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Arterial desaturation following surgical repair of tetralogy of Fallot (TOF) is rare. In most instances, it results from residual right ventricular outflow tract obstruction, causing right-to-left shunt across residual interatrial or interventricular communication. In this report, we present an unusual scenario of arterial desaturation due to a recanalized left cardinal vein in a child with repaired TOF. We also discuss stepwise evaluation that led to successful identification and occlusion of the abnormal venous channel by percutaneous device closure.

We perform an analysis on an M/G/1 system that has bulk arrival Poisson process as well as instantaneous service, Precipitous breakdown and random repair, Gqueue, and operation under an MBV (Modified Bernoulli vacation) policy. The positive outcome of a customer retrial is lost when an Anti-positive customer arrives during a positive (good) customer’s assistance period. If a new customer enters and notices that the server is currently undergoing repairs or on vacation, they may renege or balk from the system. To obtain a wide variety of additional outcomes, we use the details provided by the supplementary variable method regarding the rates at which different events occur and it is possible to determine the probability-generating functions of queue length distributions as well as the explicit formulations of important performance metrics. The numerical data confirm the analytical findings about the major performance metrics.

Laboratory classes form an important aspect of bioscience education. However, this environment is challenging for students due to cognitive load and lack of confidence. Familiarising students with aspects of their laboratory classes prior to the session can improve this. This study compares the pre-laboratory scaffolding that bioscience and chemistry students experience across UK HE institutions. Typically, bioscience modules used fewer types of activities than chemistry although reading the protocol was the most common activity for both disciplines. Within bioscience, pre-laboratory activities differed by level: first year undergraduates were more likely to be asked to read the protocol, watch videos or do calculation practice in their modules whereas final year undergraduates were more likely to experience experimental design or contextualised activities. Alongside this, this paper discusses an institutional case study of the development and evaluation of technical laboratory videos as pre-laboratory scaffolding for first year students. These were found to benefit both student focus and enhance confidence: implying that using the videos impacted on cognitive load and hence learning. Exploring barriers to the uptake of these resources identified a lack of awareness of them as a major factor, suggesting that greater integration of such resources would enhance engagement and impact.

We are witnessing environmental degradation on a massive scale. Popular reactions to the devastation of our natural surroundings are a ubiquitous image in newscasts everywhere, and yet nations and institutions seem unable to cohere around programs to stop the looming disaster. American author John Grisham, an attorney by profession, elaborates on this issue in his novel The Appeal (2008). Grisham meticulously describes the human tragedy of a degrading bio-region and provides insights into the gradual process of contemporary environmental litigation. Grisham provides a panoramic view on the lives of people in Cary County, the place where a corporate toxic waste dump has caused massive groundwater pollution. The use of polluted drinking water destroys many lives and creates the worst cancer cluster in history. Plaintiff Jeannette Baker, along with her suffering neighbours, seeks justice through legal means against the corporate companies for the loss of life caused by corporate interests. The author makes us witnesses to the long judicial process that gathers a motley group of people with conflicting interests: victims, local authorities, and corporation representatives. They come together to analyse and acknowledge their role in the process of environmental devastation.

The aim of this article is to report on the Foundation Phase (FP) teachers' professional identities in two primary schools in the Western Cape. This is meant to serve as a basis for understanding teachers' identities with regard to their teaching experience, qualifications, specialised knowledge base, and ongoing professional development. The article is based on data collected by means of a questionnaire and semi-structured interviews with the FP teachers in two township schools where isiXhosa is used as the medium of instruction in the Foundation Phase (Grades R to Three). We argue that while teacher identity research has received attention across the globe in the past four decades, little is known about the implications of teacher professional identity for literacy teaching in South African classrooms, especially where an African language is used as a language of learning and teaching. Our findings reveal the pluricentric nature of the FP teachers' qualifications and backgrounds. We conclude that FP teachers' professional identity (TPI) cannot be conceptualised in a simplistic and unidimensional way, but can be viewed as an intersectional construct that impacts on literacy instructional practices.

The ongoing wars in many regions—such as the conflict between Israel and Hamas—as well as the effects of war on communities, social services, and mental health are covered in this special editorial. This article emphasizes the need for international efforts to promote peace, offer humanitarian aid, and address the mental health challenges faced by individuals and communities affected by war and violence.

