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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.

Although the use of ionic liquids (ILs) for the pretreatment of lignocellulosic biomass has been limited due to high costs, recent efforts to develop low-cost protic ILs show promise for achieving cost-effectiveness for biorefineries. However, an additional challenge remains in that ILs present in biomass hydrolysates are toxic to most microbial hosts, resulting in poor growth phenotypes. To address this issue, we applied an adaptive laboratory evolution (ALE) approach for tolerizingPseudomonas putidaKT2440, an industrially relevant bacterial host, to two low-cost ILs (triethanolammonium acetate [TEOH][OAc] and triethylammonium hydrogen sulfate [TEA][HS]). After continuous cultivations with gradually increased IL levels, we obtained evolved strains showing significant improvements in their growth performance under high concentrations of the ILs (maximum 4% [TEOH][OAc] and 8% [TEA][HS], in w/v) at which the wild-type strain cannot grow. Sequencing of evolved strains revealed multiple regions where mutations were associated with improved performance in minimal media conditions (relA,gacS,oprB/PP_1446,fleQ,tktA, anduvrY/PP_4100) and in IL-specific conditions (PP_5350, PP_4929/emrE,oprD, and PP_5324). We further validated the causality of the PP_5350 andemrEgenes for improved IL toleranceviareverse engineering and transcriptomic analysis. A common mutation in the PP_5350 gene, encoding a RpiR family transcriptional regulator, was shown to significantly upregulate the glyoxylate cycle for efficient acetate catabolism. In addition, it was suggested that theemrEgene encodes an efflux pump which can export [TEA][HS]. Finally, the cultivation of two of the best performing evolved strains with IL-treated biomass hydrolysates demonstrated their considerable potential to be used as platform strains. Taken as a whole, this work provides strains for utilization of IL-treated biomass and a mechanistic understanding that could be further leveraged to develop efficient microbial bioprocesses.

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]

Background Attitudes towards smoking, lung cancer screening, and perceived risk of lung cancer have not been widely studied in Malaysia. The primary objective of this study was to describe the factors affecting the willingness of high-risk current smokers and ex-smokers to undergo low-dose computed tomography (LDCT) screening for lung cancer. Methods A prospective, cross-sectional questionnaire study was conducted in current smokers or ex-smokers aged between 55 and 80 years at three hospitals in Kota Kinabalu, Sabah, Malaysia. The questionnaire recorded the following parameters: perceived lung cancer risk; Prostate Lung Colon Ovarian Cancer 2012 risk prediction model excluding race and ethnicity predictor (PLCOm2012norace); demographic characteristics; psychosocial characteristics; and attitudes towards lung cancer and lung cancer screening. Results A vast majority of the 95 respondents (94.7%) indicated their willingness to undergo screening. Stigma of lung cancer, low levels of knowledge about lung cancer symptoms, concerns about financial constraints, and a preference for traditional medication were still prevalent among the respondents, and they may represent potential barriers to lung cancer screening uptake. A desire to have an early diagnosis (odds ratio [OR], 11.33; 95% confidence interval [CI], 1.53 to 84.05; p=0.02), perceived time constraints (OR, 3.94; 95% CI, 1.32 to 11.73; p=0.01), and proximity of LDCT screening facilities (OR, 14.33; 95% CI, 1.84 to 111.4; p=0.01) had significantly higher odds of willingness to undergo screening. Conclusion Although high-risk current smokers and ex-smokers are likely to undergo screening for lung cancer, several psychosocial barriers persist. The results of this study may guide the policymakers and clinicians regarding the need to improve lung cancer awareness in our population.

This study investigated the use of i-THINK Mapping in teaching reading comprehension by ESL teachers to a group of Form Five students, and the factors and challenges the ESL teachers faced in teaching reading comprehension using i-THINK Mapping. A qualitative approach, specifically a case study design, was employed in this study. Classroom observations, semi-structured interviews, and document analysis of their lesson plans were used to collect the data. Four ESL teachers with a minimum of 5-year teaching experience in a rural secondary school in Hulu Selangor, Malaysia, were selected using a purposive sampling technique to participate in this study. Thematic analysis was used to analyse the data obtained from classroom observations and interviews. The findings show that the teachers had applied five i-THINK maps, including a Circle Map to define in context, a Bubble Map to describe, a Double Bubble Map to compare and contrast, a Flow Map to show the sequence of an event, and a Tree Map to classify different ideas. The i-THINK Mapping motivated the students to discuss, brainstorm, and cooperate with their peers to detect the details from the given reading texts. The teachers’ challenges include the time constraints in preparing the lesson with i-THINK Mapping and a low level of student English proficiency. One implication of this study is that teachers’ use of i-THINK Mapping to teach reading comprehension could assist students in generating ideas, expanding ideas, and expressing them orally.

