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The phenomenon of misconception and poor conceptual understanding is a problem that often occurs in science learning, not least in physics learning. Learning models that specifically aim to improve conceptual understanding and remediate misconceptions are not widely available. This study aims to determine the effect of the CCBL model in improving conceptual understanding and remediating misconceptions of students. The method consisted of pretest-posttest control group quasi-experimental design. The sample consisted of 89 students from three groups in the physics department. The research instrument was a static fluid concept test, a type of two-level multiple-choice test, and an open reason answer. Percentage techniques and descriptive narrative were used to obtain the level of understanding of students' concepts. These results indicated that the CCBL model was effective in remediating student misconceptions. The implication of this research is that the CCBL model has the syntax that capable of remediating students' misconceptions, namely: (1) activation of preconceptions and misconceptions; (2) presentation of cognitive conflict; (3) discovery of concepts and equations; and (4) reflection. It is recommended to conduct further research to see the significance of the effectiveness of the CCBL model.

Research on English Medium Instruction (EMI) in Higher Education (HE) has tended to have a technicist orientation, examining for example how it is implemented and the challenges it has encountered. Much less critical attention has been given to the rationales that language policy makers and other stakeholders offer for introducing EMI - the drivers may be reported (e.g. Rose et al., 2020, in China; Galloway & Sahan, 2021, in Vietnam and Thailand) but they are rarely questioned. Here, we focus on these rationales, using data from a research project which monitored the spread of EMI through Indonesian HE. Managers at 24 institutions were surveyed along with 281 lecturers who taught their subject in the medium of English at 41 universities. In the stakeholders' responses, we identified four common sense assumptions (Gramsci, 1971) about English and its role in Indonesia that often underlay their justifications for introducing EMI. We also noted some signs of resistance to EMI which demand further empirical investigation. This case reminds us that public language policy should be based on careful analysis of needs at national and institutional levels.

This study examines the development of learning designs based on Realistic Mathematics Education (RME) on the probability topic at the eighth-grade junior high school level. Probability abounds in everyday life, and the RME approach is believed to develop students' mathematical communication skills. This learning design development used the Plomp model combined with Gravemeijer and Cobb model. The research phase includes preliminary research, prototyping phase, and assessment phase. The products of this research are a valid, practice, and effective Local Instructional Theory (LIT) and teacher and student books. The results showed that the students who participated in learning using RME-based designs could determine the concept of probability and effectively improve students' mathematical communication skills.

The hospital indoor air microbiome, a diverse range of microorganisms, gains prominence amid the COVID-19 pandemic. Elevated awareness underscores implications for patient and staff well-being. Concerns about risks to indoor air quality persist due to prolonged indoor exposure, necessitating further research on specific threats within the hospital environment. In this study, an independent culture-based approach was used to analyze the baseline core microbiome present in hospital environments, utilizing amplicon sequencing on the next-generation sequencing technology to target the V3 region of the 16S rRNA gene. Firmicutes, Proteobacteria, and Actinobacteria were the main bacterial phyla that were most isolated from the wards and clinics with different orders of abundance; Firmicutes being associated more in clinics and Actinobacteriota in wards. The bacteria Niallia taxi, Methyloversatilis universalis, unclassified Rummeliibacillus, unclassified Clostridium, and unclassified Sphingomonadaceae dominated the clinic area while ward areas reported Pseudonocardia bannensis, Rubrobacter aplysinae, unclassified Brachybacterium, unclassified Bradyrhizobium, and unclassified Mycobacterium to be the top five features. While the alpha-diversity index showed no significant differences, the beta-diversity analysis showed a significant difference between clinic and ward areas (p

Alzheimer’s disease (AD), which is characterized by deterioration in cognitive function and neuronal death, is the most prevalent age-related progressive neurodegenerative disease. Clinical and experimental research has revealed that gut microbiota dysbiosis may be present in AD patients. The changed gut microbiota affects brain function and behavior through several mechanisms, including tau phosphorylation and increased amyloid deposits, neuroinflammation, metabolic abnormalities, and persistent oxidative stress. The lack of effective treatments to halt or reverse the progression of this disease has prompted a search for non-pharmaceutical tools. Modulation of the gut microbiota may be a promising strategy in this regard. This review aims to determine whether specific dietary interventions, particularly antioxidant vitamins, either obtained from the diet or as supplements, may support the formation of beneficial microbiota in order to prevent AD development by contributing to the systemic reduction of chronic inflammation or by acting locally in the gut. Understanding their roles would be beneficial as it may have the potential to be used as a future therapy option for AD patients.

