including binding Ab titres and pseudo-neutralisation at the 18- and 24-month sampling time point. Responses correlated positively with the number of vaccine doses and infection. The vaccine response was blunted by an immunosuppressive state due to the underlying specific disease and/or to specific immunosuppressive treatment. Interpretation: The study results highlight the importance of continuous SARS-CoV-2 vaccine booster doses in building up and sustaining Ab responses in specific immunocompromised patient populations. Funding: The present studies were supported by the European Research Council, Karolinska Institutet, Knut and Alice Wallenberg Foundation, Nordstjernan AB, Region Stockholm, and the Swedish Research Council.

Summary: Background: We apply endoscopic ultrasound-guided fine needle aspiration biopsy to cytopathologically diagnose and sample nucleic acids from primary tumours regardless of the disease stage. Methods: 397 patients with proven pancreatic adenocarcinoma were included and followed up in a multicentre prospective study. DNA and mRNA were extracted from materials of primary tumours obtained by endoscopic ultrasound-guided fine needle aspiration biopsy and analysed using targeted deep sequencing and RNAseq respectively. Findings: The variant allele frequency of the KRAS mutation was used to evaluate the tumour cellularity, ranging from 15 to 20% in all cells, regardless of the tumour stage. The molecular profile of metastatic primary tumours significantly differed from other types of tumours, more frequently having TP53 mutations (p = 0.0002), less frequently having RNF43 mutations, and possessing more basal-like mRNA component (p = 0.001). Molecular markers associated with improved overall survival were: mutations in homologous recombination deficiency genes in patients who received first-line platinum-based chemotherapy (p = 0.025) and wild-type TP53 gene in patients with locally advanced tumours who received radio-chemotherapy (p = 0.01). The GemPred transcriptomic profile was associated with a significantly better overall survival in patients with locally advanced or metastatic pancreatic cancer who received a gemcitabine-based first-line treatment (p = 0.019). Interpretation: The combination of genomic and transcriptomic analyses of primary pancreatic tumours enables us to distinguish metastatic tumours from other tumour types. Our molecular strategy may assist in predicting overall survival outcomes for platinum or gemcitabine-based chemotherapies, as well as radio-chemotherapy. Funding: Institut National Du Cancer (BCB INCa_7294), CHU of Toulouse, Inserm and Ligue Nationale Contre le Cancer (CIT program).

This study aimed to determine the effect of the addition of tilapia oil and noni fruit extract to duck feed on egg quality at different storage times. A total of 80 duck eggs were used as research material using the factorial complete randomized design (CRD) method. In this study, there were two types of treatments: factor A was the diet, which included adding tilapia fish oil and noni fruit extract. The treatments were A1 (no added fish oil or noni fruit extract), A2 (0.5 percent fish oil and 0.75 percent noni fruit extract), A3 (0.75% fish oil and 0.75% noni fruit extract), and A4 (1% fish oil and 1% noni fruit extract). Factor B was the length of time the eggs were stored, with B1 (no storage), B2 (storage for 7 days), B3 (storage for 14 days), and B4 (stored for 21 days). The results showed that the Haugh unit value, the egg white index value, and the percentage of egg weight shrinkage in the storage treatment were significantly different at each length of storage time; the yolk index value and the yolk pH value were significantly different at day 14 and day 21 storage; and the egg white pH value at day 0 storage was significantly different from days 7, 14, and 21 storage. This study concludes there was no interaction between the two treatment factors and the egg quality at different storage times.

The sustainable growth of tourist destinations relies heavily on revisit intention. Retaining repeat tourists is not only more economical but also about five times more profitable than attracting new ones. A dominant paradigm in tourist behavior literature shows a sequential relationship among image, quality, satisfaction, and post- behavior. Few studies have examined experiential marketing as a determinant of revisit intention. This study aims to extend the literature by investigating the effects of service quality and experiential marketing on revisit intention, with tourist satisfaction as a mediator. A total of 166 responses from domestic tourists who visited Purwakarta, West Java, Indonesia, were analyzed using PLS-SEM. The results confirmed the positive effects of service quality and experiential marketing on tourist satisfaction. Interestingly, the mediating role of tourist satisfaction was only partial, as the direct relationship between experiential marketing and revisit intention was not supported. Experiential marketing might enhance specific aspects of the tourist experience, providing immediate and short-term positive effects that influence satisfaction directly after the visit. However, overall satisfaction encompasses a broader evaluation of the entire trip, integrating various elements and lasting impressions that collectively drive the intention to revisit.

Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive disease affecting lipoprotein metabolism. FCS is estimated to occur in 1 in 1–2 million individuals and can be diagnosed at any age, equally affecting all genders, races, and ethnicities. The condition is characterized by hypertriglyceridemia, which may predispose patients to acute pancreatitis. In this report, we present the case of a now 6-year-old girl with FCS on gemfibrozil and dietary restrictions. The patient initially presented at 40 days of age with bloody diarrhea. Serum samples revealed lipemia, with markedly elevated triglyceride levels. The patient was diagnosed with FCS, confirmed by genetic testing showing the homozygous variant c.833C>T(p,Ser278Phe) for the LPL gene. Despite being on a low-fat diet with medium chain triglyceride (MCT) based milk formulas, the patient developed acute pancreatitis 2 months later with continued elevated triglyceride levels. She was placed on gemfibrozil and fat-soluble vitamins at 2 months of age, with marked improvements subsequently noted. Currently, the patient is doing well, with normal growth parameters and no other episodes of acute pancreatitis. Her triglyceride levels have been maintained within normal levels. FCS is a rare, inherited lipid disorder that often goes underdiagnosed and unmanaged. It is worth considering the fibric acid derivative (gemfibrozil) to be one of the lines of management early on after diagnosis.

