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Cultivation of students' higher-order thinking ability has become the main agenda of the education curriculum. The transfer of knowledge pertaining to higher-order thinking by teachers to the students can prepare the latter with the necessary attributes for the 21st century. The present study is aimed at exploring Malaysian secondary ESL (English as a Second Language) school teachers' self-assessment of, and perceptions on the higher-order thinking skills practices for teaching writing. Using a mixed-method research design, the validated 30-item five-point Likert scale questionnaire with an open-ended question was administered to a group of respondents consisting of 72 ESL teachers. The findings indicated that the overall mean score of ESL teachers' self-assessment of using higher-order thinking skills practices for teaching writing was at a high level. Meanwhile, their perceptions on the integration of higher-order thinking skills in the teaching of writing include the concern of students' low proficiency, difficulties in implementing HOTS in writing, poor participation by passive students, and teachers' attitude towards using HOTs for teaching writing. This study suggests that fostering and creating awareness of mastering the elements of HOTS can benefit both the teachers and the students. Teachers have to be creative and innovative in their teaching so that the students can be given the opportunity to showcase their knowledge, skills and abilities in the quest to imbue them with the 21st century life skills.

Background. Emerging critical care systems have gained little attention in low- and middle-income countries. In sub-Saharan Africa, only 4% of the healthcare workforce is trained in critical care, and mortality rates are unacceptably high in this patient population. Aim. We sought to retrospectively describe the knowledge acquisition and confidence improvement of practitioners who attend the Fundamental Critical Care Support (FCCS) course in Rwanda. Methods. We conducted a retrospective study in which we assessed survey data and multiple-choice question data that were collected before and after course delivery. The purpose of these assessments at the time of delivery was to evaluate participants' perception and acquisition of critical care knowledge. Results. Thirty-six interprofessional clinicians completed the training. Performance on the multiple-choice questions improved overall after the course (mean score pre-course of 56.5% to mean score post-course of 65.8%, p-value <0.001) and improved in all content areas with the exception of diagnosis and management of acute coronary syndrome and acute respiratory failure/mechanical ventilation. Both physicians and nurses improved their scores significantly (68.9% to 75.6%, p-value = 0.031 and 52.0% to 63.5%, p-value <0.001, respectively). Self-reported confidence in level of knowledge also increased in all areas. Survey respondents indicated on open-answer questions that they would like the course offerings at least annually, and that further dissemination of the course in Rwanda was warranted. Conclusion. Deploying the established FCCS course improved Rwandan healthcare provider knowledge and confidence across most critical care content areas. Therefore, this course represents a good first step in bridging the gaps noted in emerging critical care systems. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002) were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

