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The ignorance of the role of middle leaders as a 'key broker' between school principals and teachers in the literature has motivated this study to investigate the effects of middle leaders' learning-centred leadership on teacher professional learning through teacher mastery goals and their self-efficacy with the moderating effect of the quality of communication between middle leaders and teachers. A total of 453 data were collected from 24 primary and secondary school teachers in six districts in Kedah. This study employed partial least squares structural equation modelling approach. Findings revealed that learning-centred leadership has a significant and positive effect on teacher professional learning. Teacher mastery goals and teacher self-efficacy have significant mediating effects on teacher professional learning. The effect of learning-centred leadership on teacher professional learning is stronger when the levels of quality of communication between leaders and teachers are higher compared to their counterparts. Hence, future principal preparation programmes should equip future principals with the knowledge of learning-centred leadership that could facilitate teacher learning happening and flourishing.

Abstract Heart failure (HF) patients frequently exhibit iron deficiency, which is associated with a poor prognosis. Although various trials have been conducted, it is uncertain if intravenous (IV) iron replenishment improves clinical outcomes in HF patients with iron deficiency. A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library from inception till 15 September 2023 to retrieve randomized controlled trials (RCTs) that compared IV iron therapy with placebo or standard of care in patients with HF and iron deficiency. Clinical outcomes were assessed by generating forest plots using the random‐effects model and pooling odds ratios (ORs) or weighted mean differences (WMDs). Fourteen RCTs with 6651 patients were included. IV iron therapy showed a significantly reduced incidence of the composite of first heart failure hospitalization (HHF) or cardiovascular (CV) mortality as compared with the control group (OR = 0.73, 95% CI: 0.58 to 0.92). The IV iron therapy resulted in a trend towards lower CV mortality (OR = 0.88, 95% CI: 0.76 to 1.01), 1‐year all‐cause mortality (OR = 0.85, 95% CI: 0.71 to 1.02), and first HHF (OR = 0.73, 95% CI: 0.51 to 1.05), and an improved left ventricular ejection fraction (LVEF) (MD = 4.54, 95% CI: −0.13 to 9.21). Meta‐regression showed a significant inverse moderating effect of baseline LVEF on the first HHF or CV death. In patients with HF and iron deficiency, IV iron therapy reduced the incidence of composite of first HHF or CV mortality. There was a trend of lower overall CV and 1‐year all‐cause mortality, first HHF, and improved LVEF with IV iron therapy.

戶外冒險教育作為一個教育哲學，在不同國家有著不同的發展脈絡與實踐。本研究聚焦在三個國家的教育系統，進行戶外冒險教育發展和實施的探究，旨在協助戶外冒險教育的發展與推動，透過文件分析的方式，比較分析英格蘭、臺灣和馬來西亞學校課程的演變與教育發展。本研究採用P. Bourdieu實踐理論（theory of practice）中的習性、場域和資本概念，協助研究者在不同的社會與教育背景下探究其教育發展。本研究藉由四個主題—「立法和指導」、 「課程安排」、「教育規範與價值觀」與「戶外冒險教育的態度」，探討其學校教育與高等教育之相似性與相異處。結果發現戶外冒險教育的發展在學校教育與高等教育間未存在連貫性。此外，本研究亦指出，馬來西亞教育部有必要以更全面的方式重新審視戶外冒險教育在學校教育的實施。總而言之，本研究強調在不同教育系統中發展戶外冒險教育時應考慮文化、社會和政策背景的重要性。 Outdoor Adventure Education (OAE) as an educational philosophy has varying levels of development and practices across different countries. This cross-cultural study explored the development and interpretation of OAE in academic systems of three countries, namely England, Taiwan, and Malaysia. The goal of this research was to provide insight into the development of OAE profiling measures by comparing the curricula of these countries’ schools. The study was based on document analysis with a comparative cultural perspective. The ideas of habitus, field, and capital articulated by Bourdieu were integrated as major supplements to illustrate the cultural patterns linked to bodily movements. The investigation uncovered both parallels and divergences in the development and conceptualization of OAE within the three nations, and discussed the context in both university and schooling sectors within four generated themes: “legislation and guidance,” “curriculum arrangement,” “pursuit of educational norms and values,” and “attitude toward OAE.” A notable disconnection between schools and universities regarding OAE initiatives was observed in Malaysia. Additionally, the study highlighted the significance of considering cultural, societal, and policy contexts in shaping the landscape of OAE in diverse educational systems. The findings of the study recommend that the Ministry of Education of Malaysia reassess the implementation of OAE in a more holistic manner.