ABSTRAK. Penelitian ini bertujuan untuk mengevaluasi pertumbuhan dan perkembangan organ reproduksi ayam buras betina yang diberi flavonoid dari ekstrak limbah kedelai edamame. Penelitian dilakukan dalam dua tahap; kuantifikasi total flavonoid ekstrak limbah kedelai edamame dan eksperimen menggunakan ayam buras berumur 8-16 minggu. Rancangan penelitian yang digunakan adalah Rancangan Acak Kelompok (RAK) terdiri atas empat kelompok umur dan lima perlakuan pemberian ekstrak limbah edamame per oral, dengan level 0% (P0), 0,02% (P1), 0,04% (P2), 0,08% (P3), dan 0,16% (P4) dari jumlah pakan yang diberikan. Variabel yang diamati yaitu pertambahan bobot badan (PBB), berat organ reproduksi, dan panjang saluran reproduksi. Data yang diperoleh dianalisis dengan analisis varian dan uji lanjut menggunakan Duncan. Hasil uji kuantitatif menunjukkan bahwa ekstrak limbah edamame mengandung senyawa flavonoid dari golongan isoflavon dan secara kuantitatif diperoleh 40 ppm total flavonoid. Penggunaan ekstrak limbah edamame secara signifikan meningkatkan PBB, panjang saluran reproduksi, dan berat organ (P0,05). (Stimulus for reproductive organs growth of female domestic chickens through phytoestrogens application of isoflavones group from edamame waste extracts) ABSTRACT. This study aimed to access the growth and development of female domesticated chicken reproductive organs after being treated with the addition of flavonoid compound from extract of edamae waste. The research consisted of two experiments; quantification of flavonoids compounds in edamame waste and feeding trial using female domesticated chickens (aged 4-16 weeks). The later used Randomized Block Design, consisted of four groups and five treatments (addition of edamame waste extract at 0%, 0.02%, 0.04%, 0.08%, and 0.16% of the amount of feed given). The variables observed were body weight gain, reproductive organ weight, and reproductive tract length. The data obtained were analyzed using analysis of variance analysis of variance (ANOVA) and Duncan's test. The phytochemical test showed that the edamame waste extract contained flavonoid compounds from the isoflavone group. The addition of edamame waste extract significantly affected body weight gain, reproductive tract length, and reproductive organ weight (P0.05).

“Or” is associated, in Gricean approaches, with the readings Inclusive (“at least one, and possibly both, options are true”) and Exclusive (“exactly one option is true”). Empirical findings show adults favoring Exclusive readings; but for children, the literature yields puzzling results. Laboratory comprehension tasks suggest children favor Inclusive, but naturalistic evidence suggests children’s “or” productions are overwhelmingly Exclusive. We first identify problems with previous research. Methodologically, asking children to provide truth judgements (the dominant experimental task) is not a child-friendly task. And theoretically, Inclusive and Exclusive are not optimal categories for classifying “or” readings. To resolve the comprehension-production puzzle, we adopt Ariel and Mauri’s richer analytic classification of “or” constructions, where Inclusive and Exclusive as such are not speaker-intended readings, and there are several, rather than one, “single-option” (Exclusive) readings. We apply this framework in analyzing the Berman corpus of Hebrew child language; and in designing a new, more ecologically valid, experimental task. Study 1 shows that in child-directed-speech, one specific Exclusive “or” construction, Choice Immediate (e.g., ↗Chocolates? Or ↘jelly beans?), is (i) the single dominant “or” function addressed to children, (ii) the one “or” reading children consistently respond appropriately to, and (iii) virtually the only “or” construction children produce. In Study 2, we present young children with a task involving this familiar “or” construction. The children respond with adult-like mastery even in the absence of a supporting context. These empirical findings argue for a usage-based account of how children acquire “or”.

The study aims to test the effect of two algae, Compsopogon caeruleus, and Pithophora roettleri, in three concentrations (2, 1, and 0.5). Hydrogel (4, 2) g/kg. The current study included vegetative growth characteristics: The wheat germination rate plant height, root length, water content, leave area, total chlorophyll content dry weight, root and shoot total, and. was affected by fertilization treatments. And their Interference with concentrations and gel. The treatments in which each alga was used alone outperformed the Interference treatment between them in terms of the dry weight of the shoot, as it reached 1.26 and 1.27 grams for C. caeruleus and P. roettleri, respectively, while the best treatment was for weight. Root dryness of P.roettleri alga amounted to 0.19 grams. As for plant height, the best treatments were recorded with P. roettleri and C. caeruleus, respectively, as they reached 50.03 and 49.17 cm. In root length, the highest length was recorded when treated with C.caeruleus algae and reached 13.19 cm. The highest leave area was also recorded when treated with P.roettleri algae and reached 12.47 cm. The highest total and total chlorophyll content was recorded. Chlorophyll a when treated with the alga C.caeruleus reached 22.70 and 8.44 mg/g, respectively, while chlorophyll's content reached the highest percentage in the algae P.roettleri and reached 15.15 mg/g. Adding the hydrogel at a concentration of 2g/kg soil had a significant effect on the mentioned characteristics, while it was the concentration of 4 gm/kg of soil for the gel had a significant increase in the concentration of chlorophyll a, b, and total chlorophyll an over the rest of the treatments. Laboratory results showed the effect of aqueous extracts on the wet biomass of both algae, and with the two concentrations (1, 2%), there was a significant increase in (seed germination, length of the petiole, root, and dry weight for wheat. The results of the anvil experiments indicated the presence of varying effects of aqueous extracts of wet living mass. Both the interaction between the algae and the gel, along with their concentrations, played a stimulating and moral role in some of the studied traits.

Geometry and measurement affect our daily lives, both personal and sociocultural. Geometry is one of the contents in numeracy taught at every level of education. This study aimed to determine mathematics teachers' design of numeracy tasks using geometry and measurement content. Ninety-three math problems were collected from mathematics teachers in 31 Padang Pariaman districts, West Sumatra, Indonesia. Teachers were given problem-posing tasks and then asked to design numeracy tasks. To analyze, the tasks were classified as solvable or unsolvable and then further divided into context use level and cognitive process level domains. The numeracy context (personal, sociocultural, and scientific) was also analyzed. The study found that the tasks created had varying levels of context utilization, ranging from zero to second-order context. Most of the activities proposed were at the comprehension level, with just a tiny number designated as thinking functions in terms of cognitive processes. Some teachers' draft numeracy tasks in geometry content are discussed further.

Background Fibrotic interstitial lung disease (ILD) is frequently associated with abnormal oxygenation; however, little is known about the accuracy of oxygen saturation by pulse oximetry (SpO2) compared with arterial blood gas (ABG) saturation (SaO2), the factors that influence the partial pressure of carbon dioxide (PaCO2) and the impact of PaCO2 on outcomes in patients with fibrotic ILD.Study design and methods Patients with fibrotic ILD enrolled in a large prospective registry with a room air ABG were included. Prespecified analyses included testing the correlation between SaO2 and SpO2, the difference between SaO2 and SpO2, the association of baseline characteristics with both the difference between SaO2 and SpO2 and the PaCO2, the association of baseline characteristics with acid-base category, and the association of PaCO2 and acid-base category with time to death or transplant.Results A total of 532 patients with fibrotic ILD were included. Mean resting SaO2 was 92±4% and SpO2 was 95±3%. Mean PaCO2 was 38±6 mmHg, with 135 patients having PaCO2 45 mmHg. Correlation between SaO2 and SpO2 was mild to moderate (r=0.39), with SpO2 on average 3.0% higher than SaO2. No baseline characteristics were associated with the difference in SaO2 and SpO2. Variables associated with either elevated or abnormal (elevated or low) PaCO2 included higher smoking pack-years and lower baseline forced vital capacity (FVC). Lower baseline lung function was associated with an increased risk of chronic respiratory acidosis. PaCO2 and acid-base status were not associated with time to death or transplant.Interpretation SaO2 and SpO2 are weakly-to-moderately correlated in fibrotic ILD, with limited ability to accurately predict this difference. Abnormal PaCO2 was associated with baseline FVC but was not associated with outcomes.

