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This study aims to assess and examine secondary school teachers' perceptions of school climate and job satisfaction in five diverse countries: Japan, Korea, Finland, the United States of America (USA), and Australia. It explores the impact of school climate on teachers' job satisfaction, a pivotal factor influencing teacher retention, mobility, and professional development. In order to improve teachers' skills and abilities in the classroom, improving teachers' job satisfaction and understanding the factors that influence it is highly critical. Utilizing secondary data from the Teaching and Learning International Survey (TALIS) 2018, this study provides valuable insights. The findings reveal that teachers in all five countries generally hold positive perceptions of school climates and report high job satisfaction. However, teachers in Japan and Korea express comparatively lower job satisfaction levels when contrasted with their counterparts in Finland, the USA, and Australia. Furthermore, their perceptions of school climate also rank lower. Consequently, this study concludes that a positive correlation exists between favorable perceptions of school climate and elevated job satisfaction. This assertion is supported by regression analyses, individual country data, and aggregate data from all five countries.

Objectives: Fatigue is a prominent feature of long COVID (LC) and may be related to several pathophysiologic mechanisms, including immune hyperstimulation. Aerobic endurance exercise training may be a useful therapy, with appropriate attention to preventing post-exertional malaise. Methods: Fourteen participants completed a pilot study of aerobic exercise training (twenty 1.5 h sessions of over 10 weeks). Cardiorespiratory fitness, 6 min walk distance, quality of life, symptoms, 7-day physical activity, immunophenotype, and inflammatory biomarkers were measured before and after exercise training. Results: The participant characteristics at baseline were as follows: 53.5 ± 11.6 yrs, 53% f, BMI 32.5 ± 8.4, 42% ex-smokers, 15.1 ± 8.8 months since initial COVID-19 infection, low normal pulmonary function testing, V.O2peak 19.3 ± 5.1 mL/kg/min, 87 ± 17% predicted. After exercise training, participants significantly increased their peak work rate (+16 ± 20 W, p = 0.010) and V.O2peak (+1.55 ± 2.4 mL/kg/min, p = 0.030). Patients reported improvements in fatigue severity (-11%), depression (-42%), anxiety (-29%), and dyspnea level (-46%). There were no changes in 6MW distance or physical activity. The circulating number of CD3+, CD4+, CD19+, CD14++CD16, and CD16++CD14+ monocytes and CD56+ cells (assessed with flow cytometry) increased with acute exercise (rest to peak) and was not diminished or augmented by exercise training. Plasma concentrations of TNF-α, IL-6, IL-8, IL-10, INF-γ, and INF-λ were normal at study entry and not affected by training. Conclusions: Aerobic endurance exercise training in individuals with LC delivered beneficial effects on cardiorespiratory fitness, quality of life, anxiety, depression, and fatigue without detrimental effects on immunologic function.

BACKGROUND: Understanding nutritions role in multiple sclerosis (MS) can guide recommendations and intervention-based studies. OBJECTIVE: Evaluate the association between nutrition and pediatric-onset MS outcomes. METHODS: Prospective longitudinal multicenter study conducted as part of the US Network of Pediatric MS centers. Predictors were collected using a food screener estimating intake of various dietary food groups (e.g. dairy and fruits) and additional calculated indices (e.g. Healthy Eating Index (HEI)). Outcomes included time-from-enrollment to clinical relapse, new magnetic resonance imaging (MRI) T2 lesions, and Expanded Disability Status Scale (EDSS) increase. RESULTS: 353 children with MS were enrolled (mean ± SD age 15.4 ± 2.9, follow-up 3.9 ± 2.6 years). Multivariable analysis demonstrated that increased dairy by 50% of recommended intake was associated with increased relapse risk by 41% (adjusted hazard ratio (HR) 1.41, 95% CI 1.07-1.86), and risk of T2 progression by 40% (1.40, 1.12-1.74). Increased intake of fruit or vegetable above recommended, and every five-point HEI increase decreased relapse risk by 25% (0.75, 0.60-0.95), 45% (0.55, 0.32-0.96), and 15% (0.84, 0.74-0.96), respectively. No associations were found with EDSS. CONCLUSION: This work supports the influence of dietary intake on MS course, particularly with dairy intake. Future prospective study is required to establish causation.