Objective The current study explored (1) changes in trust in federal and state governments and scientists across representative Australian national samples from 2003–2020; and (2) the extent to which trust in these sources predicted compliance with COVID-19 prevention measures at the onset of the pandemic. Method Using a nationally representative samples (N = 1000), we asked participants to rate their trust in federal and state government and in scientists, their extent of compliance with COVID-19 prevention measures, and to provide demographic information. Results We found that trust in federal and state governments had significantly increased, while trust in scientists was at a high level matched by only three other time-points. Higher levels of trust in state government and scientists uniquely predicted greater compliance with COVID-19 prevention measures. Women and older respondents also reported greater compliance. Conclusion The current findings reinforce those from Australia and other countries indicating that trust increased during the onset of the COVID-19 pandemic, and those identifying trust in government and in scientists as important predictors of compliance. Importantly, our findings highlight the role of trust in state government, which potentially reflects the role played by Australian state governments in enacting and enforcing COVID-19 prevention measures.

Any problem is a problem until a solution is designed and implemented. This paper reports on a workshop that highlights preliminary work done by the working group on Gamification in the scope of European Network for Academic Integrity (ENAI), which aims to explore the possibility of developing and testing a gamified learning module on academic integrity values. In this paper, the group aims to look at proposing steps we are currently using to develop storyboards of scenarios for the first phase of the project, which were presented at the 6th International Conference Plagiarism Across Europe and Beyond 2020 held virtually in Dubai as a workshop. The study also presents updated findings and scenarios drawn from the workshop conducted and audience feedback, in the following sections that pave the way for the future stages of the gamification process. This serves as a guide to academics and researchers in academic integrity who may wish to study gamification and apply it to develop their own modules for their learning modules.

The data produced by the scientific community impacts on academia, clinicians, and the general public; therefore, the scientific community and other regulatory bodies have been focussing on ethical codes of conduct. Despite the measures taken by several research councils, unethical research, publishing and/or reviewing behaviours still take place. This exploratory study considers some of the current unethical practices and the reasons behind them and explores the ways to discourage these within research and other professional disciplinary bodies. These interviews/discussions with PhD students, technicians, and academics/principal investigators (PIs) (N=110) were conducted mostly in European higher education institutions including UK, Italy, Ireland, Portugal, Czech Republic and Netherlands. Through collegiate discussions, sharing experiences and by examining previously published/reported information, authors have identified several less reported behaviours. Some of these practices are mainly influenced either by the undue institutional expectations of research esteem or by changes in the journal review process. These malpractices can be divided in two categories relating to (a) methodological malpractices including data management, and (b) those that contravene publishing ethics. The former is mostly related to "committed bias", by which the author selectively uses the data to suit their own hypothesis, methodological malpractice relates to selection of outdated protocols that are not suited to the intended work. Although these are usually unintentional, incidences of intentional manipulations have been reported to authors of this study. For example, carrying out investigations without positive (or negative) controls; but including these from a previous study. Other methodological malpractices include unfair repetitions to gain statistical significance, or retrospective ethical approvals. In contrast, the publication related malpractices such as authorship malpractices, ethical clearance irregularities have also been reported. The findings also suggest a globalised approach with clear punitive measures for offenders is needed to tackle this problem.

Ethics and ethical behaviour are the fundamental pillars of a civilised society. The focus on ethical behaviour is indispensable in certain fields such as medicine, finance, or law. In fact, ethics gets precedence with anything that would include, affect, transform, or influence upon individuals, communities or any living creatures. Many institutions within Europe have set up their own committees to focus on or approve activities that have ethical impact. In contrast, lesser-developed countries (worldwide) are trying to set up these committees to govern their academia and research. As the first European consortium established to assist academic integrity, European Network for Academic Integrity (ENAI), we felt the importance of guiding those institutions and communities that are trying to conduct research with ethical principles. We have established an ethical advisory working group within ENAI with the aim to promote ethics within curriculum, research and institutional policies. We are constantly researching available data on this subject and committed to help the academia to convey and conduct ethical behaviour. Upon preliminary review and discussion, the group found a disparity in understanding, practice and teaching approaches to ethical applications of research projects among peers. Therefore, this short paper preliminarily aims to critically review the available information on ethics, the history behind establishing ethical principles and its international guidelines to govern research. The paper is based on the workshop conducted in the 5th International conference Plagiarism across Europe and Beyond, in Mykolas Romeris University, Lithuania in 2019. During the workshop, we have detailed: (1) basic needs of an ethical committee within an institution; (2) a typical ethical approval process (with examples from three different universities); and (3) the ways to obtain informed consent with some examples. These are summarised in this paper with some example comparisons of ethical approval processes from different universities. We believe this paper will provide guidelines on preparing and training both researchers and research students in appropriately upholding ethical practices through ethical approval processes.