Liposarcoma is one of the most prevalent forms of soft tissue sarcoma, and its prognosis is highly dependent on its molecular subtypes. Non-coding RNAs (ncRNAs) like microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) can bind various cellular targets to regulate carcinogenesis. By affecting the expressions and activities of their downstream targets post-transcriptionally, dysregulations of miRNAs can alter different oncogenic signalling pathways, mediating liposarcoma progression. On the contrary, lncRNAs can sponge miRNAs to spare their downstream targets from translational repression, indirectly affecting miRNA-regulated oncogenic activities. In the past 15 years, multiple fundamental and clinical research has shown that different ncRNAs play essential roles in modulating liposarcoma development. Yet, there is a lack of an effective review report that could summarize the findings from various studies. To narrow this literature gap, this review article aimed to compare the findings from different studies on the tumour-regulatory roles of ncRNAs in liposarcoma and to understand how ncRNAs control liposarcoma progression mechanistically. Additionally, the reported findings were critically reviewed to evaluate the translational potentials of various ncRNAs in clinical applications, including employing these ncRNAs as diagnostic and prognostic biomarkers or as therapeutic targets in the management of liposarcoma. Overall, over 15 ncRNAs were reported to play essential roles in modulating different cellular pathways, including apoptosis, WNT/β-catenin, TGF-β/SMAD4, EMT, interleukin, and YAP-associated pathways to influence liposarcoma development. 28 ncRNAs were reported to be upregulated in liposarcoma tissues or circulation, whereas 11 were downregulated, making them potential candidates as liposarcoma diagnostic biomarkers. Among these ncRNAs, measuring the tissues or circulating levels of miR-155 and miR-195 was reported to help detect liposarcoma, differentiate liposarcoma subtypes, and predict the survival and treatment response of liposarcoma patients. Overall, except for a few ncRNAs like miR-155 and miR-195, current evidence to support the use of discussed ncRNAs as biomarkers and therapeutic targets in managing liposarcoma is mainly based on a single-center study with relatively small sample sizes or cell-based studies. Hence, more large-scale multi-center studies should be conducted to further confirm the sensitivity, specificity, and safety of ncRNAs as biomarkers and therapeutic targets. Instead of furthering investigation to confirm the translational values of all the discussed ncRNAs, which can be time- and cost-consuming, it would be more practical to focus on a few ncRNAs, including miR-155 and miR-195, to evaluate if they are sensitive and safe to be used as liposarcoma biomarkers and therapeutic agents or targets.

Background/Objectives: Few studies have analyzed in-hospital complications and events following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures for patients who underwent these interventions for single-vessel coronary artery disease (CAD). This study aims to compare the outcomes of PCI and CABG in such patients using a large propensity-matched real-world database based on procedural codes. Methods: Adult patients receiving PCI or CABG for single-vessel CAD were identified from the 2016–2020 National Inpatient Sample (NIS) database. Any cases targeting multi-vessel disease or employing a multi-treatment approach were excluded using appropriate procedural codes. Differences in events and complications from admission to discharge were studied between the two procedures (PCI vs. CABG) via logistic regression analysis. Results: After propensity matching with 273,380 patients in both groups, complication risks such as cardiac tamponade (aOR: 3.6 [3.27–3.96]), acute kidney injury (aOR: 1.53 [1.51–1.56]), cardiogenic shock (aOR: 1.38 [1.34–1.40]), procedural bleeding (aOR: 1.75 [1.67–1.83]), acute ischemic stroke (aOR: 1.89 [1.80–1.97]), and all-cause mortality (aOR: 1.05 [1.02–1.08]) were higher among CABG patients. No differences were observed for events of cardiac perforation (aOR: 0.92, [0.84–1.01]). Conclusions: In this large real-world propensity-matched analysis, CABG was associated with higher risks of multiple in-hospital complications and all-cause mortality compared to PCI following a single-vessel coronary intervention.