Abstract Introduction Data assessing longer-term real-world effectiveness and treatment patterns with upadacitinib (UPA), a Janus kinase inhibitor, in rheumatoid arthritis (RA) are lacking. We assessed improvement in clinical and patient-reported outcomes and treatment patterns for up to 12 months among adult patients with RA initiating UPA. Methods Data were collected from the CorEvitas® RA Registry (08/2019–04/2022). Eligible patients had moderate to severe RA (Clinical Disease Activity Index [CDAI] > 10) and follow-up visits at 6 or 12 months after UPA initiation. Outcomes were mean change from baseline, percentage achieving minimal clinically important differences (MCID) in clinical and patient-reported outcomes, and disease activity at follow-up. We evaluated clinical outcomes and therapy changes among patients with tumor necrosis factor inhibitor (TNFi) experience and among those receiving UPA as first-line therapy, as well as those receiving UPA as monotherapy versus as part of combination therapy. We further evaluated whether outcomes were similar among those that remained on therapy. Results Patients treated with UPA (6-month cohort, N = 469; 12-month cohort, N = 263) had statistically significant improvements (p

Abstract Stromal cells support epithelial cell and immune cell homeostasis and play an important role in inflammatory bowel disease (IBD) pathogenesis. Here, we quantify the stromal response to inflammation in pediatric IBD and reveal subset-specific inflammatory responses across colon segments and intestinal layers. Using data from a murine dynamic gut injury model and human ex vivo transcriptomic, protein and spatial analyses, we report that PDGFRA+CD142− /low fibroblasts and monocytes/macrophages co-localize in the intestine. In primary human fibroblast-monocyte co-cultures, intestinal PDGFRA+CD142− /low fibroblasts foster monocyte transition to CCR2+CD206+ macrophages through granulocyte-macrophage colony-stimulating factor (GM-CSF). Monocyte-derived CCR2+CD206+ cells from co-cultures have a phenotype similar to intestinal CCR2+CD206+ macrophages from newly diagnosed pediatric IBD patients, with high levels of PD-L1 and low levels of GM-CSF receptor. The study describes subset-specific changes in stromal responses to inflammation and suggests that the intestinal stroma guides intestinal macrophage differentiation.

Abstract Background Caudal regression syndrome is a rare complex congenital anomaly with reduced penetrance and phenotypic variability characterized by osseous defects of the caudal spine, lower limb anomalies, and accompanying genitourinary, gastrointestinal/anorectal, and cardiac system soft tissue defects. We report a rare presentation of type 1 caudal regression syndrome in a pregnant woman with preexisting diabetes, in which early recognition of severe fetal anomalies on routine antenatal ultrasound facilitated confirmation with fetal magnetic resonance imaging to characterize extent of disease and prognosticate fetal outcome. Case presentation This case of type 1 caudal regression syndrome in the setting of maternal pregestational diabetes mellitus resulted in stillbirth. The mother was a 29-year-old Caucasian primigravida female with past medical history of poorly controlled type 2 diabetes managed with metformin prior to pregnancy, prompting admission for glucose management and initiation of insulin at 13 weeks. Baseline hemoglobin A1c was high at 8.0%. Fetal ultrasound at 22 weeks was notable for severe sacral agenesis, bilateral renal pelvis dilatation, single umbilical artery, and pulmonary hypoplasia. Fetal magnetic resonance imaging at 29 weeks showed absent lower two-thirds of the spine with corresponding spinal cord abnormality compatible with type 1 caudal regression syndrome. The mother delivered a male stillborn at 39 and 3/7 weeks. Minimally invasive postmortem magnetic resonance imaging and computed tomography autopsy were performed to confirm clinical findings when family declined conventional autopsy. Etiology of sacral agenesis was attributed to poorly controlled maternal diabetes early in gestation. Conclusion Maternal preexisting diabetes is a known risk factor for development of congenital malformations. This rare case of type 1 caudal regression syndrome in a mother with preexisting diabetes with elevated hemoglobin A1c highlights the importance of preconception glycemic control in diabetic women and the utility of fetal magnetic resonance imaging for confirmation of ultrasound findings to permit accurate prognostication. Additionally, minimally invasive postmortem magnetic resonance imaging and computed tomography autopsy can facilitate diagnostic confirmation of clinical findings in perinatal death due to complex congenital anomalies while limiting the emotional burden on bereaved family members who decline conventional autopsy.

Gampong Peurada is a village located in the centre of Banda Aceh and is close to office complexes, schools, and universities. Thus, most of the buildings and housing in Gampong Peurada are used as boarding and rental houses. This has the impact of high plastic waste in the region, which is influenced by lifestyle and high consumption levels of plastic. The problem of plastic waste is a very important environmental problem. Because plastic waste is a type of waste that is very difficult to decompose, one alternative way to reduce plastic waste is to recycle it into accessory products. This process is easier, allows for honed creativity, and has become a business opportunity for housewives in Gampong Peurada. With this training, it is hoped that the community will be able to understand the management and processing of plastic waste and seize business opportunities from plastic waste to improve their welfare.

Primary lymphomas of the salivary gland are rare. The most common subtype is MALT lymphoma. MALT lymphoma has an indolent clinical course, and patients often present with a prolonged history. Evaluations of parotid masses begin initially with radiological imaging, but pathological and histological examination remains the mainstay of definitive diagnosis. This case describes a primary non-Hodgkin’s lymphoma of the parotid gland in a healthy 32-year-old male. This case report will evaluate the prevalence of primary MALT lymphoma and discuss the possible presentation.

This study aimed to determine nutrient consumption, body weight gain, feed conversion, and feed efficiency of Simmental crossbred bulls through different feeding management specifically for levels of time on feed offered. Nine bulls were allocated on three different level treatments and three replicates. They were T0=feeding whole concentrate first in the morning then offering whole chopped forages after 6 hours later; T1=feeding half of the concentrate first then offering half of the chopped forages after 2 hours later in the morning and afternoon; T2=feeding half of the concentrate and chopped forages simultaneously in the morning and afternoon. Bulls were fed twice daily and had free access to drinking water ad libitum. Parameters observed were nutrient consumption, daily gain, feed conversion and efficiency. Data were analyzed using ANOVA and further analysis by DMRT for the significant parameter. The results showed that the treatment of different feeding management presented significantly different (P0.05) on daily gain, feed conversion, and feed efficiency. Feed-offered time differences affected nutrient consumption but did not alter the concentrate and forage ratio consumed or cattle performances.