PurposeUse of the electronic health record (EHR) has motivated the need for data standardization. A gap in knowledge exists regarding variations in existing terminologies for defining diabetic retinopathy (DR) cohorts. This study aimed to review the literature and analyze variations regarding codified definitions of DR.DesignLiterature review and quantitative analysis.SubjectsPublished manuscripts.MethodsFour graders reviewed PubMed and Google Scholar for peer-reviewed studies. Studies were included if they used codified definitions of DR (e.g., billing codes). Data elements such as author names, publication year, purpose, data set type, and DR definitions were manually extracted. Each study was reviewed by ≥ 2 authors to validate inclusion eligibility. Quantitative analyses of the codified definitions were then performed to characterize the variation between DR cohort definitions.Main outcome measuresNumber of studies included and numeric counts of billing codes used to define codified cohorts.ResultsIn total, 43 studies met the inclusion criteria. Half of the included studies used datasets based on structured EHR data (i.e., data registries, institutional EHR review), and half used claims data. All but 1 of the studies used billing codes such as the International Classification of Diseases 9th or 10th edition (ICD-9 or ICD-10), either alone or in addition to another terminology for defining disease. Of the 27 included studies that used ICD-9 and the 20 studies that used ICD-10 codes, the most common codes used pertained to the full spectrum of DR severity. Diabetic retinopathy complications (e.g., vitreous hemorrhage) were also used to define some DR cohorts.ConclusionsSubstantial variations exist among codified definitions for DR cohorts within retrospective studies. Variable definitions may limit generalizability and reproducibility of retrospective studies. More work is needed to standardize disease cohorts.Financial disclosuresProprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

BACKGROUND: Artemisinin resistance in Plasmodium falciparum threatens global malaria elimination efforts. To contain and then eliminate artemisinin resistance in Eastern Myanmar a network of community-based malaria posts was instituted and targeted mass drug administration (MDA) with dihydroartemisinin-piperaquine (three rounds at monthly intervals) was conducted. The prevalence of artemisinin resistance during the elimination campaign (2013-2019) was characterized. METHODS: Throughout the six-year campaign Plasmodium falciparum positive blood samples from symptomatic patients and from cross-sectional surveys were genotyped for mutations in kelch-13-a molecular marker of artemisinin resistance. RESULT: The program resulted in near elimination of falciparum malaria. Of 5162 P. falciparum positive blood samples genotyped, 3281 (63.6%) had K13 mutations. The prevalence of K13 mutations was 73.9% in 2013 and 64.4% in 2019. Overall, there was a small but significant decline in the proportion of K13 mutants (p

BACKGROUND AND OBJECTIVE: Prior Epstein-Barr virus (EBV) infection is associated with an increased risk of pediatric-onset multiple sclerosis (POMS) and adult-onset multiple sclerosis (MS). It has been challenging to elucidate the biological mechanisms underlying this association. We examined the interactions between candidate human leukocyte antigen (HLA) and non-HLA variants and childhood EBV infection as it may provide mechanistic insights into EBV-associated MS. METHODS: Cases and controls were enrolled in the Environmental and Genetic Risk Factors for Pediatric MS study of the US Network of Pediatric MS Centers. Participants were categorized as seropositive and seronegative for EBV-viral capsid antigen (VCA). The association between prior EBV infection and having POMS was estimated with logistic regression. Interactions between EBV serostatus, major HLA MS risk factors, and non-HLA POMS risk variants associated with response to EBV infection were also evaluated with logistic regression. Models were adjusted for sex, age, genetic ancestry, and the mothers education. Additive interactions were calculated using relative risk due to interaction (RERI) and attributable proportions (APs). RESULTS: A total of 473 POMS cases and 702 controls contributed to the analyses. Anti-VCA seropositivity was significantly higher in POMS cases compared to controls (94.6% vs 60.7%, p

