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This study sought to investigate in-service mathematics teachers' knowledge of differentiated instruction in junior high schools in Tano South Municipality of Ghana. The study adopted an explanatory sequential mixed method design. We employed a sample of 50 JHS mathematics teachers comprising 41 general in-service teachers and 9 special in-service teachers in the quantitative study through a proportionate stratified sampling technique. In the qualitative phase, 6 JHS mathematics teachers comprising 4 general in-service teachers and 2 special in-service teachers were purposively selected and interviewed. In line with the design adopted, the quantitative data obtained through a questionnaire was first collected and analysed. This was followed by the qualitative data obtained through semi-structured interviews. The quantitative data were analysed using both descriptive statistical tools (such as frequency counts, percentages, mean, standard deviation, and average per item rating), and inferential statistical tools (independent samples t-test). Qualitative data used inductive content analysis. Among the findings, we found no statistically significant difference in the knowledge scores on differentiated instruction for general in-service teachers and special in-service teachers (t = -0.80, df = 48, p > 0.05). We, therefore, recommend teacher education institutions review their mathematics curriculum to reflect the use of differentiated instructional approaches among mathematics teachers.

Abstract We evaluated the impacts of COVID‐19 on multi‐organ and metabolic function in patients following severe hospitalised infection compared to controls. Patients (n = 21) without previous diabetes, cardiovascular or cerebrovascular disease were recruited 5–7 months post‐discharge alongside controls (n = 10) with similar age, sex and body mass. Perceived fatigue was estimated (Fatigue Severity Scale) and the following were conducted: oral glucose tolerance (OGTT) alongside whole‐body fuel oxidation, validated magnetic resonance imaging and spectroscopy during resting and supine controlled exercise, dual‐energy X‐ray absorptiometry, short physical performance battery (SPPB), intra‐muscular electromyography, quadriceps strength and fatigability, and daily step‐count. There was a greater insulin response (incremental area under the curve, median (inter‐quartile range)) during the OGTT in patients [18,289 (12,497–27,448) mIU/min/L] versus controls [8655 (7948–11,040) mIU/min/L], P

A total of 10% of children looked after in residential care in Scotland are aged 5–11. Although there has been a significant amount of information published about the care trajectories of adolescents in residential care, there is limited information about the experiences of younger children. In this paper, we explore the care trajectories and nature of care received by 5–11-year-olds identified as being in need of residential care. Our results show that younger children who enter residential care have significant trauma histories and experience significant levels of emotional and behavioural dysregulation that foster carers find challenging to manage, resulting in recurrent placement breakdowns. Residential care, particularly small-group-sized care that adopts social pedagogical and psychotherapeutic approaches, was considered beneficial for addressing the psychosocial and emotional needs of younger children. Despite these findings, there were concerns about the long-term use of residential care for younger children. Our results highlight that there is a need to improve access to paediatric mental health services for children in family-based placements. There is also a need to invest in better training and support for foster carers looking after children in severe distress. Community-based outreach services and in-home respite services provided by residential care teams are one way this could be achieved. Finally, in order to promote earlier and more timeous use of residential care, there is a need to shift societal views around residential care being a placement of last resort to rather being a place of recovery and healing that should sometimes be used as a placement of first resort.

Abstract Background A central goal of modern evidence-based medicine is the development of simple and easy to use tools that help clinicians integrate quantitative information into medical decision-making. The Bayesian Pre-test/Post-test Probability (BPP) framework is arguably the most well known of such tools and provides a formal approach to quantify diagnostic uncertainty given the result of a medical test or the presence of a clinical sign. Yet, clinical decision-making goes beyond quantifying diagnostic uncertainty and requires that that uncertainty be balanced against the various costs and benefits associated with each possible decision. Despite increasing attention in recent years, simple and flexible approaches to quantitative clinical decision-making have remained elusive. Methods We extend the BPP framework using concepts of Bayesian Decision Theory. By integrating cost, we can expand the BPP framework to allow for clinical decision-making. Results We develop a simple quantitative framework for binary clinical decisions (e.g., action/inaction, treat/no-treat, test/no-test). Let p be the pre-test or post-test probability that a patient has disease. We show that $$r^{*}=(1-p)/p$$ r ∗ = ( 1 - p ) / p represents a critical value called a decision boundary. In terms of the relative cost of under- to over-acting, $$r^{*}$$ r ∗ represents the critical value at which action and inaction are equally optimal. We demonstrate how this decision boundary can be used at the bedside through case studies and as a research tool through a reanalysis of a recent study which found widespread misestimation of pre-test and post-test probabilities among clinicians. Conclusions Our approach is so simple that it should be thought of as a core, yet previously overlooked, part of the BPP framework. Unlike prior approaches to quantitative clinical decision-making, our approach requires little more than a hand-held calculator, is applicable in almost any setting where the BPP framework can be used, and excels in situations where the costs and benefits associated with a particular decision are patient-specific and difficult to quantify.