Cardiac arrhythmias are serious myocardial electrical disturbances that affect the rate and rhythm of heartbeats. Despite the rapidly accumulating data about the pathophysiology and the treatment, new insights are required to improve the overall clinical outcome of patients with cardiac arrhythmias. Three major arrhythmogenic processes can contribute to the pathogenesis of cardiac arrhythmias; 1) enhanced automaticity, 2) afterdepolarization-triggered activity and 3) reentry circuits. The mathematical model of the quantum tunneling of ions is used to investigate these mechanisms from a quantum mechanical perspective. The mathematical model focuses on applying the principle of quantum tunneling to sodium and potassium ions. This implies that these ions have a non-zero probability of passing through the gate, which has an energy that is higher than the kinetic energy of ions. Our mathematical findings indicate that, under pathological conditions, which affect ion channels, the quantum tunneling of sodium and potassium ions is augmented. This augmentation creates a state of hyperexcitability that can explain the enhanced automaticity, after depolarizations that are associated with triggered activity and a reentry circuit. Our mathematical findings stipulate that the augmented and thermally assisted quantum tunneling of sodium and potassium ions can depolarize the membrane potential and trigger spontaneous action potentials, which may explain the automaticity and afterdepolarization. Furthermore, the quantum tunneling of potassium ions during an action potential can provide a new insight regarding the formation of a reentry circuit. Introducing these quantum mechanical aspects may improve our understanding of the pathophysiological mechanisms of cardiac arrhythmias and, thus, contribute to finding more effective anti-arrhythmic drugs.

Abstract Background Metabolic-associated fatty liver disease (MAFLD) is a public health issue that can result in liver cirrhosis and its complications. Aim of work Assess the dietary pattern, physical activity, and sleep quality of MAFLD patients. Methods Cross-sectional study of 77 MAFLD patients being present in the outpatient clinic of Endemic Medicine Department at Cairo University Hospital. An interview questionnaire including sociodemographic, medical history, validated food frequency questionnaire (FFQ), Pittsburg Sleep Quality Index (PSQI), and international physical activity questionnaire (IPAQ) were utilized to collect data. Results Among patients, 36%, 34%, and 30% had liver steatosis grades I (mild), II (moderate), and III (severe) respectively. Waist circumference, body mass index (BMI), daily caloric and carbohydrate intake, impaired sleep quality, and low physical activity were significantly linked with steatosis grades. The independent significant predictors for MAFLD severity were waist circumference (P = 0.011, OR 1.119), poor sleep quality (P = 0.038, OR 3.871), habitual sleep efficiency (OR 3.402, 95%CI 1.403–8.252), daytime dysfunction (OR 2.487, 95%CI 1.374–4.501), and physical activity (P = 0.027, OR 4.6). Conclusion Waist circumference, poor sleep quality, habitual sleep efficiency, daytime dysfunction, and low physical activity were the real marked predictors for MAFLD severity.

This study investigates electromyography activation and force development differences in key lower limb muscles between female football players with previous anterior cruciate ligament injuries compared with healthy players. Twenty-two semi-professional players were divided into ACL-injured (n = 11) and non-injured groups (n = 11). Participants underwent maximal voluntary isometric contractions while electromyography activation, peak and average, and peak torque of force were measured. Results indicated significant differences in electromyography activation patterns between anterior cruciate ligament players and non-injured players, particularly in biceps femoris and gluteus maximus muscles. These differences were also evident when comparing between limbs within anterior cruciate ligament players. Interestingly, both groups exhibited similar peak torque of force during maximal contractions, suggesting a compensatory neuromuscular strategy that supports a return to sport based on kinetic and kinematic factors. However, these findings underscore persistent muscle integration imbalances potentially contributing to the high rate of anterior cruciate ligament reinjury. In conclusion, this study highlights the importance of evaluating electromyography activation alongside force development in understanding neuromuscular adaptations post anterior cruciate ligament injury. These insights emphasize the need for comprehensive rehabilitation strategies that address muscle imbalance to mitigate the risk of recurrent anterior cruciate ligament injuries in female football players.

Background: COVID-19 has a serious impact on mental well-being. The rapid spread of the pandemic, effects of quarantine or isolation, financial and physical burden of the disease caused a general state of anxiety, stress, and depression. This study aimed to screen for anxiety, stress, depression, and insomnia among patients suffering from mild or moderate COVID-19. Methods: This observational cross-sectional analytical study was conducted on 203 COVID-19 patients who attended the COVID-19 outpatient clinic in Kasr Al-Ainy hospital, Egypt, in a time frame from July 2020 to February 2021. They were subjected to: full history, examination, imaging and Psychometric tools. Results: Majority of the included patients (203) were 30 years of age and less (27.6 %). Most of the patients had extremely severe depression, anxiety and stress (65%, 77.8% & 48.3% respectively), while insomnia was moderate to severe in 36 % of the sample. Myalgia was the most common complaint among all patients. Anxiety, stress and depression were positively correlated with insomnia severity index score (P= 0.014), statistically negative correlation was found between chronic illness and history of chest disease with insomnia severity index (p=0.038). Conclusion: Depression, anxiety and stress were remarkably high among our patients, while insomnia was moderate to severe in 36 % of the sample.

Abstract Background High academic achievement, an important determinant of future success, is known to be influenced by many factors including dietary behavior, lifestyle and mental health, among others. The objectives of the current study were to explore university students’ nutritive habits, daily lifestyle, and mental status, and to scrutinize the associations between these factors and students’ academic achievement. Methods A cross-sectional study was conducted among students of a private Lebanese university, using an electronic survey. Diet, eating habits, physical activity, sleep, and smoking were evaluated, and mental health was assessed using a validated Arabic version of the combined Depression, Anxiety, Stress Score (DASS-8). Academic achievement was measured using the Subjective Academic Achievement Scale (SAAS). Results A total of 1677 students participated in the questionnaire. The results of a linear regression taking the SAAS score as the dependent variable, showed that students who have a non-scientific versus scientific major (Beta = 0.53), and having breakfast ≥ 4 days per week compared to less than 2 days (Beta = 0.28) were significantly associated with higher SAAS scores. More psychological distress (Beta = − 0.06) and a higher number of days of eating out (Beta = − 0.07) were significantly associated with lower SAAS scores. Conclusions This is the first investigation on a Lebanese university students’ academic success in relation to lifestyle and mental profiles. Better academic achievement was demonstrated by students having healthier dietary and lifestyle habits, as well as less distressing mental status. Such results, in light of the compounded and unprecedented crises with which Lebanon has been assailed, suggest the need to focus on promoting healthy habits among students in higher education as a possible driver of better academic success.