Abstract Background Early diagnosis of syphilis is vital for its effective control. This study aimed to develop an Artificial Intelligence (AI) diagnostic model based on radiomics technology to distinguish early syphilis from other clinical skin lesions. Methods The study collected 260 images of skin lesions caused by various skin infections, including 115 syphilis and 145 other infection types. 80% of the dataset was used for model development with 5-fold cross-validation, and the remaining 20% was used as a hold-out test set. The exact lesion region was manually segmented as Region of Interest (ROI) in each image with the help of two experts. 102 radiomics features were extracted from each ROI and fed into 11 different classifiers after deleting the redundant features using the Pearson correlation coefficient. Different image filters like Wavelet were investigated to improve the model performance. The area under the ROC curve (AUC) was used for evaluation, and Shapley Additive exPlanations (SHAP) for model interpretation. Results Among the 11 classifiers, the Gradient Boosted Decision Trees (GBDT) with the wavelet filter applied on the images demonstrated the best performance, offering the stratified 5-fold cross-validation AUC of 0.832 ± 0.042 and accuracy of 0.735 ± 0.043. On the hold-out test dataset, the model shows an AUC and accuracy of 0.792 and 0.750, respectively. The SHAP analysis shows that the shape 2D sphericity was the most predictive radiomics feature for distinguishing early syphilis from other skin infections. Conclusion The proposed AI diagnostic model, built based on radiomics features and machine learning classifiers, achieved an accuracy of 75.0%, and demonstrated potential in distinguishing early syphilis from other skin lesions.

Objectives: Staphylococcus argenteus, a newly described species of coagulase-positive Staphylococcus, was first identified in clinical isolates in northern Japan in 2019. The aim of the present study was to clarify the trends in the epidemiological features and antimicrobial resistance traits of S. argenteus in the recent years. Methods: S. argenteus isolates from various clinical specimens were screened using MALDI-TOF and genotyped using the multilocus sequence typing scheme. Antimicrobial susceptibility was determined using broth microdilution test and resistance genes were detected by multiplex/uniplex PCR. Nucleotide sequences of haemolysin genes (hla, hlb, hld, and hlg) were determined and analysed in some isolates. Results: From August 2020 to December 2023, 210 isolates were identified as S. argenteus. The ratio of S. argenteus to Staphylococcus aureus clinical isolates was 0.0045, showing a slightly decreasing trend compared to what was previously reported (2019.8–2020.7). Three genotypes, ST1223-coa-XV, ST2198-coa-XIV, and ST2250-coa-XId were identified, with ST2250 being dominant (49%) and exhibiting an increasing trend. S. argenteus isolates were almost susceptible to antimicrobials examined, while ST2198 isolates showed higher resistance rates to ampicillin, macrolides, and aminoglycosides than other clones, harbouring blaZ, msrA, and aac(6′)-Ie-aph(2″)-Ia. Only eight isolates (4-ST2250, 3-ST1223, and 1-ST2198) did not show haemolysis on blood agar plates. These isolates had intact haemolysin genes and promoter regions; however, a novel deletion mutation in hlg-component A was detected in some haemolytic and non-haemolytic isolates. Conclusions: The present study revealed the epidemiological trend of S. argenteus clones in northern Japan, along with the occurrence of non-haemolytic isolates with intact haemolysin genes.