COVID-19 pandemic had an impact on many day-to-day activities but one of the biggest collateral impacts was felt by the education sector. The nature and the complexity of higher education is such that no matter how prepared we are as faculty, how planned our teaching and assessments, faculty are all too aware of the adjustments that have to be made to course plans, assessments designed, content delivery strategies and so on once classes begin. Faculties find themselves changing, modifying and deviating from original plans to ensure accessibility and inclusiveness, this may be due to a variety of reasons such as student abilities, behaviour, disturbances and even outside factors that may be political, environmental, social etc. Majority of the time, faculty are prepared for the change that needs to be incorporated and are quick to adjust. However, no one expected the disruption to education that was caused by COVID-19 pandemic. The world came to a standstill while schools and universities scrambled to push learning to the digital space. It was important to try to ensure continuity of learning for students, but the issue of integrity came to the forefront by summertime. Faculties were suddenly expected to restructure their lessons, delivery, teaching and assessing digitally, at the same time ensuring and upholding integrity of the concepts taught and assessed. This has neither been easy or straightforward because the situation was unprecedented with little or no prior documentation or guidelines to help. Recognising this gap, this paper is an attempt at providing exploratory findings from authors' experiences in their respective institutions over the ensuing months. The paper attempts to record the changes made by the faculty and colleagues to lessons and assessments with particular focus on how technology has been used to help restructure classes, deliver lessons and assess students which have aided in minimizing the likelihood of students cheating. The paper further narrates the reflective changes that were made in response to experience, student/external examiners feedback etc.

Music plagiarism is defined as using tune, or melody that would closely imitate with another author's music without proper attributions. It may occur either by stealing a musical idea (a melody or motif) or sampling (a portion of one sound, or tune is copied into a different song). Unlike the traditional music, the Indian cinematic music is extremely popular amongst the public. Since the expectations of the public for songs that are enjoyable are high, many music directors are seeking elsewhere to "borrow" tunes. Whilst a vast majority of Indian cinemagoers may not have noticed these plagiarised tunes, some journalists and vigilant music lovers have noticed these activities. This study has taken the initiative to investigate the extent of plagiaristic activities within one Indian cinematic music industry. A list of plagiarised songs was produced by using YouTube® searches for "comparative videos" made by the vigilant music lovers about accused/detected music plagiarism. Some of these individuals were also interviewed to understand their views on this. During the investigation, it was possible to identify a vast number of plagiarised tunes, snippets, or even the full songs. In fact, some of these examples' dates to 1954, during the era when no one would have noticed plagiarism. The paper would highlight the similarities of these music files. It will also show some examples of the excuses/denial given by the composers and would try to highlight the attitudes of general public towards these types of activities.

Objectives: Patients with ST elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs; dyslipidaemia, hypertension, diabetes mellitus and smoking) are reported to have a worse clinical outcome compared to those with SMuRFs. However, robust prospective data and low-and middle-income country perspective are lacking. We aimed to study the patients with first STEMI and assess the influence of SMuRFs on clinical outcomes by comparing the patients with and without SMuRFs. Methods: We included all consecutive STEMI patients without prior coronary artery disease enrolled in the Madras Medical College STEMI Registry from September 2018 to October 2019. We collected baseline clinical characteristics, revascularisation strategies and clinical outcome. We analysed suboptimal self-reported sleep duration as a 5th extended SMuRF (eSMuRF). Primary outcome was in-hospital mortality. Secondary outcomes included in-hospital complications and one-year all-cause mortality. Results: Among 2,379 patients, 605 patients (25.4%) were SMuRF-less. More women were SMuRF-less than men (27.1% vs 22.1%; P = 0.012). SMuRF-less patients were older (57.44 ± 13.95 vs 55.68 ± 11.74; P < 0.001), more often former tobacco users (10.4% vs 5.0%; P < 0.001), with more anterior wall MI (62.6% vs 52.1%; P = 0.032). The primary outcome [in-hospital mortality (10.7% vs 11.3%; P = 0.72)] and secondary outcomes [in-hospital complications (29.1% vs 31.7%; P = 0.23) and one-year all-cause mortality (22.3% vs 22.7%; P = 0.85)] were similar in both groups. Addition of suboptimal self-reported sleep duration as a 5th eSMuRF yielded similar results. Conclusions: 25% of first STEMI patients were SMuRF-less. Clinical outcomes of patients without SMuRFs were similar to those with SMuRFs. Suboptimal sleep duration did not account for the risk associated with the SMuRF-less status.