Purpose/objective(s): Low-dose radiotherapy (LD-RT) is a well-established treatment for multiple human inflammatory conditions. Whole-lung LD-RT may be effective in COVID-19-related pneumonia.Materials/methods: Patients hospitalized with COVID-19-related pneumonia receiving supportive care, glucocorticosteroids, and/or remdesivir were administered LD-RT treatment of 0.5 or 1.5 Gy to the bilateral lungs on a prospective, combined phase I/II, multi-site, single-institution trial. Patients were followed for 28 days or until discharge and compared to controls blindly matched by age, comorbidity, duration of symptoms, and disease severity. Eligible patients were confirmed by SARS-CoV-2 positive PCR, unable to wean from oxygen at enrollment, and had radiographic consolidations. Patients were enrolled into 5 cohorts stratified by treatment variables and severity of illness: LD-RT alone vs. LD-RT with concurrent drug therapies, non-intubated vs. intubated status, and low (1.5 Gy) vs. lower (0.5 Gy) radiation dose. Qualitative aims were to establish safety and explore efficacy. Quantitative endpoints were continuous, categorical, and time-to-event, and included clinical recovery, intubation, radiographic changes, and biomarker responses. Intubation endpoints are reported for all cohorts using the log-rank test and Kaplan-Meier method.Results: Outcomes of 80 patients were available for analysis at study closure. In total, 40 of 70 planned patients (57% trial enrollment) received whole-lung LD-RT between April 24 and December 7, 2020 and were compared to 40 matched controls. Cohorts 1&2: Ten non-intubated patients received 1.5 Gy without concurrent COVID-directed drug therapies (10 of 10 planned, 100% cohort enrollment) and were compared to matched controls. Intubation rates were 40% in controls compared to 10% following LD-RT (P = 0.11). Cohort 3: One intubated patient received 1.5 Gy (1 of 20 planned, 5% cohort enrollment). Cohort 4: Twenty separate non-intubated patients received 1.5 Gy with concurrent dexamethasone/remdesivir (20 of 20 planned, 100% cohort enrollment) and were compared to matched controls. Intubation rates were 32% in controls compared to 14% following LD-RT (P = 0.09). Cohort 5: Nine patients received 0.5 Gy with concurrent drug therapies (9 of 20 planned, 45% cohort enrollment) and were compared to matched controls. Zero controls required intubation compared to 11% following LD-RT (P = 0.32). Among all non-intubated patients and matched controls combined (n = 78), mechanical ventilation was required in 28% of controls compared to 12% following LD-RT (reduced 57%, P = 0.05). The trial was prematurely closed due to observed reproducibility of efficacy. A randomized trial is now ongoing.Conclusion: In the first, prospective, phase I/II trial of radiotherapy for COVID-19-related pneumonia, a single treatment of whole-lung LD-RT reduced intubation rates by 57% compared to controls in patients receiving supportive care with or without drug therapies (P = 0.05). [ABSTRACT FROM AUTHOR]

Several European waste management organizations have started work on creating a technology platform to accelerate the implementation of deep geological disposal of radioactive waste in Europe. There is an increasing consensus in the international community about geological disposal as the preferred option for solving the long-term management of spent fuel, high-level waste and other long-lived radioactive wastes. At the same time, European citizens have a widespread desire for a permanent solution for high-level radioactive waste disposal. A majority of European countries with nuclear power have active waste-management programmes, but the current status and the main challenges of those programmes vary. The most advanced waste management programmes in Europe (i.e. those in Sweden, Finland and France) are prepared to start the licensing process of deep geological disposal facilities within the next decade. Despite the differences between the timing and the challenges of the different programmes, there is a joint awareness that cooperation on the scientific, technical and social challenges related to geological disposal is needed, and that it is beneficial for the timely and safe implementation of the first geological disposal facilities. Such a demonstration of a viable solution for the management of high-level radioactive waste will enhance stakeholder confidence in Europe. It is envisaged that a technology platform would enhance European cooperation in this area. The platform will provide a tool for reducing overlapping work, to produce savings in total costs of research and implementation, and to make better use of existing competence and research infrastructures. From 2008, SKB (Sweden) and Posiva (Finland) led the preparation work to set up the implementing geological disposal of radioactive waste technology platform (IGD-TP). Since then other implementers from France, Germany, Switzerland, United Kingdom, Spain and Belgium have joined the project. To date a strategic research agenda for the platform has been prepared and consulted upon, which is now the basis for taking the platform into a deployment phase. [ABSTRACT FROM AUTHOR]

Background: The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001-2002. Methods: A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002) were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results: The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion: Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million. [ABSTRACT FROM AUTHOR]

Physicians who treat men with prostate cancer are often faced with the challenge of caring for patients for whom treatment is directed toward palliation rather than cure. For these patients, a range of treatments and support mechanisms is available to help alleviate physical-and emotional-suffering. [ABSTRACT FROM AUTHOR]