Colorectal cancer poses a significant threat to global health, necessitating the development of effective early detection techniques. However, the potential of the fungal microbiome as a putative biomarker for the detection of colorectal adenocarcinoma has not been extensively explored. We analyzed the viability of implementing the fungal mycobiome for this purpose. Biopsies were collected from cancer and polyp patients. The total genomic DNA was extracted from the biopsy samples by utilizing a comprehensive kit to ensure optimal microbial DNA recovery. To characterize the composition and diversity of the fungal mycobiome, high-throughput amplicon sequencing targeting the internal transcribed spacer 1 (ITS1) region was proposed. A comparative analysis revealed discrete fungal profiles among the diseased groups. Here, we also proposed pipelines based on a predictive model using statistical and machine learning algorithms to accurately differentiate colorectal adenocarcinoma and polyp patients from normal individuals. These findings suggest the utility of gut mycobiome as biomarkers for the detection of colorectal adenocarcinoma. Expanding our understanding of the role of the gut mycobiome in disease detection creates novel opportunities for early intervention and personalized therapeutic strategies for colorectal cancer. • Detailed method to identify the gut mycobiome in colorectal cancer patients using ITS-specific amplicon sequencing. • Application of machine learning algorithms to the identification of potential mycobiome biomarkers for non-invasive colorectal cancer screening. • Contribution to the advancement of innovative colorectal cancer diagnostic methods and targeted therapies by applying gut mycobiome knowledge.

The exposure of the air microbiome in indoor air posed a detrimental health effect to the building occupants compared to the outdoor air. Indoor air in hospitals has been identified as a reservoir for various pathogenic microbes. The conventional culture-dependent method has been widely used to access the microbial community in the air. However, it has limited capability in enumerating the complex air microbiome communities, as some of the air microbiomes are uncultivable, slow-growers, and require specific media for cultivation. Here, we utilized a culture-independent method via amplicon sequencing to target the V3 region of 16S rRNA from the pool of total genomic DNA extracted from the dust samples taken from hospital interiors. This method will help occupational health practitioners, researchers, and health authorities to efficiently and comprehensively monitor the presence of harmful air microbiome thus take appropriate action in controlling and minimizing the health risks to the hospital occupants. Key features; • Culture-independent methods offer fast, comprehensive, and unbias profiles of pathogenic and non-pathogenic bacteria from the air microbiomes. • Unlike the culture-dependent method, amplicon sequencing allows bacteria identification to the lowest taxonomy levels.

Green honey, was discovered on Banggi Island, Sabah, showing high in essential amino acids and chlorophyll derivatives. Despite its lucrative market potential owing to its distinctive color, uncertainties persist regarding its nature. This study leverages amplicon sequencing by targeting micro- and macro-organisms present in honey environmental DNA (eDNA) using Internal Transcribed Spacer 2 (ITS2) region, enabling the identification of floral and microorganism sources that represent the honey's composition. The investigation into green honey from Banggi Island concerns the prevalence of honey adulteration and authenticity for economic gain. Adulteration methods, such as the addition of sugar syrups, compromise honey purity. Using a sequencing approach would help in determining the geographic origin and verifying the authenticity of the honey. The study aims to identify plant species or microorganisms in honey's eDNA. To authenticate honey, we utilized ITS2 with Illumina sequencing, exploring the diversity of green honey samples. Raw sequence reads obtained for the green honey sample revealed 1,438,627 raw reads, with a GC average of 49.22 %. A total of 44 amplicon sequence variances (ASVs) were identified, including three genera: Zygosaccharomyces with two species, Fraxinus with three species, and the genus Ficaria with only one species. Their respective relative abundances were 98.55%, 0.94%, and 0.51%. Zygosaccharomyces rouxii and Zygosaccharomyces mellis were identified as the pre-dominant yeast species in honey, while the Fraxinus and Ficaria genus represent common plant species in Sabah, particularly in Banggi Island. The dominance of Zygosaccharomyces species aligns with their known prevalence in honey, affirming the reliability of our findings. The presence of Fraxinus and Ficaria in the honey sample correlates with its abundance in the local environment. This amplicon sequencing approach not only contributes to our understanding of green honey composition but also serves as a valuable resource for authenticating honey origin in Malaysia, particularly for green honey from Banggi Island, Sabah. Our study pioneers the application of ITS2 amplicon sequencing for green honey amplicon sequencing, providing valuable insights into its composition and origin. This methodology, with a focus on eDNA, contributes to the authentication and quality determination of honey in Malaysia, addressing the pressing concerns of adulteration and variability in production practices.