Abstract Two tumor (Classical/Basal) and stroma (Inactive/active) subtypes of Pancreatic adenocarcinoma (PDAC) with prognostic and theragnostic implications have been described. These molecular subtypes were defined by RNAseq, a costly technique sensitive to sample quality and cellularity, not used in routine practice. To allow rapid PDAC molecular subtyping and study PDAC heterogeneity, we develop PACpAInt, a multi-step deep learning model. PACpAInt is trained on a multicentric cohort (n = 202) and validated on 4 independent cohorts including biopsies (surgical cohorts n = 148; 97; 126 / biopsy cohort n = 25), all with transcriptomic data (n = 598) to predict tumor tissue, tumor cells from stroma, and their transcriptomic molecular subtypes, either at the whole slide or tile level (112 µm squares). PACpAInt correctly predicts tumor subtypes at the whole slide level on surgical and biopsies specimens and independently predicts survival. PACpAInt highlights the presence of a minor aggressive Basal contingent that negatively impacts survival in 39% of RNA-defined classical cases. Tile-level analysis ( > 6 millions) redefines PDAC microheterogeneity showing codependencies in the distribution of tumor and stroma subtypes, and demonstrates that, in addition to the Classical and Basal tumors, there are Hybrid tumors that combine the latter subtypes, and Intermediate tumors that may represent a transition state during PDAC evolution.

In the last decades, academic publishing in the Social Sciences has experienced a shift toward research management by non-academic stakeholders and performance-based funding systems (PBFSs). The resulting conditions of knowledge production and dissemination are increasingly described with “game” metaphors. This article provides a literature review of research concerning publishing in the Social Sciences and discusses how gamification becomes a key element. Quantifying publication outcomes to assess and financially incentivize research performance results in a highly competitive playing field where access to goods and services is denied to those who play the game poorly. The pressure to publish leads to unethical behavior and predatory publishing which are two side-effects of gamified practices. The reviewed literature also shows unequal starting conditions in terms of gender and language inequalities, as well as the dominance of the Global North. We conclude that the gamification of publication practices in the Social Sciences leads to stressful and dreadful environments.

BackgroundColon microbiome composition contributes to the pathogenesis of colorectal cancer (CRC) and prognosis. We analyzed 16S rRNA sequencing data from tumor samples of patients with metastatic CRC and determined the clinical implications.Materials and methodsWe enrolled 133 patients with metastatic CRC at St. Vincent Hospital in Korea. The V3-V4 regions of the 16S rRNA gene from the tumor DNA were amplified, sequenced on an Illumina MiSeq, and analyzed using the DADA2 package.ResultsAfter excluding samples that retained

Abstract We produce projections of global mean sea‐level rise to 2500 for low and medium emissions scenarios (Shared Socioeconomic Pathways SSP1‐2.6 and SSP2‐4.5) relative to 2020, based on extending and combining model ensemble data from current literature. We find that emissions have a large effect on sea‐level rise on these long timescales, with [5, 95]% intervals of [0.3, 4.3]m and [1.0, 7.6]m under SSP1‐2.6 and SSP2‐4.5 respectively, and a difference in the 95% quantile of 1.6 m at 2300 and 3.3 m at 2500 for the two scenarios. The largest and most uncertain component is the Antarctic ice sheet, projected to contribute 5%–95% intervals of [−0.1, 2.3]m by 2500 under SSP1‐2.6 and [0.0, 3.8]m under SSP2‐4.5. We discuss how the simple statistical extensions used here could be replaced with more physically based methods for more robust predictions. We show that, despite their uncertainties, current multi‐centennial projections combined into multi‐study projections as presented here can be used to avoid future “lock‐ins” in terms of risk and adaptation needs to sea‐level rise.

Background and rationale: Coronavirus disease 2019 (COVID-19) infection is a respiratory tract infection because of a novel coronavirus. The clinical picture ranges from asymptomatic to severe manifestations mandating intensive care and respiratory support. We aimed to assess the serum level of iron, total iron binding capacity (TIBC), and transferrin saturation in COVID-19 patients and their relation to disease severity and outcome. Methodology: This observational cross-sectional analytical study was conducted on 100 confirmed cases of COVID-19 who were admitted to Kasr Al-Ainy hospitals between June and December 2020.Serum levels of iron, total iron binding capacity (TIBC), and transferrin saturation were measured for all study populations. Result: One hundred patients were involved in this research, 51males and 49 females, with a mean age of 51±14.9years. Regarding the disease severity,53% were moderate cases, 34% were mild, and 13% were severe cases. Fifty-two (54.2%) patients showed normal serum levels of iron, 38 patients (39.6%) showed high serum levels of iron, and 6 patients (6.3%) showed low serum levels of iron. The mean ±SD values of iron, TIBC, and transferrin saturation were 163.1±105 mcg/dL, 366 ± 162.6 mcg/dL, 44.4 ± 20.2 %, respectively. Iron, total iron binding capacity (TIBC) levels and transferrin saturation did not show a significant association as regards either COVID-19 severity or mortality. Mortality and deterioration were detected in 31.7% out of 60 patients with COVID-19. The results showed that obese patients showed a higher percentage of severe COVID-19,which was statistically significant (p < /em>=0.037).There was a statistically significant higher mortality rate in patients with severe COVID-19 (p < /em>=0.000).High mortality was observed significantly in patients with diabetes mellitus (p < /em>=0.041).Iron levels, total iron binding capacity (TIBC) levels and transferrin saturation did not show a significant association regarding either COVID-19 severity or mortality. Conclusion: In our study, COVID-19 severity was not related to iron metabolism but was affected by obesity and diabetes mellitus. COVID-19 mortality was significantly associated with diabetes.

[Purpose] The purpose of the article is to consider the issue of civil law regulation of electronic transactions in many countries. [Methodology/Approach/Design] The authors used the dialectical method of cognition of social and legal phenomena and general scientific research methods, such as analysis, synthesis, a systematic approach. [Findings] General features of legal regulation of electronic transactions were explained. The relevance of electronic transactions is shown on the example of regulatory legal acts in this field in Kazakhstan. Advantages and disadvantages of digitalization in the field of electronic transactions were analysed. Special attention was paid to current realities of electronic transactions and electronic tendering during a pandemic. It was concluded that the advent of digital opportunities simplifies a life greatly, but since these relations are not directly regulated by the laws of several countries, great risks are created. And the adoption of new standards will reduce risks in terms of the circulation of digital rights, the purchase of financial assets and the use of new means of payment.