The silond catfish, Silonia silondia (Hamilton, 1822), known locally as Nga Myin Yinn, is rare in Myanmar fish markets and can fetch a high price. Efforts are being made to increase the production for domestic demand. We examined the distribution and growth of S. silondia based on catches in the Ayeyarwady River and growth records in fish farms near the river. The smaller fish were observed downstream near their nursery and the medium fish were around 1 m total length (TL) were often widespread, whereas the larger fish preferred upstream locations. Estimating the individual age from poorly defined periodic rings on the surface of otolith sections was difficult, but their microchemistry may reflect a shared nursery environment and subsequent migration throughout the entire river region. The growth curve estimates in the farmed population revealed a mean TL of 60 cm at four years, indicating that farmed fish were smaller than commercially captured wild fish. This is one of the first comprehensive studies of the river region, but more detailed surveys are needed to manage the fish resource sustainably.

Abstract Aims Both patients with heart failure (HF) with reduced ejection fraction (HFrEF) and those with HF with preserved ejection fraction (HFpEF) present with elevated N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and have multiple comorbidities; consequently, the prognostic effect of NT‐proBNP according to beta‐blocker (BB) use is unknown. Methods This retrospective study evaluated patients admitted for acute HF between January 2012 and December 2017 at Ulsan University Hospital. Clinical, echocardiographic, laboratory and drug prescription data, including BB data, were collected from the hospital database. Information on mortality was collected by reviewing medical records or using national death data. Results Of the 472 patients evaluated, 216 (45.8%) and 256 (54.2%) patients were and were not prescribed BB at discharge, respectively. A total of 224 (47.5%) patients died within a median follow‐up duration of 44 months. The Kaplan–Meier analysis showed reduced all‐cause mortality with BB in HFrEF (ejection fraction ≤ 40%) but not in HFpEF (ejection fraction > 40%). In the multivariate Cox regression analysis, transmitral to tissue Doppler imaging, early diastolic velocity ratio (E/E′), NT‐proBNP and BB use were independent predictors of all‐cause mortality in HFrEF. Meanwhile, haemoglobin and NT‐proBNP levels were independent predictors of HFpEF. The NT‐proBNP cut‐off value for determining all‐cause mortality was set to 4800 pg/mL. Among HFrEF patients with NT‐proBNP

Infection behaviors of some susceptible and resistant Diaporthe citri isolates against two fungicides such as benomyl and kresoxim-methyl were observed on citrus leaves. On the chemically unsprayed leaves, there were no differences in not only the conidial germination rate but also hyphal growth between the resistant and susceptible isolates. However, on the benomyl or kresoxim-methyl-pretreated leaves, both conidial germination rate and hyphal growth of the resistant isolates were not decreased, which was different with those of the susceptible isolates. These unchanging germination rate and hyphal growth of the resistant isolates, resulting in the lack of chemical efficacy, coincided with the previous studies in which strong infection was observed by the resistant isolates after pre-treatment with each chemical. On the other hand, a point mutation occurred at 198th amino acid of β-tubulin gene in the resistant isolate NEL21-2 which may cause the resistant against benomyl. However, no mutation was found in cytochrome b in the resistant isolates indicating other genomic changes may be responsible for the resistant against kresoxim-methyl.

Background Telekyanmar (Telehealth), one of the telemedicine services in Myanmar, was initiated a few months after the military coup and amidst the onset of the third wave of COVID-19 pandemic. The program aims to address the urgent requirement for accessible medical services for Myanmar’s vulnerable population. Given the critical importance of both clients’ and providers’ satisfaction in the success of telemedicine services, this study aims to evaluate clients’ and providers’ satisfaction regarding the telehealth services offered by the Telekyanmar project in Myanmar. Methods A cross-sectional study was conducted from February 2023 to September 2023 by utilizing a quantitative research method. Data were collected online through a structured questionnaire. The clients who have received health care services and clinicians who are working at Telekyanmar clinics during the study period were included in the study. Data management and analysis were done by using R software ( https://www.r-project.org/). Results A total of 306 clients and 79 clinicians were included in the assessment. The mean age of the clients and clinicians were 33.2±13.6 years and 35.6±6.8 years, respectively. Over 85% of the clients and 58.2% of clinicians were residing inside the country. Clients’ satisfaction on various aspects of Telekyanmar services were assessed, with the question regarding “health staff respect for privacy” receiving the highest proportion of “good” and “excellent” responses at 96.1%. Regarding overall treatment experience, 96.7% of clients reported being “very satisfied” and “satisfied” with the Telekyanmar services. Overall satisfaction was reported by 88.6% of clinicians. Specifically, over 87% of clinicians reported their satisfaction on “communication with patients”, 79.7% satisfied with “quality of clinical consultation”, and 78.5% satisfied with “treatment prescription”. Conclusions The findings indicated that majority of the clients and clinicians expressed their satisfaction with the Telekyanmar services, which was established to address the healthcare needs of people in Myanmar after the military coup.