A multi-disciplinary symposium on early-age onset cancer (EAOC) was held in October 2023 to explore challenges experienced by this rapidly growing population. A major outcome of the symposium was recognition of the remarkable similarities of EAOC patients’ journeys across cancer sites. Prevention and early detection of cancer are hindered by a lack of awareness among patients and family doctors that cancer can and does occur in younger persons. Distinct characteristics of the disease—such as a later stage at diagnosis and more aggressive tumor biology—require more potent treatments, which result in profound physical and psychosocial consequences that are unique to this age group. EAOC patient empowerment emerged as another key theme of the symposium. The development of a greater number of specialized clinics was called for, and patient support groups were recognized for the vital role they play in empowering patients and their families. Leading-edge medical advancements hold tremendous hope across the spectrum of EAOC care. New technologies based on genomic profiling, immunotherapy and microbiome alteration contribute to the development of highly effective, personalized approaches to treatment. All symposium participants expressed their commitment to speak with one resounding voice to advocate for equitable access to leading care practices for EAOC patients; thus, a fourth symposium is planned for November 2024.

Abstract The essential oil obtained from the dry leaves of Gynoxys szyszylowiczii Hieron. was described in this study for the first time. The chemical analysis, conducted on two stationary phases of different polarity, permitted to identify sixty-four compounds, that were quantified with at least one column. The main components, on a non-polar and polar stationary phase respectively, were germacrene D (21.6–19.2%), α-pinene (4.4–4.9%), n-tricosane (4.3% on both columns), (E)-β-caryophyllene (3.3–4.3%), 1-docosene (3.2–2.8%), α-cadinol (2.8–3.1%), and cis-β-guaiene (2.6–3.0%). This investigation was complemented by the enantioselective analysis of some major chiral compounds, carried out on two chiral selectors based on β-cyclodextrines. As a result, (S)-( +)-α-phellandrene, (S)-( +)-β-phellandrene, and (1S,2R,6R,7R,8R)-( +)-α-copaene appeared enantiomerically pure, whereas α-pinene, β-pinene, terpinen-4-ol, and germacrene D were detected as scalemic mixtures. Finally, linalool was practically racemic. The distillation yield, analytically calculated by weight of dry plant material, was 0.03%.

Abstract Communicable disease risk is high in refugee camps and reception centers. To better understand the risks for communicable disease diagnoses among refugees and asylum seekers, this study assesses individual- and camp-level risk factors among individuals utilizing Médecins du Monde clinics in four large refugee camps—Elliniko, Malakasa, Koutsochero, and Raidestos—on mainland Greece between July 2016 and May 2017. Descriptive statistics are reported for the demographic characteristics of the study population and for communicable disease burdens within the four camps—Elliniko, Malakasa, Raidestos, and Koutsochero. A hierarchical generalized linear model was used to assess risk factors for communicable disease diagnoses while accounting for individual-level clustering. This study shows marginal patterns in risk factors for communicable disease. Males had marginally higher risk of communicable disease diagnosis than females (OR = 1.12; 95% CI 0.97—1.29), and increased age was more protective against communicable disease for females (OR = 0.957; 95% CI 0.953—0.961) than for males (OR = 0.963; 95% CI 0.959—0.967). Communicable disease risk was significantly different between camps, with Elliniko (OR = 1.58; 95% CI 1.40–1.79) and Malakasa (OR = 1.43; 95% CI 1.25–1.63) having higher odds of communicable disease than Raidestos. The demographic and epidemiologic profiles of displaced populations differ across settings, and epidemiologic baselines for displaced populations are fundamental to evidence-informed provision of humanitarian aid. Further, while influences and risks for negative health outcomes in complex emergencies are broadly, the causal mechanisms that underpin these relationships are not as well understood. Both practitioners and researchers should engage with further research to elucidate the mechanisms through which these risks operate among displaced populations, including multilevel analyses.