IntroductionThe COVID-19 pandemic has become the greatest challenge of the new millennium. Most healthcare workers (HCWs) experienced unprecedented levels of workload since the pandemic. This study aims to identify the prevalence and factors of depression, anxiety and stress among HCWs in Malaysian healthcare facilities in the midst of the pandemic due to the SARs-CoV-2.MethodsAn emergency response programme on mental health was conducted from June to September 2020. A standardized data collection form was distributed among the HCWs in the government hospital in Klang Valley. The form contained basic demographic information and the self-reported Malay version of the Depression, Anxiety and Stress scale (BM DASS-21).ResultsOf the1,300 staff who attended the Mental Health and Psychosocial Support in Covid-19 (MHPSS COVID-19) programme, 996 staff (21.6% male, 78.4% female) completed the online survey (response rate: 76.6%). Result showed that staff aged above 40 years old were almost two times more likely to have anxiety (AOR = 1.632; 95% CI = 1.141-2.334, p:0.007) and depression (AOR = 1.637; 95% CI = 1.1.06-2.423, p:0.014) as compared to staff who were less than 40 years old. Those who had direct involvement with COVID-19 patients were likely to suffer stress (AOR = 0.596; 95% CI = 0.418-0.849, p:0.004), anxiety (AOR = 0.706; 95% Ci = 0.503-0.990, p:0.044) and depression (AOR = 0.630; 95% Ci = 0.427-0.928, p:0.019). HCWs with stress (AOR = 0.638; 95% CI of 0.476-0.856, p = 0.003), anxiety (AOR = 0.720; 95% CI 0.542-0.958, p = 0.024) and depression (AOR = 0.657; 95% CI 0.480-0.901, p = 0.009) showed less confidence to treat critically ill patients and need psychological help during outbreak.ConclusionThis study showed the importance of psychosocial support to reduce psychological distress among HCWs when working or coping during the COVID-19 pandemic or outbreak.

Interstitial lung disease is characterised by a combination of cellular proliferation, inflammation of the interstitium and fibrosis within the alveolar wall. A 58-year-old man was referred for lung transplantation after developing worsening dyspnoea and progressive hypoxaemic respiratory failure from idiopathic pulmonary fibrosis. Three years later, he developed desquamative interstitial pneumonia in his transplanted lungs, and despite augmentation of immune suppression, he had a progressive decline in his lung function and exercise capacity. Interestingly, in our case, the histopathology obtained post transplant strongly goes against the recurrence of usual interstitial pneumonia/idiopathic pulmonary fibrosis; rather, two separate interstitial disease processes have been identified.

Summary: Background: Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods: This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings: In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation: Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding: DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

The last two decades have witnessed a skyrocketing growth in digital marketing that made customers interested in purchasing products particularly electronic goods. However, it is not known whether those customers attained satisfaction through this purchase. To confirm the fact, this research has attempted to analyze the retention rate of digital marketing customers who have experience in purchasing electronic goods and for this purpose, 603 consumers of Tamilnadu (India) who have the purchase experience on a digital marketing basis were selected on a simple random basis. Tools like structural equation modeling, percentage analysis, one-way ANOVA, and paired sample ‘t’ test were applied and the result revealed that only customer satisfaction has mediated the influence of digital marketing on their loyalty but, the important parameter, trust has a negative role between these constructs. Marketers need to create trust about the product with the actual features as informed in digital marketing so that consumers can reach a high level of satisfaction and this may lead to a positive word of mouth. In addition, this enhances sales and enables marketers to attain profit maximization along with building consumer confidence.

Integration of technology is widespread in laboratory teaching, whose purpose includes building theoretical understanding and practical skills. How second-year bioscience undergraduate students at a UK university use technology to construct their understanding of laboratory-based topics was investigated using a concurrent think-aloud protocol in the laboratory, followed by semi-structured interviews. Analysis of think-aloud data used socially shared metacognitive coding since students may co-construct their understanding in these collaborative spaces. This analysis demonstrated that participants used technology within the laboratory either as a tool to conduct their experiment or, as a source of information to help them understand, apply or perform their experimental task. Semi-structured interviews demonstrated that students integrated technology into all aspects of their laboratory learning. Eight out of the ten participants described using technology to help them make connections between theory and practice as part of post-laboratory activities such as analysing or conducting further research on the topic. A survey of UK bioscience undergraduate modules found that 22% of modules did not use post-laboratory activities, suggesting that more scaffolding of post-laboratory activities could provide bioscience students with greater integration of practical and theoretical understanding and consequently meaningful laboratory learning.