Zebrafish is a developing vertebrate model with several advantages, including its small size, and high experimental efficiency. Malaysia exhibit one of the highest diabetes rates in the Western Pacific and incurring an annual cost of 600 million US dollars. The objective of the study is to determine the antidiabetic properties of green honey (GH) using a zebrafish model. Adult zebrafish, aged 3–4 months, were subjected to overfeeding and treated with streptozotocin (STZ) through intraperitoneal injection (IP) on days 7 and 9. The study assessed the oral sucrose tolerance test (OSTT) and the anti-diabetic effects of green honey. The evaluation was conducted at three time points: 30, 60, and 120 min after treatment and sucrose administration. The study utilised a model with a sample size of 5. The study was performed in six groups. These groups are (1) Normal control (non-diabetic, no intervention), (2) Normal control + GH (non-diabetic, supplemented with GH 3 μl), (3) DM control (diabetic, no intervention), (4) DM Gp1 (diabetic, 3 μL GH), (5) DM Gp2 (diabetic, 6 μ L GH), (6) DM Acarbose (diabetic, treated with acarbose). Fasting blood glucose levels for non-diabetic (non-DM) and diabetic (DM) groups were evaluated before and after the 10 days of diabetic induction. DM groups (excess of food and two injections of STZ) have caused a significant increment in the fasting blood glucose to 11.55 mmol/l (p

This study aimed to reveal the Dayah Perbatasan innovation based on the concept of organization development. Dayah Perbatasan is a government-affiliated Islamic boarding school educational institution. Operatively, Dayah Perbatasan is under Aceh province's education department. The research method used in descriptive qualitative approach. The subject of this study were pesantren leaders, school principal, vice of curriculum and pesantren senior teacher. The data collection technique used observation, interviews, focus group interviews and analysis of documentation materials. The data were analyzed by using the constant comparative analysis method. Based on the result, there were three innovations in the Dayah Perbatasan, first work engagement; second, leadership trust and the last organization management; These three innovations could lead the Dayah Perbatasan to be an innovative Islamic Boarding School in Aceh Province. This study has the originality of the concept value of developing pesantren government-style. In addition, the study adopted the development theory of change management organizations integrated with various factors related to boarding school changes.

Abstract Titanium tetrachloride (TiCl4) pretreatment on the fluorine‐doped tin oxide (FTO) is one of the alternative techniques to enhance short‐circuit current density (Jsc) and efficiency of dye‐sensitised solar cells (DSSC) by improving the inter‐particle bonding between FTO grain and nanoporous titanium dioxide (TiO2). The present study investigbrkates the effect of TiCl4 pretreatment on the surface of FTO glass to enhance the Jsc and efficiency of silver‐titanium dioxide (Ag‐TiO2) nanocomposites. The pretreatment process was prepared by immersing FTO glass into TiCl4 solution at 70°C for 30 min, and then sintered at 500°C for 30 min. Morphological and elemental characteristics were done to observe the structure and composition of pretreatment on the FTO glass. The results showed that the Ag‐TiO2 with TiCl4 pretreatment achieved high efficiency of 7.27% with Jsc of 18.95 mA/cm2. The proposed method shows that the pretreatment can improve the efficiency by improving the inter‐particle bonding between nanoporous TiO2 and FTO grain, which can enhance the electron transfer. Also, the presence of Ag in the nanocomposites as a solar concentrator can increase the light absorption by TiO2 nanoparticles and also increase the DSSC efficiency.

We investigate the dynamics of high energy dual regime unidirectional Erbium-doped fiber laser in ring cavity, which is passively Q-switched and mode-locked through the use of an environmentally friendly graphene filament–chitin film-based saturable absorber. The graphene–chitin passive saturable absorber allows the option for different operating regimes of the laser by simple adjustment of the input pump power, yielding, simultaneously, highly stable and high energy Q-switched pulses at 82.08 nJ and 1.08 ps mode-locked pulses. The finding can have applications in a multitude of fields due to its versatility and the regime of operation that is on demand.