Introduction The top research priority for cavernoma, identified by a James Lind Alliance Priority setting partnership was ‘Does treatment (with neurosurgery or stereotactic radiosurgery) or no treatment improve outcome for people diagnosed with a cavernoma?’ This pilot randomised controlled trial (RCT) aims to determine the feasibility of answering this question in a main phase RCT.Methods and analysis We will perform a pilot phase, parallel group, pragmatic RCT involving approximately 60 children or adults with mental capacity, resident in the UK or Ireland, with an unresected symptomatic brain cavernoma. Participants will be randomised by web-based randomisation 1:1 to treatment with medical management and with surgery (neurosurgery or stereotactic radiosurgery) versus medical management alone, stratified by prerandomisation preference for type of surgery. In addition to 13 feasibility outcomes, the primary clinical outcome is symptomatic intracranial haemorrhage or new persistent/progressive focal neurological deficit measured at 6 monthly intervals. An integrated QuinteT Recruitment Intervention (QRI) evaluates screening logs, audio recordings of recruitment discussions, and interviews with recruiters and patients/parents/carers to identify and address barriers to participation. A Patient Advisory Group has codesigned the study and will oversee its progress.Ethics and dissemination This study was approved by the Yorkshire and The Humber—Leeds East Research Ethics Committee (21/YH/0046). We will submit manuscripts to peer-reviewed journals, describing the findings of the QRI and the Cavernomas: A Randomised Evaluation (CARE) pilot trial. We will present at national specialty meetings. We will disseminate a plain English summary of the findings of the CARE pilot trial to participants and public audiences with input from, and acknowledgement of, the Patient Advisory Group.Trial registration number ISRCTN41647111.

There is no clear definition of what constitutes an ideal teacher educator, particularly from the perspective of Malaysian educators. Developing teacher educators’ vision of an ideal teacher ensures that teachers have high levels of professional, personal, and contextual dimensions in teaching practices, including competence in the practice of professional teaching, knowledge, and understanding. Therefore, the objective of this study was to find out the range of visions of what it is to be a good teacher educator in a Malaysian teacher education institution. Seventeen teacher educators from an established university in Malaysia participated in the study. A survey consisting of eight questions was used as the research instrument. The data obtained from the questionnaire were analysed by using descriptive and textual analysis techniques. The findings reveal certain criteria of an ideal teacher such as possessing sound subject matter knowledge, mastery of both generic and content-specific pedagogy, and hands-on teaching skills. The teacher educators shared that they have to adjust their goals to attain their vision, namely the need to adapt to the current policies, new ideas, and the ever-changing educational trends. The findings also show that an ideal teacher is the one who is responsible to nurture and bring about the best learning experience for students. This research has unfolded the teacher educators’ vision of the ideal teacher and pedagogical implications reflected in every facet of their educational practices.

ObjectiveNormal pressure hydrocephalus (NPH) is a neurological condition characterized by a clinical triad of gait disturbance, cognitive impairment, and urinary incontinence in conjunction with ventriculomegaly. Other neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, and vascular dementia share some overlapping clinical features. However, there is evidence that patients with comorbid NPH and Alzheimer's or Parkinson's disease may still exhibit good clinical response after CSF diversion. This study aims to evaluate clinical responses after ventriculo-peritoneal shunt (VPS) in a cohort of patients with coexisting NPH and neurodegenerative disease.MethodsThe study has two components; (i) a pilot study was performed that specifically focused upon patients with Complex NPH and following the inclusion of the Complex NPH subtype into consideration for the clinical NPH programme, (ii) a retrospective snapshot study was performed to confirm and characterize differences between Classic and Complex NPH patients being seen consecutively over the course of 1 year within a working subspecialist NPH clinic. We studied the characteristics of patients with Complex NPH, utilizing clinical risk stratification and multimodal biomarkers.ResultsThere was no significant difference between responders and non-responders to CSF diversion on comorbidity scales. After VPS insertion, significantly more Classic NPH patients had improved cognition compared to Complex NPH patients (p = 0.005). Improvement in gait and urinary symptoms did not differ between the groups. 26% of the Classic NPH group showed global improvement of the triad, and 42% improved in two domains. Although only 8% showed global improvement of the triad, all Complex NPH patients improved in gait.ConclusionsOur study has demonstrated that the presence of neurodegenerative disorders co-existing with NPH should not be the sole barrier to the consideration of high-volume tap test or lumbar drainage via a specialist NPH programme. Further characterization of distinct cohorts of NPH with differing degrees of CSF responsiveness due to overlay from neurodegenerative or comorbidity risk burden may aid toward more precise prognostication and treatment strategies. We propose a simplistic conceptual framework to describe NPH by its Classic vs. Complex subtypes to promote the clinical paradigm shift toward subspecialist geriatric neurosurgery by addressing needs for rapid screening tools at the clinical-research interface.