Information and communication technologies may help reduce health disparities through their potential for promoting health, preventing disease, and supporting clinical care for all. Unfortunately, those who have preventable health problems and lack health insurance coverage are the least likely to have access to such technologies. Barriers to access include cost, geographic location, illiteracy, disability, and factors related to the capacity of people to use these technologies appropriately and effectively. A goal of universal access to health information and support is proposed to augment existing initiatives to improve the health of individuals and the public. Both public- and private-sector stakeholders, particularly government agencies and private corporations, will need to collaboratively reduce the gap between the health information "haves" and "have-nots." This will include supporting health information technology access in homes and public places, developing applications for the growing diversity of users, funding research on access-related issues, ensuring the quality of health information and support, enhancing literacy in health and technology, training health information intermediaries, and integrating the concept of universal access to health information and support into health planning processes. [ABSTRACT FROM AUTHOR]

Objective: To examine the current status of interactive health communication (IHC) and propose evidence-based approaches to improve the quality of such applications.Participants: The Science Panel on Interactive Communication and Health, a 14-member, nonfederal panel with expertise in clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication, convened by the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services.Evidence: Published studies, online resources, expert panel opinions, and opinions from outside experts in fields related to IHC.Consensus Process: The panel met 9 times during more than 2 years. Government agencies and private-sector experts provided review and feedback on the panel's work.Conclusions: Interactive health communication applications have great potential to improve health, but they may also cause harm. To date, few applications have been adequately evaluated. Physicians and other health professionals should promote and participate in an evidence-based approach to the development and diffusion of IHC applications and endorse efforts to rigorously evaluate the safety, quality, and utility of these resources. A standardized reporting template is proposed to help developers and evaluators of IHC applications conduct evaluations and disclose their results and to help clinicians, purchasers, and consumers judge the quality of IHC applications. [ABSTRACT FROM AUTHOR]

Rationnel L'accumulation de tissu adipeux (TA) viscéral est fortement associée au diabète de type 2 et aux facteurs de risque cardiovasculaire. Il a été suggéré qu'au-delà de son volume, la densité du TA (atténuation mesurée par tomodensitométrie (TDM)) pourrait aussi influencer le profil de risque cardiométabolique (CM). L'objectif de cette étude est d'examiner si l'atténuation du TA viscéral, marqueur de sa densité, est associée aux facteurs de risque cm, indépendamment du volume de TA viscéral. Patients et Méthodes Une analyse transversale a été réalisée chez 2 061 hommes et 1 842 femmes de l'étude INSPIRE ME IAA (INternational Study of Prediction of Intra-abdominal adiposity and its RElationship with cardioMEtabolic risk/Intra-Abdominal Adiposity). La surface (cm 2 ) et l'atténuation (HU) du TA viscéral, évaluées par TDM au niveau L4-L5, ainsi que plusieurs facteurs de risque cm (diabète de type 2, maladies cardiovasculaires, hypertension, glycémie, insulinémie, HOMA, triglycérides (TG), HDL-Cholestérol (HDL-C), apolipoprotéine A1 (ApoA1), apolipoprotéine B (ApoB), protéine C-réactive (CRP), plasminogen activator inhibitor 1 et adiponectine) ont été mesurées. Les relations entre paramètres d'intérêt ont été étudiées par analyses de variance (tertiles de surface TA viscéral) et modèles de régression multivariée. Résultats L'atténuation du TA viscéral, marqueur de sa densité, diminue inversement avec la surface de TA viscéral ( p < 0,0001). Indépendamment de la surface de TA viscéral, l'atténuation du TA viscéral est significativement associée aux facteurs de risque cm. Une interaction significative entre surface et atténuation du TA viscéral a été identifiée pour les niveaux de TG, HDL-C, ApoA1 (femmes), ApoB (hommes), adiponectine et HOMA, avec un impact plus important de l'atténuation pour les niveaux d'adiposité viscérale les plus faibles. Conclusions La densité du TA viscéral est associée de manière significative et indépendante au profil cm, et ce, plus particulièrement à des niveaux d'adiposité plus faible. L'atténuation du TA mesuré par TDM peut donc permettre de caractériser plus précisément la qualité du TA viscéral et son impact sur le profil cardiométabolique, au-delà de la quantité de TA viscéral. [ABSTRACT FROM AUTHOR]