Chocolate is a popular confectionery worldwide and thus, there is a need to improve the nutritional quality of chocolates. Broccoli leaves which are normally disposed as wastes were turned into the fillings of chocolates to enhance the quality of chocolates. This research aimed to propose the best formulation of chocolate incorporated with broccoli leaves jellies. Six formulations of broccoli leaves jellies (F1: 1.25%, F2: 5.00%, F3: 8.75%, F4: 12.50%, F5: 16.25% and F6: 20.00%) were incorporated into chocolates of fixed formulation. F2, with 5.00% of broccoli leaves was chosen as the best formulation on the basis of sensory evaluation and physiochemical tests which included water activity (aw) and hardness tests. Subsequently, F2 was compared with the control from the aspects of proximate compositions, melting properties and antioxidant capacity. F2 recorded higher proximate compositions, except for moisture and crude fat content than the control. Higher melting properties, total phenolic and flavonoid contents together with a lower half maximal effective concentration (EC50) were seen in F2 as compared to the control. Thus, the upcycling of broccoli leaves as food ingredients is a feasible one as proven in this study. Overall, we can also expect the valorization of broccoli leaves in the development of other functional food products.

Accurate determination of sodium chloride (NaCl) density in water is vital for assessing environmental impact, preventing soil salinization in agriculture, ensuring quality and consistency in industrial processes, facilitating medical treatments, and maintaining taste and preservation standards in the food and beverage industry. This paper introduces a novel microwave sensor design specifically tailored to accurately assess NaCl density in aqueous solutions. Starting with a standard solution of 10 g of salt dissolved in 100 ml of water, resulting in a molarity of approximately 1.71 M, five distinct samples are meticulously prepared. These samples cover a range of NaCl concentrations, with different ratios of salt solution and drinking water, including pure water, 10 ml of salt solution with 90 ml of water, 20 ml of salt solution with 80 ml of water, 30 ml of salt solution with 70 ml of water, and 40 ml of salt solution with 60 ml of water. Each sample undergoes analysis using the developed microwave sensor to determine its transmission coefficient. The magnitude of the transmission coefficient is closely tied to the density of the salt solution based on molarity. Through a detailed regression analysis, a strong quantitative relationship between the transmission coefficient and salt solution density is revealed. This correlation can be accurately represented by a third-order polynomial equation. This research is significant as it advances microwave sensor technology, allowing for accurate and efficient measurement of NaCl density in water.