Abstract The global energy budget is pivotal to understanding planetary evolution and climate behaviors. Assessing the energy budget of giant planets, particularly those with large seasonal cycles, however, remains a challenge without long-term observations. Evolution models of Saturn cannot explain its estimated Bond albedo and internal heat flux, mainly because previous estimates were based on limited observations. Here, we analyze the long-term observations recorded by the Cassini spacecraft and find notably higher Bond albedo (0.41 ± 0.02) and internal heat flux (2.84 ± 0.20 Wm−2) values than previous estimates. Furthermore, Saturn’s global energy budget is not in a steady state and exhibits significant dynamical imbalances. The global radiant energy deficit at the top of the atmosphere, indicative of the planetary cooling of Saturn, reveals remarkable seasonal fluctuations with a magnitude of 16.0 ± 4.2%. Further analysis of the energy budget of the upper atmosphere including the internal heat suggests seasonal energy imbalances at both global and hemispheric scales, contributing to the development of giant convective storms on Saturn. Similar seasonal variabilities of planetary cooling and energy imbalance exist in other giant planets within and beyond the Solar System, a prospect currently overlooked in existing evolutional and atmospheric models.

Abstract Background The FROM-16 is a generic family quality of life (QoL) instrument that measures the QoL impact of patients’ disease on their family members/partners. The study aimed to assess the responsiveness of FROM-16 to change and determine Minimal Important Change (MIC). Methods Responsiveness and MIC for FROM-16 were assessed prospectively with patients and their family members recruited from outpatient departments of the University Hospital Wales and University Hospital Llandough, Cardiff, United Kingdom. Patients completed the EQ-5D-3L and a global severity question (GSQ) online at baseline and at 3-month follow-up. Family members completed FROM-16 at baseline and a Global Rating of Change (GRC) in addition to FROM-16 at follow-up. Responsiveness was assessed using the distribution-based (effect size-ES, standardized response mean -SRM) and anchor-based (area under the receiver operating characteristics curve ROC-AUC) approaches and by testing hypotheses on expected correlation strength between FROM-16 change score and patient assessment tools (GSQ and EQ-5D). Cohen’s criteria were used for assessing ES. The AUC ≥ 0.7 was considered a good measure of responsiveness. MIC was calculated using anchor-based (ROC analysis and adjusted predictive modelling) and distribution methods based on standard deviation (SD) and standard error of the measurement (SEM). Results Eighty-three patients with 15 different health conditions and their relatives completed baseline and follow-up questionnaires and were included in the responsiveness analysis. The mean FROM-16 change over 3 months = 1.43 (SD = 4.98). The mean patient EQ-5D change over 3 months = −0.059 (SD = 0.14). The responsiveness analysis showed that the FROM-16 was responsive to change (ES = 0.2, SRM = 0.3; p

Children of Deaf Adults (CODAs) are uniquely positioned at the intersection between Deaf and hearing communities and often act as interpreters for their parents and hearing individuals. Informed by previous research which has highlighted language brokering as a core element of CODAs' experiences, along with the research which identifies the risk for parentification among CODAs, the aim of this study is to explore CODAs' experiences of their roles within deaf-parented households and beyond the household, at the intersection between the Deaf and hearing worlds. Semi-structured interviews were conducted with 12 CODAs (Mean age 36.33 years, Range 22-54 years) in Ireland. Three themes were generated from the analysis of the interviews: "It was really normal", Facing the Stigma associated with Deafness, and Being a Language Broker. The findings suggest that healthcare and education providers need a better understanding of the unique situations faced by CODAs in their roles as mediators between their parents and the hearing community, so that children and Deaf parents can be appropriately supported in their interactions with professionals.

Close-in giant exoplanets with temperatures greater than 2,000 K (ultra-hot Jupiters) have been the subject of extensive efforts to determine their atmospheric properties using thermal emission measurements from the Hubble Space Telescope (HST) and Spitzer Space Telescope1-3. However, previous studies have yielded inconsistent results because the small sizes of the spectral features and the limited information content of the data resulted in high sensitivity to the varying assumptions made in the treatment of instrument systematics and the atmospheric retrieval analysis3-12. Here we present a dayside thermal emission spectrum of the ultra-hot Jupiter WASP-18b obtained with the NIRISS13 instrument on the JWST. The data span 0.85 to 2.85 μm in wavelength at an average resolving power of 400 and exhibit minimal systematics. The spectrum shows three water emission features (at >6σ confidence) and evidence for optical opacity, possibly attributable to H-, TiO and VO (combined significance of 3.8σ). Models that fit the data require a thermal inversion, molecular dissociation as predicted by chemical equilibrium, a solar heavy-element abundance (metallicity, [Formula: see text] times solar) and a carbon-to-oxygen (C/O) ratio less than unity. The data also yield a dayside brightness temperature map, which shows a peak in temperature near the substellar point that decreases steeply and symmetrically with longitude towards the terminators.

