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Sumedh Jayanti,1,2 Gopala K Rangan1,2 1Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia; 2Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, AustraliaCorrespondence: Gopala K Rangan, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia, Email g.rangan@sydney.edu.auAbstract: Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice.Keywords: patient-centred care, chronic dialysis, kidney failure, patient preference, renal replacement therapy, innovation

Background: The Health and Family Welfare Department of Gujarat implemented a mHealth Programme called TeCHO+ (Technology for Community Health Operations) in 2018. TeCHO+ is aimed at making progress across all dimensions of the comprehensive primary healthcare services. Objective: The objective of this study is to record the document rollout and early implementation experience of TeCHO+ programme in Gujarat. Methods: The present participatory process documentation exercise was undertaken in Gujarat. The various steps for process documentation were decided after participation in multiple task force meetings and state/district- and taluka-level action seminars and reviewing the TeCHO+ programme data and progress reports. The perceptions of the health officials and field staff were gathered using key informant interviews from five districts of Gujarat: Bharuch, Narmada, Gandhinagar, Mahisagar, and The Dangs. In addition, stakeholders involved with TeCHO+ Programme were interviewed to understand the process of rollout, implementation challenges, and success. Results: In the initial phase, the TeCHO+ application focussed only on updating the Family Health Survey to improve the quality of data captured in the system. FHWs log-in the mobile application daily to access their daily work plan for which SMS alerts were are also generated. Most FHWs were in their 50s and were first-time smartphone users. Although, they were enthusiastic and open to the new technology, initially they faced certain difficulties in operating the application. The programme had a strong troubleshooting mechanism in terms of the use of WhatsApp group, helpline numbers, and voice calls in addition to supportive supervision. Discussion: TeCHO+ showed the potential to enhance the quality of the collected data and also service coverage. However, poor technology literacy of old FHWs, the launch of multiple programme memes at the same time, and target-driven task assignments pose major challenges.

This research aimed to make nanoparticles from Allium cepa. L extract that can inhibit Bcl-2 protein expression in MCF-7 cells in vitro. The particles were broken down to nano with the addition of NaTPP dissolved in distilled water and chitosan dissolved in 1% acetic acid. The particle size based on the SEM and PSA tests had an average size of 336 nm. Nanoparticles from Allium cepa. L extract based on the KLT test contained flavonoids, saponins, and tannins. MCF-7 cells were treated with doses of 40 μg/ml, 80 ug/ml, 160 ug/ml, and 320 ug/ml. The results showed that nanoparticles from Allium cepa. L extract had cytotoxicity in MCF-7 cells with the IC50 value of 235 μg/ml and proved to inhibit Bcl-2 protein expression.

Purpose: Middle leadership is difficult to define and fathom as these roles are fluid, adapting to the context of individual schools. However, little is known about the relationships among middle leadership, teacher commitment and job satisfaction in the field of education. The purpose of this paper is to propose a conceptual framework on the mediating role of teacher job satisfaction in the relationship between middle leadership and teacher commitment in schools based on past research, particularly in the context of schools. Design/methodology/approach: A review of literature was undertaken to develop the conceptual framework. Findings: Findings suggested that middle leadership can positively influence teacher commitment via the mediating effect of teacher job satisfaction. Originality/value: The value of this paper lies in understanding middle leadership as a salient factor in influencing teacher commitment via teacher job satisfaction. This paper's framework lays a strong foundation for the expansion of the middle leadership knowledge base on middle leadership as well as for future theory development and debate.

Aloe (Aloe barbadensis Mill.) is commercially cultivated for its transparent leaf gel and leaf exudates. The leaf exudates collected from epidermal layer contain anthraquinone glycosides (aloins) mainly barbaloin (aloin A) and isobarbaloin (aloin B). Aloin A is used as a raw material for the production of diacylrhein, a potent drug prescribed for rheumatoid arthritis. Conventional drying of leaf exudates in open sun causes changes in physicochemical properties and altered aloin A and B composition. Various drying techniques, viz. oven drying, freeze drying, shade drying and open sun drying were employed to evaluate the qualitative and physico-chemical changes in final product of aloe leaf exudates. Freeze drying resulted in high quality dried exudates having maximum aloin A content of 54.16%. The other three drying techniques resulted in lower aloin A content in the final dried product of leaf exudates. Fresh aloe exudates contained lower amount of aloin B (4.65% w/v). Sun drying increased aloin B content to 17.73% (to the extent of 2.27 fold) in the final product compared to freeze drying. Shade drying and sun drying lowered the total aloin content by 13.2% and 8% respectively compared to freeze dried exudates. Freeze drying is the most efficient technique to obtain high quality dried aloe exudates having good textural and physicochemical property. Alternately, shade drying with proper ventilation can be employed to get acceptable final product with marginally lower (8%) total aloin content compared to freeze drying.

Banks have a very important role in the economy. Not only as financial intermediaries. They have also played a big role in the effectiveness of monetary policy. Therefore, bank stability is very important. This research aims to determine the influence of micro-prudential variables represented by CAR, NPL, and LDR variables, as well as the influence of macro-prudential variables represented by the Rupiah exchange rate variable against USD, inflation, interest rates, and IHSG, on bank stability in Indonesia, both in the short and long term. Using the vector error correction model (VECM) analysis technique, this research provides results that microprudential variables and macroprudential variables are both proven to have an influence on banking stability in Indonesia. Micro-prudential indicators such as CAR and LDR have been proven to have a positive effect on banking stability. Meanwhile, NPLs have a negative effect on banking stability. Likewise for macro-prudential indicators: the exchange rate and inflation have a negative effect on financial system stability. Meanwhile, interest rates and IHSG have a positive effect on banking stability. The impact of surprises or shocks that occur in micro-prudential and macro-prudential variables on banking stability is permanent. The implication of the findings in this research is that Bank Indonesia and the Financial Services Authority have a very large role in achieving banking stability in Indonesia.

Kemajuan ilmu pengetahuan dan teknologi mau tidak mau telah merubah paradigma dunia pendidikan khususnya dalam proses belajar mengajar di kelas. Proses pembelajaran saat ini dituntut untuk relevan dengan kemajuan zaman, sehingga dapat menciptakan pembelajaran yang berkualitas. Dengan demikian sebagai orang yang memiliki peran penting dalam keberhasilan pembelajaran, guru harus mampu merespon perubahan global ini dengan baik, misalnya dengan menyediakan media pembelajaran berbasis teknologi. Tidak dapat dipungkiri bahwa fakta di lapangan masih banyak ditemukan guru yang belum melek teknologi, sebagai salah satu bentuk upaya mengatasi tantangan tersebut adalah dilakukan pelatihan dan workshop pemanfaatan media pembelajaran interaktif bagi guru-guru. Pelatihan dilakukan selama dua hari melalui metode ceramah, diskusi dan pelatihan (praktik) pembuatan media pembelajaran interaktif. Hasil dari kegiatan pelatihan menunjukkan: 1) peserta aktif mendengar dan berdiskusi terkait materi yang disampaikan, 2) peserta sangat antusias dalam mengikuti pelatihan praktik membuat media pembelajaran interaktif. Selain itu, selama pelatihan berlangsung ada beberapa kendala yang dihadapi, di antaranya yaitu peserta belum terbiasa memanfaatkan teknologi dan keterbatasan waktu. Berdasarkan hasil ini dapat disimpulkan bahwa peserta sudah mampu membuat media pembelajaran interaktif, hanya saja beberapa guru memerlukan waktu lebih banyak untuk memperoleh hasil yang lebih baik.