Continuous chemotherapy causes side effects in children, one of which affects the quality of life of children. The quality of life of children with cancer can be improved by providing complementary and alternative therapies, one of which is art therapy. Objective: To determine art therapy's effect on the quality of life of cancer children undergoing chemotherapy. Methods: The design of this study was a quasi-experimental one-group pre-test post-test on 30 children with cancer who underwent chemotherapy. The art therapy in this study was coloring activities. Quality of life assessed using PedsQoL instruments (Pediatric‘s Quality of Life) Generic 4.0. Data analysis used the Mann-Whitney test. Results: The average age of children with cancer was ten, and more than half (53.3%) were male. Most of them were diagnosed with Acute Leukemia Limfoblastic and more than half (73.3%) were diagnosed more than six months. There was a difference in the quality of life of children with cancer before and after being given art therapy with a p-value = 0.000 (

This research aims to analyze and describe the innovation of Sugihwaras Village, Sidoarjo Regency as a smart village based on government policy. The research method uses descriptive with a qualitative approach. Data collection techniques were conducted through interviews, observation, and documentation. The results show that the smart village in Sugihwaras Village is in the form of government administration system applications and public services made by village officials, computer training for underprivileged village children, integrated landfill management, eco-enzyme training, and adequate access to education, health, and information technology. The implementation of smart economy in Sugihwaras Village is still not evenly felt. Innovation in Sugihwaras Village is supported by the leadership of the village head who is sensitive to the condition of children in Sugihwaras Village. Culture is also an important factor in innovating in Sugihwaras Village, namely care and excellent service. The ability to innovate is that the teachers who are village officials and the Village Community Empowerment Agency have qualified skills in the computer field. The work team is still within the scope of village officials and village institutions, but will work with Muhammadiyah Sidoarjo University in providing certification. The performance of the village government in the Griya Sinau Digital (GSD) program is that training participants have increased and some participants have found jobs.

Hemochromatosis, either hereditary hemochromatosis (HH) or secondary hemochromatosis, consists of the accumulation of iron in the liver, heart, and other organs. It leads to end-organ damage in a proportion of affected subjects. Although liver-related morbidity (cirrhosis and hepatocellular carcinoma [HCC]) and mortality are well established, the frequency of these complications remains controversial. The aim of this study is to examine the rate of hospitalization and the incidence of iron overload-related comorbidities in patients with hemochromatosis between the years of 2002 and 2010. We queried the Nationwide Inpatient Sample (NIS) database from the year 2002 to 2010. We included adults (age ≥18 years) and used the ICD-CM 9 code 275.0x to identify hospitalized patients with a diagnosis of hemochromatosis. Data analysis for this study was generated using SAS software version 9.4. A total of 168,614 hospitalized patients between 2002 and 2010 had a diagnosis of hemochromatosis. The majority were males (57%) with a median age of 54 years (37–68), with a predominance of white patients (63.3%) followed by black (26.8%). The rate of hospitalization among patients with hemochromatosis increased by 79% between the years 2002 and 2010 (34.5/100,000 in 2002 vs 61.4/100,000 in 2010). The main associated diagnoses were diabetes mellitus (20.2%), cardiac disease, including arrhythmias (14%) and cardiomyopathy (dilated 3.8%; peri-, endo-, myocarditis 1.3%), liver cirrhosis (8.6%), HCC (1.6%), and acute liver failure (0.81%). Of note, HCC was associated with cirrhosis in 1188 patients (43% of HCC patients) and male sex (87%). Diagnostic biopsies were performed in 6023 (3.6%) of those patients and liver transplant was performed in 881 (0.5%). In-hospital mortality occurred in 3638 (2.16%) patients. In this large database study, we found a rising trend in hospitalization for hemochromatosis, possibly due to the increased recognition of this entity and billing for the condition. The incidence of cirrhosis in hemochromatosis was found to be similar to other studies (8.6% vs 9%). However, the rate of HCC was lower than previous reports (1.6% vs 2.2%–14.9%), and only 43% of HCC was associated with cirrhosis. This raises important pathophysiologic questions regarding the impact of iron overload in HCC. There has been an increase in the rate of hospitalization for patients with a diagnosis of hemochromatosis. This may be related to an increased recognition of hemochromatosis as the underlying etiology for conditions such as diabetes, cardiomyopathy, cirrhosis, and HCC. Further prospective studies are needed to clarify the burden of liver disease in HH and secondary iron overload.

Postacute sequelae of SARS-CoV-2 infection, commonly known as long COVID, is estimated to affect 10% to 80% of COVID-19 survivors. We examined the prevalence and predictors of long COVID from a sample of 1,338 COVID-19 cases among university members in Washington, DC, USA, during July 2021‒March 2022. Cases were followed up after 30 days of the initial positive result with confidential electronic surveys including questions about long COVID. The prevalence of long COVID was 36%. Long COVID was more prevalent among those who had underlying conditions, who were not fully vaccinated, who were female, who were former/current smokers, who experienced acute COVID-19 symptoms, who reported higher symptom counts, who sought medical care, or who received antibody treatment. Understanding long COVID among university members is imperative to support persons who have ongoing symptoms and to strengthen existing services or make referrals to other services, such as mental health, exercise programs, or long-term health studies.

IntroductionUniversal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month.MethodsWe conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization.ResultsAmong the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities.DiscussionIn the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.

The medical students of the current generation are expected to perform a wide range of activities targeted toward the acquisition of a multitude of skills and the attainment of various learning competencies. The purpose of the current review is to explore the challenges in the cognitive, interpersonal, and intrapersonal domains, and to propose an educational plan to respond to the challenges defined in the cognitive domain. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 39 articles were selected based on their suitability with the current review objectives. Keywords used in the search include critical thinking and medical education in the title alone only. The findings of a committee reported that a successful health-care professional will essentially require competence in three domains, namely cognitive, intrapersonal, and interpersonal domain. However, the careful analysis of the medical education delivery system across different parts of the world suggests that we are falling short in our efforts to adequately expose medical students' to these competencies. In the global mission to improve the quality of health-care delivery, we have to take specific measures to ensure the attainment of the desired competencies, and the involvement of teachers will be crucial. In conclusion, considering the dynamism in the health sector, it is the responsibility of educators to enhance the attainment of cognitive competencies of the students. Further, students should be encouraged to reflect, and experiential learning should be regularly practiced to equip the students with intrapersonal skills. Finally, we also have to focus on the attainment of interpersonal competencies, as it prepares them to work as effective members of the team.