Turbofan engines have been the dominant type of engine in aircraft for the last forty years. Ensuring the quality of these engines is crucial for flight safety, particularly for long-distance flights. However, their performance degrades over time, impacting flight safety. To address this issue, it is essential to predict potential engine failures by estimating the Remaining Useful Life (RUL) of the engines Deep learning, especially Convolutional Neural Networks (CNNs), has demonstrated exceptional proficiency in handling intricate, non-linear data, leading to improved RUL predictionsdue to their ability to process complex and non-linear data. In this project, a 1-D CNN is used to predict RUL using the NASA C-MAPSS FD001 dataset, which consists of 3 settings and 21 sensors, though sensors with stagnant readings are excluded. The dataset is normalized using min-max and z-score methods, and then segmented into sequences for input into the 1-D CNN model. Various training scenarios were evaluated, with the best RMSE of 3.26 achieved using 10 epochs, a learning rate of 0.0001, and z-score normalization. The results indicate that feature selection can produce a lower RMSE compared to scenarios without feature selection. [ABSTRACT FROM AUTHOR]

An interactive multimedia-based e-module is an enhanced version of conventional modules incorporating information technology. It integrates navigation buttons and user instructions, enabling independent use by those at any location and time. This phenomenon facilitates the optimal implementation of learning in the digital literacy era. This study employed a quantitative design utilizing the preexperimental design research method. It specifically utilized a one-shot case study research form to examine the effectiveness of learning. Additionally, it employed the correlation analysis method to investigate the relationship between student responses and learning outcomes. This effort is achieved by utilizing interactive multimedia-based e-modules focused on the topic of building space in elementary school. A total of 24 fifth-grade students were included as research subjects. Moreover, the employed instruments consisted of tests of learning outcomes and questionnaires. The research data were evaluated using descriptive statistics, the N-Gain, and the correlation test. The findings indicated that using interactive multimediabased e-modules for teaching space-related content yielded significant positive effects on learning outcomes. The research data were analyzed using descriptive statistics, N-Gain, and correlation tests. The findings revealed that: 1) the utilization of interactive multimedia-based E-Modules for teaching space-related content is quite effective, resulting in significant improvements in learning outcomes falling within the medium category; and 2) there exists a strong and close relationship between student responses to the implementation of interactive multimedia-based E-Modules and their learning outcomes in mathematics learning at the elementary school level. [ABSTRACT FROM AUTHOR]

Argumentative writing is a fundamental aspect of undergraduate students' academic and scientific writing related to critical thinking and problem-solving skills. However, previous studies have shown that students face various difficulties with argumentative writing, such as unclear and illogical ideas, less-structured arguments, and unbalanced interpretation of issues, data, and evidence. This study aims to improve the argumentative writing skills of undergraduate students by integrating computer-supported argumentative writing tools, such as annotation, conversational agents (CAs), and collaborative concept maps, into an online learning management system. Since the study was conducted during the COVID-19 pandemic, these tools can support meaningful learning activities and investigation in argumentative writing. The researchers divided sixty participants into the experimental group (N = 30) and the control group (N = 30). The results showed that the experimental group's writing achievements outperformed the control group, and the three tools effectively improved the five elements of argumentative writing, including claims, grounds, warrants, backings, and rebuttal. Furthermore, a deep analysis found that the number of annotations, valid CAs' responses, and argument nodes on collaborative concept maps can significantly predict students' argumentative writing development. Moreover, students perceived that the incorporated tools could effectively improve their argumentative writing skills. [ABSTRACT FROM AUTHOR]

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This paper presents a humidity sensing based on perovskites nanostructured thin film for improved sensitivity and optical performance. The nickel-doped zinc thin oxide (NZTO) perovskites thin film was used as a sensing material for the humidity sensing application. The NZTO was deposited on borosilicate glass substrates via aerosol-assisted chemical vapour deposition (AACVD) and nickel (Ni) dopant with 2 %mol was added into the precursor solution. The optical performance was investigated by inserting the NZTO into the optical reflection cavity. The cavity comprises NZTO on the glass that placed in a fixed position in front of single-mode fiber (SMF) and SMF was adjusted using x-direction of the 3-axis stage to obtained different cavity lengths. The performance was evaluated from the free-spectral range (FSR) and extinction ratio (ER) of the different cavity lengths. Then, the cavity with an optimized length was placed inside the humidity chamber for sensing applications. The result shows that the optimized cavity length is 100 µm with FSR and ER of 12.05 nm and 7.247 dB. The sensitivity of the humidity sensing is 0.2657 nm/RH% indicates that the NZTO is an excellent candidate for humidity sensing application.