Abstract Background Cotard’s syndrome (CS) is a neuropsychiatric condition marked by nihilistic delusional(s). Due to its rarity, misdiagnosis of the syndrome often occurs. The current case study is of a Malaysian woman who was misdiagnosed for several years by professionals due to the presence of hypochondriac symptoms before receiving the correct diagnosis. Case presentation In this case presentation, we describe the case of L, a 42-year-old Malaysian lady who was first misdiagnosed with depression. The diagnosis of schizophrenia and CS was confirmed after thorough clinical examination, diagnostic investigations, and deliberation at a departmental forum. The patient improved after receiving electroconvulsive therapy (ECT) along with antipsychotic medications. Conclusions This case study highlights the importance of early recognition of CS by professionals as it can save time for both parties when setting up a treatment plan. Essentially, early recognition of CS in schizophrenia is paramount in the process of rapid stabilization through ECT and promotion of patient recovery.

Abstract Covid-19 pandemic had an impact on many day-to-day activities but one of the biggest collateral impacts was felt by the education sector. The nature and the complexity of higher education is such that no matter how prepared we are as faculty, how planned our teaching and assessments, faculty are all too aware of the adjustments that have to be made to course plans, assessments designed, content delivery strategies and so on once classes begin. Faculties find themselves changing, modifying and deviating from original plans to ensure accessibility and inclusiveness, this may be due to a variety of reasons such as student abilities, behaviour, disturbances and even outside factors that may be political, environmental, social etc. Majority of the time, faculty are prepared for the change that needs to be incorporated and are quick to adjust. However, no one expected the disruption to education that was caused by COVID19 pandemic. The world came to a standstill while schools and universities scrambled to push learning to the digital space. It was important to try to ensure continuity of learning for students, but the issue of integrity came to the forefront by summertime. Faculties were suddenly expected to restructure their lessons, delivery, teaching and assessing digitally, at the same time ensuring and upholding integrity of the concepts taught and assessed. This has neither been easy or straightforward because the situation was unprecedented with little or no prior documentation or guidelines to help. Recognising this gap, this paper is an attempt at providing exploratory findings from authors’ experiences in their respective institutions over the ensuing months. The paper attempts to record the changes made by the faculty and colleagues to lessons and assessments with particular focus on how technology has been used to help restructure classes, deliver lessons and assess students which have aided in minimizing the likelihood of students cheating. The paper further narrates the reflective changes that were made in response to experience, student/external examiners feedback etc.

Abstract Ethics and ethical behaviour are the fundamental pillars of a civilised society. The focus on ethical behaviour is indispensable in certain fields such as medicine, finance, or law. In fact, ethics gets precedence with anything that would include, affect, transform, or influence upon individuals, communities or any living creatures. Many institutions within Europe have set up their own committees to focus on or approve activities that have ethical impact. In contrast, lesser-developed countries (worldwide) are trying to set up these committees to govern their academia and research. As the first European consortium established to assist academic integrity, European Network for Academic Integrity (ENAI), we felt the importance of guiding those institutions and communities that are trying to conduct research with ethical principles. We have established an ethical advisory working group within ENAI with the aim to promote ethics within curriculum, research and institutional policies. We are constantly researching available data on this subject and committed to help the academia to convey and conduct ethical behaviour. Upon preliminary review and discussion, the group found a disparity in understanding, practice and teaching approaches to ethical applications of research projects among peers. Therefore, this short paper preliminarily aims to critically review the available information on ethics, the history behind establishing ethical principles and its international guidelines to govern research. The paper is based on the workshop conducted in the 5th International conference Plagiarism across Europe and Beyond, in Mykolas Romeris University, Lithuania in 2019. During the workshop, we have detailed a) basic needs of an ethical committee within an institution; b) a typical ethical approval process (with examples from three different universities); and c) the ways to obtain informed consent with some examples. These are summarised in this paper with some example comparisons of ethical approval processes from different universities. We believe this paper will provide guidelines on preparing and training both researchers and research students in appropriately upholding ethical practices through ethical approval processes.