BACKGROUND: Reference intervals of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) are statistically defined by the 2·5-97·5th percentiles, without accounting for potential risk of clinical outcomes. We aimed to define the optimal healthy ranges of TSH and FT4 based on the risk of cardiovascular disease and mortality. METHODS: This systematic review and individual participant data (IPD) meta-analysis identified eligible prospective cohorts through the Thyroid Studies Collaboration, supplemented with a systematic search via Embase, MEDLINE (Ovid), Web of science, the Cochrane Central Register of Controlled Trials, and Google Scholar from Jan 1, 2011, to Feb 12, 2017 with an updated search to Oct 13, 2022 (cohorts found in the second search were not included in the IPD). We included cohorts that collected TSH or FT4, and cardiovascular outcomes or mortality for adults (aged ≥18 years). We excluded cohorts that included solely pregnant women, individuals with overt thyroid diseases, and individuals with cardiovascular disease. We contacted the study investigators of eligible cohorts to provide IPD on demographics, TSH, FT4, thyroid peroxidase antibodies, history of cardiovascular disease and risk factors, medication use, cardiovascular disease events, cardiovascular disease mortality, and all-cause mortality. The primary outcome was a composite outcome including cardiovascular disease events (coronary heart disease, stroke, and heart failure) and all-cause mortality. Secondary outcomes were the separate assessment of cardiovascular disease events, all-cause mortality, and cardiovascular disease mortality. We performed one-step (cohort-stratified Cox models) and two-step (random-effects models) meta-analyses adjusting for age, sex, smoking, systolic blood pressure, diabetes, and total cholesterol. The study was registered with PROSPERO, CRD42017057576. FINDINGS: We identified 3935 studies, of which 53 cohorts fulfilled the inclusion criteria and 26 cohorts agreed to participate. We included IPD on 134 346 participants with a median age of 59 years (range 18-106) at baseline. There was a J-shaped association of FT4 with the composite outcome and secondary outcomes, with the 20th (median 13·5 pmol/L [IQR 11·2-13·9]) to 40th percentiles (median 14·8 pmol/L [12·3-15·0]) conveying the lowest risk. Compared with the 20-40th percentiles, the age-adjusted and sex-adjusted hazard ratio (HR) for FT4 in the 80-100th percentiles was 1·20 (95% CI 1·11-1·31) for the composite outcome, 1·34 (1·20-1·49) for all-cause mortality, 1·57 (1·31-1·89) for cardiovascular disease mortality, and 1·22 (1·11-1·33) for cardiovascular disease events. In individuals aged 70 years and older, the 10-year absolute risk of composite outcome increased over 5% for women with FT4 greater than the 85th percentile (median 17·6 pmol/L [IQR 15·0-18·3]), and men with FT4 greater than the 75th percentile (16·7 pmol/L [14·0-17·4]). Non-linear associations were identified for TSH, with the 60th (median 1·90 mIU/L [IQR 1·68-2·25]) to 80th percentiles (2·90 mIU/L [2·41-3·32]) associated with the lowest risk of cardiovascular disease and mortality. Compared with the 60-80th percentiles, the age-adjusted and sex-adjusted HR of TSH in the 0-20th percentiles was 1·07 (95% CI 1·02-1·12) for the composite outcome, 1·09 (1·05-1·14) for all-cause mortality, and 1·07 (0·99-1·16) for cardiovascular disease mortality. INTERPRETATION: There was a J-shaped association of FT4 with cardiovascular disease and mortality. Low concentrations of TSH were associated with a higher risk of all-cause mortality and cardiovascular disease mortality. The 20-40th percentiles of FT4 and the 60-80th percentiles of TSH could represent the optimal healthy ranges of thyroid function based on the risk of cardiovascular disease and mortality, with more than 5% increase of 10-year composite risk identified for FT4 greater than the 85th percentile in women and men older than 70 years. We propose a feasible approach to establish the optimal healthy ranges of thyroid function, allowing for better identification of individuals with a higher risk of thyroid-related outcomes. FUNDING: None.