The prevalence of non-alcoholic fatty liver disease (NAFLD) has soared globally. As our understanding of the disease grows, the role of the gut-liver axis (GLA) in NAFLD pathophysiology becomes more apparent. Hence, we focused mainly on the small intestinal area to explore the role of GLA. We looked at how multi-strain probiotics (MCP® BCMC® strains) containing six different Lactobacillus and Bifidobacterium species affected the small intestinal gut microbiota, inflammatory cytokines, and permeability in NAFLD patients. After six months of supplementation, biochemical blood analysis did not show any discernible alterations in either group. Five predominant phyla known as Actinobacteria, Proteobacteria, Firmicutes, Bacteroidota and Fusobacteria were found in NAFLD patients. The probiotics group demonstrated a significant cluster formation of microbiota composition through beta-diversity analysis (p < 0.05). This group significantly reduced three unclassifiable species: unclassified_Proteobacteria, unclassified_Streptococcus, and unclassified_Stenotrophomonas. In contrast, the placebo group showed a significant increase in Prevotella_melaninogenica and Rothia_mucilaginosa, which were classified as pathogens. Real-time quantitative PCR analysis of small intestinal mucosal inflammatory cytokines revealed a significant decrease in IFN-γ (−7.9 ± 0.44, p < 0.0001) and TNF-α (−0.96 ± 0.25, p < 0.0033) in the probiotics group but an increase in IL-6 (12.79 ± 2.24, p < 0.0001). In terms of small intestinal permeability analysis, the probiotics group, unfortunately, did not show any positive changes through ELISA analysis. Both probiotics and placebo groups exhibited a significant increase in the level of circulating zonulin (probiotics: 107.6 ng/mL ± 124.7, p = 0.005 vs. placebo: 106.9 ng/mL ± 101.3, p = 0.0002) and a significant decrease in circulating zonula occluden-1 (ZO-1) (probiotics: −34.51 ng/mL ± 18.38, p < 0.0001 vs. placebo: −33.34 ng/mL ± 16.62, p = 0.0001). The consumption of Lactobacillus and Bifidobacterium suggested the presence of a well-balanced gut microbiota composition. Probiotic supplementation improves dysbiosis in NAFLD patients. This eventually stabilised the expression of inflammatory cytokines and mucosal immune function. To summarise, more research on probiotic supplementation as a supplement to a healthy diet and lifestyle is required to address NAFLD and its underlying causes.

This research demonstrated an ultrafast passively mode-locked thulium-holmium doped fibre laser (THDFL) using a carbon nanotube (CNT)-chitin composite film as a saturable absorber (SA). The CNTs were fabricated using ultrasonic-assisted liquid-phase exfoliation, and the chitin biopolymer was derived from oyster mushrooms (Pleurotus Ostreatus). The free-standing SA successfully performed a mode-locking operation at a threshold input pump power of 203 mW with an operating wavelength of 1908.53 nm. The generated mode-locked pulses had repetition rate, pulse width, and signal-to-noise ratio (SNR) values of 16 MHz, 1.1 ps, and 69 dB, respectively. The work demonstrates the potential of CNTs embedded in chitin biopolymer as a sustainable and environmentally friendly SA for a wide range of applications, particularly for pulsed lasers.

SARS-CoV-2 has spread throughout the world since its discovery in China, and Malaysia is no exception. WGS has been a crucial approach in studying the evolution and genetic diversity of SARS-CoV-2 in the ongoing pandemic. Despite considerable number of SARS-CoV-2 genome sequences have been submitted to GISAID and NCBI databases, there is still scarcity of data from Malaysia. This study aims to report new Malaysian lineages of the virus, responsible for the sustained spikes in COVID-19 cases during the third wave of the pandemic. Patients with nasopharyngeal and/or oropharyngeal swabs confirmed COVID-19 positive by real-time RT-PCR with CT value < 25 were chosen for WGS. The selected SARS-CoV-2 isolates were then sequenced, characterized and analyzed along with 986 sequences of the dominant lineages of D614G variants currently circulating throughout Malaysia. The prevalence of clade GH and G formed strong ground for the presence of two Malaysian lineages of AU.2 and B.1.524 that has caused sustained spikes of cases in the country. Statistical analysis on the association of gender and age group with Malaysian lineages revealed a significant association (p