Background: Interprofessional Education (IPE), is the engagement of two or more healthcare professions in an integrated learning environment to foster collaboration and improve healthcare services. In IPE, initiatives are taken where technology is a crucial part of the learning process. Current technology practices in IPE comprise eLearning modules on collaborative practice skills and many others. This study aims to determine the readiness for interprofessional education of the health sciences students. Methods: A questionnaire called Readiness for Interprofessional Learning Scale (RIPLS) was used to assess attitudes related to interprofessional collaboration & education. Descriptive and non-parametric statistics were used to analyze the results in aggregate, as well as by each faculty. Results: Medical students gave a higher rating in terms of the perceived benefits of working together to solve patient problems compared to other faculties. Also, they were more open to working in small-group projects with other healthcare students and value the importance of shared learning to clarify the nature of patients' problems. But compared to others, the Nursing students were unsure of what their professional role will be and wanted to acquire more knowledge and skills than other healthcare students. The total RIPLS score amongst all was in the high range. Conclusion: Thus, students were deemed ready for IPE. Recommendations: The University need to consider how to implement IPE within their curricula, define learning outcomes and/ or competencies, develop and utilize the 4Dimensional curriculum development framework in line with the health professional accreditation standards in order to promote collaboration and competence amongst all students ,whereby upon graduation, they as healthcare professionals, in turn will optimize health services, strengthen health system and improve health outcomes.

ABSTRACT: Objectives: Staphylococcus aureus (S. aureus) is a major cause of bloodstream infections. The recent epidemiological features and antimicrobial resistance trend were analysed for methicillin-resistant and susceptible S. aureus (MRSA/MSSA) isolates from blood samples in people from northern Japan. Methods: The S. aureus isolates from blood culture were screened by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) and genotyped by the schemes of multilocus sequence typing (MLST), coa, agr, spa, and SCCmec types. Antimicrobial resistance genes and virulence factors were detected by multiplex/uniplex polymerase chain reaction (PCR). Antimicrobial susceptibility was examined using a broth microdilution test. Results: A total of 301 isolates (163 MRSA and 138 MSSA) were isolated from bloodstream infections in 2023 (from April to December). The MRSA isolates were classified into three groups, that is, clonal complexes (CC)1-SCCmec-IV (CC1-IV) (52%), CC5-II (36%), and CC8-IV (12%). The prevalence of CC1 was significantly higher than those in our previous studies (2017–2021). Four CC8-IVa isolates with PVL genes on ΦSa2usa were considered to be the USA300 clone (sequence type [ST]8/spa-t008/coa IIIa/agr I) or its variants that were genotyped as those closely related to ST8/t008 or lacking arginine catabolic mobile element (ACME). In contrast, MSSA was genetically highly divergent and classified into 22 STs, with CC1 (ST1 and ST188) being the most common (25%). It was notable that 29 MSSA isolates (21%) were classified into livestock-associated (LA) genotypes, ST20, ST97, and CC398 (ST398 and ST291). Genetic characterization of the CC398 isolates suggested that these belong to human-adapted MSSA clones. Conclusions: The present study revealed the increasing trend of CC1 MRSA surpassing CC5, and the emergence of MSSA representing human-adapted CC398, and LA types ST97 and ST20 from bloodstream infections in people in Japan. © 2024 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.