Background: The Coronavirus disease 2019 (COVID-19) pandemic led to healthcare system changes aimed at minimizing disease transmission that impacted experiences with obstetric healthcare. Objective: To explore experiences of clinicians providing obstetric care during the COVID-19 pandemic. Study Design: Qualitative, in-depth, semi-structured interviews were conducted with five nurse practitioners and 16 obstetrical physicians providing a mix of outpatient and inpatient obstetric care during the COVID-19 pandemic in a mid-sized, Midwestern city in the United States. Interviews elucidated challenges and facilitators of obstetric care provision and vaccination of pregnant patients against COVID-19 during the pandemic. Transcripts were coded inductively then deductively using the Health Equity Implementation Framework (HEIF), which integrates a disparities framework and implementation framework to highlight multilevel factors that influence obstetric care. Thematic analysis was conducted, and thematic saturation was reached. Results: We interviewed 21 clinicians. Clinicians recounted personal challenges such as social isolation and burnout that could be countered by social support. Challenges within the clinical encounter included implementation of infection mitigation efforts, vaccine counseling, and limitations of telehealth. However, when successfully implemented, telehealth facilitated care and circumvented barriers. Clinicians cited challenges at the healthcare system level such as rapidly evolving knowledge and recommendations, restrictive visitor policies, personnel shortage, and inadequate institutional resources to support pandemic-related stressors. However, interdisciplinary care and guidelines available for clinicians facilitated care. Clinicians reported that challenges at the societal level included financial strain, lack of childcare, medical mistrust, politicization of medicine, misinformation, and racism. Societal-level facilitators included insurance access, community outreach, positive policy changes, and fostering trust in medicine. Conclusion: The pandemic produced unique stressors and exacerbated existing challenges for clinicians providing obstetric care. Applying the HEIF to the findings emphasizes the influence of societal factors on all other levels. Identified facilitators can inform interventions to address stressors in obstetric care that have resulted from the changed sociopolitical landscape of the pandemic.

A large variety of chemical and physical properties are exhibited by mercurides and amalgams. In this work, we have successfully examined seven strontium mercurides: SrHg11, SrHg8, Sr10Hg55, SrHg2, SrHg, Sr3Hg2, and Sr3Hg. The interest in the mercury-rich region is motivated by the large number of mercury-based superconductors that have high mercury content. At the same time, the preparation on the mercury-rich side of the binary phase diagram is experimentally non-trivial, due to the high vapor pressure of mercury and extreme air-sensitivity of mercury-rich compounds. By employing a set of specialized techniques, we were able to discover superconductivity in three mercury-strontium compounds – SrHg11 (Tc=3.2±0.3 K, Hc2=0.18±0.05 T), SrHg8 (Tc=3.0±0.1 K, Hc2=0.35±0.02 T), and Sr10Hg55 (Tc=2.2±0.25 K, Hc2=0.54±0.05 T).

Background: The impact of social health on patient-reported outcomes (PROs) is gaining increasing attention within the orthopaedic community. Few studies have explored any relationship between social deprivation levels and PROs in orthopaedic foot and ankle patients. Methods: We retrospectively identified patients who presented to an orthopaedic foot and ankle clinic for new evaluation. Patients completed PROs including PROMIS physical function (PF), PROMIS pain interference (PI), and the Foot and Ankle Ability Measure (FAAM). Social deprivation was measured using the Area Deprivation Index (ADI), a metric that incorporates various domains of poverty, education, housing, and employment. The ADI score quantifies the degree of social deprivation based on the 9-digit home zip code but is not a specific measure to an individual patient. Briefly, a lower ADI indicates less deprivation whereas a higher score denotes greater deprivation. Patient characteristics and outcomes were summarized and stratified by the nationally defined median ADI. Multivariable linear regression models assessed the relationships between PROs and continuous ADI controlling for demographics (age, sex, race/ethnicity, marital status, and employment status). Results: Our cohort consisted of 1565 patients with PRO and appropriate zip code data. Patients in the most-deprived median ADI split had more pain (median PROMIS-PI 62.7 vs 61.2, P = .001) and less function (median PROMIS-PF 37.1 vs 38.6, P = .021) compared with the least-deprived median ADI split. The clinical significance of these findings is unclear, though, given the minimal differences between groups for PROMIS measures. There was no relationship between ADI and FAAM scores. Conclusion: More socially deprived patients presented to the clinic with marginally less function and greater pain. Although statistically significant, the clinical significance of these relationships is unclear and merits further exploration. We plan to continue to study the connection between social deprivation and patient outcomes in specific clinical conditions as well as before/after surgical interventions. Level of Evidence: Level IV, retrospective cases series.