Colorectal cancer (CRC) is a heterogeneous disease that commonly affects individuals aged more than 50 years old globally. Regular colorectal screening, which is recommended for individuals aged 50 and above, has decreased the number of cancer death toll over the years. However, CRC incidence has increased among younger population (below 50 years old). Environmental factors, such as smoking, dietary factor, urbanization, sedentary lifestyle, and obesity, may contribute to the rising trend of early-onset colorectal cancer (EOCRC) because of the lack of genetic susceptibility. Research has focused on the role of gut microbiota and its interaction with epithelial barrier genes in sporadic CRC. Population with increased consumption of grain and vegetables showed high abundance of Prevotella, which reduces the risk of CRC. Microbes, such as Fusobacterium nucleatum, Bacteroides fragilis and Escherichia coli deteriorate in the intestinal barrier, which leads to the infiltration of inflammatory mediators and chemokines. Gut dysbiosis may also occur following inflammation as clearly observed in animal model. Both gut dysbiosis pre- or post-inflammatory process may cause major alteration in the morphology and functional properties of the gut tissue and explain the pathological outcome of EOCRC. The precise mechanism of disease progression from an early stage until cancer establishment is not fully understood. We hypothesized that gut dysbiosis, which may be influenced by environmental factors, may induce changes in the genome, metabolome, and immunome that could destruct the intestinal barrier function. Also, the possible underlying inflammation may give impact microbial community leading to disruption of physical and functional role of intestinal barrier. This review explains the potential role of the interaction among host factors, gut microenvironment, and gut microbiota, which may provide an answer to EOCRC.

Dark pulse mode-locked Erbium doped fiber laser (EDFL) was demonstrated in this work by employing side polished fiber (SPF) coated with Ti _3 AlC _2 solution using drop casting method. The modulation depth of fabricated SPF coated with Ti _3 AlC _2 solution was characterized at 2.2%. This SPF coated structure allowed the formation of dark mode-locked pulse with improved the birefringence and nonlinearity in EDFL. The dark pulse generated was cubic-quintic nonlinear Schrödinger equation (CQNLSE) dark pulse with center wavelength at 1558.935 nm, repetition rate 1.839 MHz and pulse width 170.2 ns. Pulse stability was examined, revealing a high signal to noise ratio (SNR) of 65.86 dB. This work could serve as a foundation for the development of sustainable industry, innovation and infrastructure.

Background: Hirschsprung-associated enterocolitis (HAEC) is a major contributor in the mortality of Hirschsprung disease (HSCR) patients that can occur both preoperatively and post-operatively. Several cut-off values of HAEC score have been used, i.e., ≥10 and ≥4. Here, we compared the HAEC frequency after transanal endorectal pull-through (TEPT) using two cut-offs of scoring system and associated them with the risk factors.Methods: Cross-sectional analysis was conducted using medical records of HSCR patients who were aged ≤18 years old and underwent TEPT at our institution, Indonesia between 2009 and 2016. HAEC was determined using the scoring system with cut-off values of ≥10 and ≥4.Results: Seventy subjects were used in the final analysis, consisting of 44 males and 26 females. There was a significant difference in one HAEC finding between the ≥10 and ≥4 cut-off groups; diarrhea with explosive stools (p = 0.002). The HAEC frequency was 5/70 (7.1%) and 49/70 (70%) patients using cut-off values of ≥10 and ≥4 (p < 0.0001), respectively. We found that patients with anemia (i.e., iron deficiency anemia) had a higher risk of HAEC after TEPT than patients with normal hemoglobin level with OR of 3.77 (95% CI = 1.28–11.1; p = 0.027), while no associations were found between other variables, including sex, age at diagnosis, age at definitive therapy, albumin level, and nutritional status and HAEC following TEPT (p = 0.87, 0.15, 0.33, 0.26, and 0.60, respectively). Also, no associations were observed between maternal education level, mother's age at pregnancy and gestational age and HAEC after definitive surgery (p = 0.10, 0.46, and 0.86, respectively).Conclusions: This report is the first study comparing two different cut-off values of scoring system to evaluate the HAEC frequency after TEPT and results suggest further using cut-off of ≥4 to expand the diagnosis of HAEC. Moreover, we also show for the first time that hemoglobin level is a strong risk factor for the HAEC development after TEPT.