BACKGROUND: Various factors modulate circulating testosterone in men, affecting interpretation of testosterone measurements. PURPOSE: To clarify factors associated with variations in sex hormone concentrations. DATA SOURCES: Systematic literature searches (to July 2019). STUDY SELECTION: Prospective cohort studies of community-dwelling men with total testosterone measured using mass spectrometry. DATA EXTRACTION: Individual participant data (IPD) (9 studies; n = 21 074) and aggregate data (2 studies; n = 4075). Sociodemographic, lifestyle, and health factors and concentrations of total testosterone, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), dihydrotestosterone, and estradiol were extracted. DATA SYNTHESIS: Two-stage random-effects IPD meta-analyses found a nonlinear association of testosterone with age, with negligible change among men aged 17 to 70 years (change per SD increase about the midpoint, -0.27 nmol/L [-7.8 ng/dL] [CI, -0.71 to 0.18 nmol/L {-20.5 to 5.2 ng/dL}]) and decreasing testosterone levels with age for men older than 70 years (-1.55 nmol/L [-44.7 ng/dL] [CI, -2.05 to -1.06 nmol/L {-59.1 to -30.6 ng/dL}]). Testosterone was inversely associated with body mass index (BMI) (change per SD increase, -2.42 nmol/L [-69.7 ng/dL] [CI, -2.70 to -2.13 nmol/L {-77.8 to -61.4 ng/dL}]). Testosterone concentrations were lower for men who were married (mean difference, -0.57 nmol/L [-16.4 ng/dL] [CI, -0.89 to -0.26 nmol/L {-25.6 to -7.5 ng/dL}]); undertook at most 75 minutes of vigorous physical activity per week (-0.51 nmol/L [-14.7 ng/dL] [CI, -0.90 to -0.13 nmol/L {-25.9 to -3.7 ng/dL}]); were former smokers (-0.34 nmol/L [-9.8 ng/dL] [CI, -0.55 to -0.12 nmol/L {-15.9 to -3.5 ng/dL}]); or had hypertension (-0.53 nmol/L [-15.3 ng/dL] [CI, -0.82 to -0.24 nmol/L {-23.6 to -6.9 ng/dL}]), cardiovascular disease (-0.35 nmol/L [-10.1 ng/dL] [CI, -0.55 to -0.15 nmol/L {-15.9 to -4.3 ng/dL}]), cancer (-1.39 nmol/L [-40.1 ng/dL] [CI, -1.79 to -0.99 nmol/L {-51.6 to -28.5 ng/dL}]), or diabetes (-1.43 nmol/L [-41.2 ng/dL] [CI, -1.65 to -1.22 nmol/L {-47.6 to -35.2 ng/dL}]). Sex hormone-binding globulin was directly associated with age and inversely associated with BMI. Luteinizing hormone was directly associated with age in men older than 70 years. LIMITATION: Cross-sectional analysis, heterogeneity between studies and in timing of blood sampling, and imputation for missing data. CONCLUSION: Multiple factors are associated with variation in male testosterone, SHBG, and LH concentrations. Reduced testosterone and increased LH concentrations may indicate impaired testicular function after age 70 years. Interpretation of individual testosterone measurements should account particularly for age older than 70 years, obesity, diabetes, and cancer. PRIMARY FUNDING SOURCE: Medical Research Future Fund, Government of Western Australia, and Lawley Pharmaceuticals. (PROSPERO: CRD42019139668).

Oil palm (Elaeis guineensis) yield is impacted by abiotic stresses, leading to significant economic losses. To understand the core abiotic stress transcriptome (CAST) of oil palm, we performed RNA-Seq analyses of oil palm leaves subjected to drought, salinity, waterlogging, heat, and cold stresses. A total of 19,834 differentially expressed genes (DEGs) were identified. Cold treatment induced the highest number of DEGs (5,300), followed by heat (4,114), drought (3,751), waterlogging (3,573), and, lastly, salinity (3096) stress. Subsequent analysis revealed the CAST of oil palm, comprising 588 DEGs commonly expressed under drought, salinity, waterlogging, heat, and cold stress conditions. Function annotation of these DEGs suggests their roles in signal transduction, transcription regulation, and abiotic stress responses including synthesis of osmolytes, secondary metabolites, and molecular chaperones. Moreover, we identified core DEGs encoding kinases, ERF, NAC TFs, heat shock proteins, E3 ubiquitin-protein ligase, terpineol synthase, and cytochrome P450. These core DEGs may be potential key modulators that interplay in triggering rapid abiotic stress responses to achieve delicate equilibrium between productivity and adaptation to abiotic stresses. This comprehensive study provides insights into the key modulators in the CAST of oil palm, and their potential applications as markers for selecting climate-resilient oil palms or opportunities to develop future climate resilient oil palm using genome editing.