Indirect addition of water into chocolate may form secondary sugar networks. This condition creates an increased melting temperature of chocolate. The purpose of this study was to increase the melting point of premium couverture chocolate without addition of fat/oil from other sources. Chocolate was formulated with coconut/palm sugar as sweetener at various fat levels (32%, 34%, and 36%). Aside from this, Konjac glucomannan and Xanthan gum-based hydrogel with a concentration of 3%, 5%, and 7% was added. Characterization of chocolate quality parameters with the addition of konjac glucomannan-based hydrogel (CKG) and xanthan gum-based hydrogel (CXG) was carried out. Moisture content, melting point, hardness, particle size and brown color analyses were carried out at intervals of 1, 5, 9 days of maturation (crystal growth period). The results showed that the addition of hydrogel influenced the melting point and hardness. As the period of crystal growth (maturation) increased, the melting point and hardness of the chocolate also increased.

Aim: The study aimed to explore differences in usefulness and the ease of use of electronic health records (EHRs) as perceived by nurses and other healthcare providers (HCPs) during the 2019 coronavirus (Covid-19) pandemic in Jordan. It also aimed to investigate the association of gender, marital status, age, educational level, experience, and experience of using EHRs in predicting the technology acceptance model (TAM) of EHRs among the same selected group. Design: A comparative cross-sectional study. Methods: A convenience sample of 90 nurses and 96 HCPs completed the technology acceptance model survey. The response rate for nurses was 60%, compared to 64% for HCPs. The study was conducted from May to July 2020. Results: The study found that, generally, both nurses and other HCPs perceived high levels of usefulness and ease of use of EHRs during the Covid-19 pandemic. Other HCPs perceived higher levels of usefulness (86%) and ease of use (76.5%) of EHRs than nurses (79.5% and 73.5%, respectively) during the Covid-19 pandemic. Statistical differences were noted between both groups (p < 0.05). Marital status and experience in using EHRs were found to be associated with TAM among nurses. There were no associations of TAM among other HCPs during the Covid-19 pandemic. Conclusion: Due to the nature of nurses' work, the implementation and acceleration of the use of EHRs during the Covid-19 pandemic could be expected to encounter certain obstacles.

The purpose of this study was to determine the correlation between teacher creativity in teaching variations using Canva-based media and student learning outcomes in science. The research method used is correlational quantitative. The population of this study were all fourth grade students as well as a sample of 63 students. The instruments used in this study were questionnaires and documentation. The techniques used in this research are descriptive analysis, normality test, linearity test, and hypothesis testing using the Pearson product moment test assisted by SPSS 25. The results of this study indicate that: teacher creativity in science learning has moderate criteria. Class IV science learning outcomes have a high average score with a percentage (82.3%). Based on the results of data analysis between teacher creativity and science learning outcomes there is a significant relationship with tcount 6.752 greater than ttable 2.000 or (6.752 2.000) out of n = 63 at a significant level of 5%. This shows that there is a strong, positive, and significant relationship between teacher creativity using Canva-based media and science learning outcomes for fourth grade students at SDN 006 Langgini, Bangkinang District, Kampar Regency.

Educational research is currently more dominated by the development of learning models. However, this has not shown satisfactory results because it tends not to be piloted or disseminated. The purpose of this study is to explain the effect of applying the reading to learn learning model on improving students' narrative text writing skills, especially junior high school students. The sample of this study was the 9th-grade students of SMPN 5 Padang Panjang, totaling 32 students. Data was collected by processing the results of the pretest in the form of performance obtained before the implementation of the reading to learn learning model and the post-test obtained after the implementation of the reading to learn learning model. Data were analyzed using the descriptive analysis method. Based on the results of data analysis, it was found that there was an increase in students' narrative text writing skills before and after the implementation of the reading to learn learning model. This increase can be seen from the number of scores obtained by students regarding the completeness of the narrative text structure from 68 to 89, the completeness of narrative elements from 60 to 75, and the application of EBI from 50 to 72. Therefore, this study can be useful to see the effectiveness of the reading to learn learning model toward students' writing skills and as a way out of writing problems.

Abstract Background Outcome of HCV treatment with direct antiviral agents in malignant patients is questionable. The aim is to assess the safety and efficacy of DAAs in treatment of chronic HCV patients who received chemotherapy for malignancies. Materials Retrospective cohort study of 83 patients with HCV post chemotherapy receiving DAAs treatment compared to a matched group of 88 chronic HCV patients without cancer. Demographic, laboratory and abdominal ultrasound data, and SVR were taken for all patients. Results Patients’ data revealed mean age (52 years) and BMI (29). A total of 52% of HCV patients were females, and 83.6% were treatment naïve. Patients with cancer had higher FIB4 values and more cirrhosis (20.5% vs. 13.6%) with no statistical significance. Total bilirubin and HbA1C levels were significantly higher in HCV patients without cancer. All patients in either groups received SOF-based DAAs except 2 cases received PAR/OMP/RBV. SVR rate was very high and comparable between the two groups (100% and 97.7% in post chemotherapy and control groups) with no statistical difference. Mortality was represented in 23% in patients post chemotherapy with FIB4 score considered the only predictor for mortality. Conclusion DAAs have excellent efficacy in patients post chemotherapy. Further studies should be conducted for their concomitant use with chemotherapy.

Green algae are a biological source rich in phenolic compounds and potentially inhibit the growth of microorganisms. Spirogyra sp. PDNA1 is one of the most types of green algae found in freshwater. Because of the increasing resistance of most bacteria and fungi to available antibiotics, a continuous search is required for the most effective, economical, and environmentally friendly alternatives. There are 30 compounds were identified, including alkaloids, phenols, and esters, and the highest percentage was oleic acid, with a retention time of 21.949 min and a concentration of 32.89%. The highest percentage of inhibition showed on the bacteria for the methanolic algal extract was against Salmonella typhi (22.5 mm), while the lowest percentage of it was against Bacillus cereus (10 mm). The hexane extract had the highest inhibition percentage against Salmonella typhi (19.5 mm) and the lowest inhibition percentage against Klebsiella pneumoniae (11 mm). It was also noted that the effect of the methanolic extract was highest against Trichoderma asperallum (22 mm) and the lowest percentage of inhibition against Candida albicans (7 mm), while the hexane extract recorded the highest percentage of inhibition against Candida albicans (15 mm) and the lowest percentage of inhibition was against the fungus Aspergillus Niger with inhibition diameter (8 mm). Phenols were identified by HPLC technology. The phenolic compounds included Rutin, Gallic acid, Tannic acid, Quercetin, and Kaempferol, where the highest percentage of Rutin was in the phenolic methanolic extract (240.99) ppm, Kaempferol (7.2124) ppm, while the phenolic hexane extract had the highest percentage of Rutin (19.606) ppm, Kaempferol (10.997) ppm. The phenols showed the highest inhibition rate of the phenolic-methanolic extract against (Klebsiella pneumoniae) (30) mm and the least inhibition against (Escherichia. coli) (11) mm while the phenolic hexane extract has the highest inhibition to (Salmonella typhi) (27) mm and the lowest effect was against (Escherichia coli) (10) mm. The antifungal effect of the phenolic methanolic extract recorded the highest percentage against (Candida albicans) (30) mm and had the lowest effect on Mucor racemosus (18) mm, while the phenolic hexane extract had the highest effect with Candida albicans (22.5) mm, and the least inhibition percentage was in Mucor racemosus with (11) mm. Therefore, the study aimed to isolate and identify the effective compounds of the methanolic and hexanoic extract of this algae, and active phenolic compounds were detected using GC-MS and HPLC technology.