Magnetic Resonance Spectroscopic Imaging (MRSI) is a powerful technique that can map the metabolic profile in the brain non-invasively. Extracranial lipid contamination and insufficient B0 homogeneity however hampers robustness, and as a result has hindered widespread use of MRSI in clinical and research settings. Over the last six years we have developed highly effective extracranial lipid suppression methods with a second order gradient insert (ECLIPSE) utilizing inner volume selection (IVS) and outer volume suppression (OVS) methods. While ECLIPSE provides > 100-fold in lipid suppression with modest radio frequency (RF) power requirements and immunity to B1+ field variations, axial coverage is reduced for non-elliptical head shapes. In this work we detail the design, construction, and utility of MC-ECLIPSE, a pulsed second order gradient coil with Z2 and X2Y2 fields, combined with a 54-channel multi-coil (MC) array. The MC-ECLIPSE platform allows arbitrary region of interest (ROI) shaped OVS for full-axial slice coverage, in addition to MC-based B0 field shimming, for robust human brain proton MRSI.In vivo experiments demonstrate that MC-ECLIPSE allows axial brain coverage of 92–95 % is achieved following arbitrary ROI shaped OVS for various head shapes. The standard deviation (SD) of the residual B0 field following SH2 and MC shimming were 25 ± 9 Hz and 18 ± 8 Hz over a 5 cm slab, and 18 ± 5 Hz and 14 ± 6 Hz over a 1.5 cm slab, respectively. These results demonstrate that B0 magnetic field shimming with the MC array supersedes second order harmonic capabilities available on standard MRI systems for both restricted and large ROIs. Furthermore, MC based B0 shimming provides comparable shimming performance to an unrestricted SH5 shim set for both restricted, and 5-cm slab shim challenges.Phantom experiments demonstrate the high level of localization performance achievable with MC-ECLIPSE, with ROI edge chemical shift displacements ranging from 1–3 mm with a median value of 2 mm, and transition width metrics ranging from 1–2.5 mm throughout the ROI edge. Furthermore, MC based B0 shimming is comparable to performance following a full set of unrestricted spherical harmonic fields up to order 5. Short echo time MRSI and GABA-edited MRSI acquisitions in the human brain following MC-shimming and arbitrary ROI shaping demonstrate full-axial slice coverage and extracranial lipid artifact free spectra. MC-ECLIPSE allows full-axial coverage and robust MRSI acquisitions, while allowing interrogation of cortical tissue proximal to the skull, which has significant value in a wide range of neurological and psychiatric conditions.

Most malaria rapid diagnostic tests (RDTs) detect Plasmodium falciparum histidine-rich protein 2 (PfHRP2) and PfHRP3, but deletions of pfhrp2 and phfrp3 genes make parasites undetectable by RDTs. We analyzed 19,313 public whole-genome-sequenced P. falciparum field samples to understand these deletions better. Pfhrp2 deletion only occurred by chromosomal breakage with subsequent telomere healing. Pfhrp3 deletions involved loss from pfhrp3 to the telomere and showed three patterns: no other associated rearrangement with evidence of telomere healing at breakpoint (Asia; Pattern 13-TARE1); associated with duplication of a chromosome 5 segment containing multidrug-resistant-1 gene (Asia; Pattern 13-5++); and most commonly, associated with duplication of a chromosome 11 segment (Americas/Africa; Pattern 13-11++). We confirmed a 13–11 hybrid chromosome with long-read sequencing, consistent with a translocation product arising from recombination between large interchromosomal ribosome-containing segmental duplications. Within most 13-11++ parasites, the duplicated chromosome 11 segments were identical. Across parasites, multiple distinct haplotype groupings were consistent with emergence due to clonal expansion of progeny from intrastrain meiotic recombination. Together, these observations suggest negative selection normally removes 13-11++pfhrp3 deletions, and specific conditions are needed for their emergence and spread including low transmission, findings that can help refine surveillance strategies.