Introduction: Gamification has been shown to improve academic gains, but the mechanism remains elusive. We aim to understand how psychological constructs interact, and influence medical education using mathematical modelling. Methods: Studying a group of medical students (n=100; average age: 20) over a period of 4 years with the Personal Responsibility Orientation to Self-Direction in Learning Scale (PRO-SDLS) survey. Statistical tests (Paired t-test) and models (logistic regression) were used to decipher the changes within these psychometric constructs (Motivation, Control, Self-efficacy & Initiative), with gamification as a tool. Students were encouraged to partake in a maze (10 stations) that challenged them to answer anatomical questions using potted human specimens. Results: We found that the combinatorial effects of the maze and Script Concordance Test (SCT) resulted in a significant improvement for “Self-Efficacy” and “Initiative” (p

The effectiveness of the 5E Inquiry Learning Model as compared to the teacher-centred traditional method on science achievement in electricity was examined in this study. The quasi-experimental pretest-posttest control group research design was utilized. A total of 65 students (33 and 32 students in the experimental and the control groups, respectively) from two Year 5 intact classes in Malaysia participated in this study. A test comprising 54 dichotomously scored items with overall KR-20 reliability of 0.84 was used in the pretest and posttest. Given the significant difference in the pretest and posttest, it was presumed that the analysis could be done using the ANCOVA. However, on further analysis, the assumption for homogeneity of the regression slope was violated and ANCOVA could not be performed. Instead, the covariate was categorized into two equally-spaced categories (i.e., low and average achievers) and further t-test supported the equivalency of the experimental and control groups. When analyzed using the t-test, the two groups differed significantly in the posttest means across the two categories of students. These findings unequivocally indicate the effectiveness of employing the 5E Inquiry Learning Model in enhancing students’ science achievement among the low and average achieving students.

This study examined the test taking strategies of weak ESL students of an English language proficiency course. Test taking strategies are known as the methods that test takers use as an alternative aimed at attaining correct answers on a specified form of language assessment. The study adopted a qualitative study. The participants in this study were forty-four learners from the Bachelor of Arts Program. The learners were asked to think aloud while reading an assigned text to answer the questions. Four learners’ thinking aloud recordings were transcribed and analysed. Focus group interviews were carried out for triangulation purposes. Data collected were analysed manually. The ESL learners implemented many test taking strategies as they coped with the reading comprehension test. The findings of the study show how ESL students used cognitive, metacognitive, compensating, and social strategies. Participants expressed that understanding and reading the passage allowed them to draw conclusions better in answering the multiple choice questions. The findings revealed that they used a compensation strategy whereby they tried guessing the answers on a number of occasions. The findings of the study implicate teachers’ roles in L2 reading and also to guide the ESL learners in the process of answering reading passage and answer the comprehension questions.

This study aimed to determine the effectiveness of a professional development program on the use of a STEM-based 5E Inquiry Learning Model in enhancing the learning of STEM-based Inquiry Learning Model among 78 in- and pre-service science teachers. The topic electric circuit was used as the context of the study. Given the aim and the exploratory nature of this study, a triangulation mixed-methods design was employed: One-group pretest-posttest design which involved a single group that was pre-tested, exposed to the STEM-based 5E Inquiry Learning Model, and post-tested. This was triangulated by the qualitative responses from the participants’ reflections. The analysis of the quantitative dataset using the paired samples t-test indicated that the post-test mean score was statistically significantly higher than the pre-test mean score and that the effect size obtained was educationally significant. Further analyses by gender and participants’ teacher status, indicated a non-significant difference, giving credence that this result was truly the outcome of the intervention (treatment) effect instead of any disguised effect. The analysis of qualitative data through a recursive process resulted in the crystallization of three overarching key themes: Enhanced knowledge on the content used, empowered pedagogical skills on STEM-based Inquiry Learning, and heightened classroom management skill on promoting collaboration in the classroom.

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]