Departing from the experience of being lost in the forest, this essay explores the idea of “laku” and local embodied knowledge. Laku refers to learnings gained through bodily experiences under specific circumstances, as well as those passed down orally from one generation to another in the form of rituals, ceremonies and embodied knowledge. Laku is inclusive and contains an element of internalising values by getting involved. It requires a progressive and stimulating process to reflect and learn about the harmony of humans’ minds and the universe. When knowledge is transmitted orally or through embodied experience, what are the proper academic protocols and citation processes? Were stories and myths properly cited or were they considered and dismissed as backwards/non-modern knowledge? Can an embodied local knowledge traverse beyond the realm of a footnote into a properly credited idea, incorporated and equally acknowledged in academic essays? Is it even necessary, or can we demand the right to opacity for local embodied knowledge to traverse beyond academic protocols?

Summary: Background: Immunocompromised patients have varying responses to SARS-CoV-2 mRNA vaccination. However, there is limited information available from prospective clinical trial cohorts with respect to long-term immunogenicity-related responses in these patient groups following three or four vaccine doses, and in applicable cases infection. Methods: In a real-world setting, we assessed the long-term immunogenicity-related responses in patients with primary and secondary immunodeficiencies from the prospective open-label clinical trial COVAXID. The original clinical trial protocol included two vaccine doses given on days 0 and 21, with antibody titres measured at six different timepoints over six months. The study cohort has subsequently been followed for one year with antibody responses evaluated in relation to the third and fourth vaccine dose, and in applicable cases SARS-CoV-2 infection. In total 356/539 patients were included in the extended cohort. Blood samples were analysed for binding antibody titres and neutralisation against the Spike protein for all SARS-CoV-2 variants prevailing during the study period, including Omicron subvariants. SARS-CoV-2 infections that did not require hospital care were recorded through quarterly in-person, or phone-, interviews and assessment of IgG antibody titres against SARS-CoV-2 Nucleocapsid. The original clinical trial was registered in EudraCT (2021-000175-37) and clinicaltrials.gov (NCT04780659). Findings: The third vaccine dose significantly increased Spike IgG titres against all the SARS-CoV-2 variants analysed in all immunocompromised patient groups. Similarly, neutralisation also increased against all variants studied, except for Omicron. Omicron-specific neutralisation, however, increased after a fourth dose as well as after three doses and infection in many of the patient subgroups. Noteworthy, however, while many patient groups mounted strong serological responses after three and four vaccine doses, comparably weak responders were found among patient subgroups with specific primary immunodeficiencies and subgroups with immunosuppressive medication. Interpretation: The study identifies particularly affected patient groups in terms of development of long-term immunity among a larger group of immunocompromised patients. In particular, the results highlight poor vaccine-elicited neutralising responses towards Omicron subvariants in specific subgroups. The results provide additional knowledge of relevance for future vaccination strategies. Funding: The present studies were supported by grants from the Swedish Research Council, the Knut and Alice Wallenberg Foundation, Nordstjernan AB, Region Stockholm, and Karolinska Institutet.

BackgroundBreakthrough infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are increasingly observed in vaccinated individuals. Immune responses towards SARS-CoV-2 variants, particularly Omicron-BA.5, are poorly understood. We investigated the humoral and cellular immune responses of hospitalized COVID-19 patients during Delta and Omicron infection waves.MethodsThe corresponding SARS-CoV-2 variant of the respective patients were identified by whole genome sequencing. Humoral immune responses were analyzed by ELISA and a cell culture-based neutralization assay against SARS-CoV-2 D614G isolate (wildtype), Alpha, Delta (AY.43) and Omicron (BA.1 and BA.5). Cellular immunity was evaluated with an IFN-γ ELISpot assay.ResultsOn a cellular level, patients showed a minor IFN-γ response after stimulating PBMCs with mutated regions of SARS-CoV-2 variants. Neutralizing antibody titers against Omicron-BA.1 and especially BA.5 were strongly reduced. Double-vaccinated patients with Delta breakthrough infection showed a significantly increased neutralizing antibody response against Delta compared to double-vaccinated uninfected controls (median complete neutralization titer (NT100) 640 versus 80, p

A multi-objective genetic algorithm approach is formulated to optimize the design of silicon-photonics complex circuits with contradicting performance metrics and no closed-form expression for the circuit performance. A case study is the interleaver/deinterleaver circuit which mixes/separates optical signals into/from different physical channels while preserving the wavelength-division-multiplexing specifications. These specifications are given as channel spacing of 50 GHz, channel 3-dB bandwidth of at least 20 GHz, channel free spectral range of 100 GHz, crosstalk of −23 dB or less, and signal dispersion less than 30 ps/nm. The essence of the proposed approach lies in the formulation of the fitness functions and the selection criteria to optimize the values of the three coupling coefficients, which govern the circuit performance, in order to accommodate the contradicting performance metrics of the circuit. The proposed approach achieves the optimal design in an incomparably short period of time when contrasted with the previous tedious design method based on employing Z-transform and visual inspection of the transmission poles and zeros.

Abstract Coronavirus disease 2019 (COVID‐19) infection causes a variety of extrapulmonary complications in pediatric patients. Multisystem inflammatory syndrome and hemophagocytic lymphohistiocytosis (HLH) are related to hypercytokinemia in COVID‐19 patients. HLH is a disorder of exaggerated inflammation resulting in a cytokine storm and unrestricted hemophagocytosis. HLH can be primary (familial) or secondary (acquired). Secondary HLH (sHLH) can occur in patients with rheumatologic, oncologic, or infectious diseases. The link between COVID‐19 and HLH has been reported in pediatric patients. Here we report a case of a pediatric patient who developed refractory sHLH secondary to COVID‐19 infection and required a hematopoietic cell transplant for the cure.