bluuebunny/crossref_metadata_2025 huggingface dataset:
UPAYA MENINGKATKAN KEMAMPUAN BERHITUNG ANAK USIA DINI MENGGUNAKAN MEDIA PERMAINAN TRADISIONAL ENGKLEK DI TK BAROKATUL HAMZAH
Authors: Toyib  , Syamsiyah
Published: December 2023

Penelitian ini bertujuan untuk mengetahui penggunaan, faktor pendukung dan faktor penghambat media pembelajan permainan engklek dalam meningkatan kemampuan berhitung pada anak usia dini di TK Barokatul Hamzah Pekadan Galis Bangkalan. Penelitian ini merupakan penelitian yang bersifat kualitatif, yaitu suatu pendekatan penelitian yang menghasilkan data deskriptif berupa data-data tertulis atau lisan dari orang-orang dan pelaku yang dapat diamati.[1]

Setelah penulis melakukan analisis data, hasil dari pengimplementasian media permainan engklek  terhadap kemampuan berhitung anak kelas A2 kelompok eksperimen menunjukan hasil yang baik. Hal ini terlihat dari analisis penilaian guru terhadap penggunaan media permainan engklek, dengan parameter nilai pengamatan yang “cukup tinggi”, sedangkan analisa data mengenai kemampuan berhitung juga cukup tinggi sehingga dapat disimpulkan bahwa penggunaan media permainan engklek dalam meningkatkan kemampuan berhitung anak cukup efektif dan memuaskan.
THE INFLUENCE OF LOAN TO DEPOSIT RATIO AND CAPITAL ADEQUACY RATIO ON NON PERFORMING LOANS AT PT. WEST JAVA REGIONAL DEVELOPMENT BANK, Tbk.
Authors: Sartika Andi , Salam Safaruddin
Published: December 2023

This research aims to determine the effect of Loan To Deposit Ratio and Capital Adequacy Ratio on Non-Performing Loans at PT. West Java Regional Government Bank, Tbk. The type of data used is a quantitative data model. The data source used is secondary data. The analytical methods used are descriptive quantitative, multiple linear regression, correlation coefficient (R), coefficient of determination (R2), F test and t test. The research results show the value of the regression equation Y = 14.3929 + 0.00029X1 - 0.7005X2. The t b1 test shows that the Loan To Deposit Ratio has a positive but not significant effect on Non Performing Loans and the b2 t test shows that the Capital Adequacy Ratio has a negative and significant effect on Non Performing Loans. The F test results show that the Loan To Deposit Ratio and Capital Adequacy Ratio have a simultaneous and significant effect on Non-Performing Loans at PT. West Java Development Bank, Tbk. Hyoptheses H2 and H3 are accepted but hypothesis H1 is rejected.
THE INFLUENCE OF WORK MOTIVATION AND DISCIPLINE ON THE PERFORMANCE OF CIVIL SERVANTS IN THE PASER DISTRICT TRANSPORTATION SERVICE
Authors: Syarifah Noor , Darmawan Dedi , Azis Syamsuddin
Published: December 2023

This research aims to analyze the influence of motivation and work discipline on the performance of Civil Servants (PNS) in the Paser Regency Transportation Service. Data was obtained from 67 civil servant respondents via questionnaires, and multiple regression analysis using SPSS 20 was carried out. The results of the analysis show that there is a positive relationship between motivation (X1) and work discipline (X2) and civil servant performance (Y), with the regression formula Y = 0.490 + 0.560X1 + 0.289X2. The coefficient of determination (R2) is 51.9%, indicating the contribution of motivation and work discipline variables to civil servant performance, while 48.1% is influenced by other factors. The F test shows the significance of the relationship together, with H0 rejected. Partially, motivation (X1) and work discipline (X2) each have a significant effect on civil servant performance. Motivation (X1) is the dominant variable with the largest t-count value (4.374). Thus, the hypothesis that motivation (X1) partially has a dominant influence on the performance of civil servants in the Paser Regency Transportation Service can be accepted based on the results of this research.
Anti-inflammatory and Antioxidative Potential of Herbs and Fruits in the Management of Inflammatory Bowel Disease Beyond Medications
Authors: Hamza Muhammad , Zubair Ahsan , Habib Ayesha , Noor Qudsia , Ijaz Ammar , Khalid Ayesha , Javaid Maria , Awan Areej , Rasheed Iqra , Sana Rubab
Published: December 2023

Inflammatory Bowel Disease (IBD), a chronic inflammatory condition of the gastrointestinal tract, primarily encompasses ulcerative colitis and Crohn's disease. Characterized by recurring inflammation, IBD is marked by its unpredictability and complexity. Crohn's disease may impact any part of the digestive system, causing significant ulcerations, whereas ulcerative colitis is mainly restricted to the colon, leading to persistent damage and ulcers. The intermittent nature of IBD, alternating between remission and active flare-ups, presents continuous challenges in patient care and treatment. Its etiology is multifaceted, involving a combination of genetic susceptibility, environmental triggers, and immune system malfunctions. Symptomatically diverse, IBD can manifest as abdominal discomfort, diarrhea, weight loss, and fatigue, complicating the establishment of uniform treatment protocols. Traditional pharmacological treatments often offer limited relief and may introduce side effects, necessitating frequent adjustments in therapy. This disease profoundly impacts not only the physical well-being of individuals but also their overall quality of life, calling for a comprehensive and individualized management approach. This review delves into the potential of herbs and fruits in IBD management, examining their proximate composition and the roles their anti-inflammatory and antioxidant properties play in enhancing gut health.
Development Of Android-Based Application For English Learning System Using Drill and Practice Method
Authors: Rohman Abdur , Diantoro Karno , Rinaldo  , Sitorus Anwar T. , Juwari  , Juwari
Published: December 2023

English, being an international language, plays a significant part in daily life worldwide. Many nations utilize English as their primary language of communication. The lack of a novel approach to English learning—such as the use of contemporary technology—means that kindergarteners at Al-Barkah Kindergarten only learn the language through books. In light of these issues, Al-Barkah Kindergarten developed an Android-based application to teach English via the drill and practice method, hence creating a variance in teaching methods. Because this method applies a learning system in the form of visual, audio, and animation that can attract students' interest in learning language, the application design results show that the learning method is effective and that a solution, especially for Al-Barkah Kindergarten students, can easily understand the learning material. English.
Transformation of the Role of Android Smartphones: From Communication Devices to Remote Control for IoT Based Home Automation Systems
Authors: Sumaryanto Agus , Diantoro Karno , Rinaldo  , Juwari
Published: December 2023

Smartphone technology, especially Android smartphones, has advanced quickly in terms of their function as smart and communication devices. Their capacity to function as remote control tools, enabling users to view and manage electronic gadgets via an Internet connection, is one notable advancement. Through the use of the Internet connection as a bridge between devices, smartphone-based remote control indirectly makes it easier to monitor and manage electrical gadgets. Uncontrolled electricity use and instances of high power consumption that occur when people forget to turn off equipment provide a challenge. The author suggests using the prototyping method, in which a prototype is created at the beginning stage for later development, to overcome this problem. Through
Analysis of the Impact of Project-Based Learning Education Innovations on the Merdeka Belajar Program in Primary School X in Jakarta
Authors: Purwadianto Purwadianto
Published: December 2023

Project-based learning (PBL) is one of the educational innovations encouraged by the Merdeka Belajar program. PBL is a learning approach that actively involves students in solving complex problems or projects. PBL has the potential to improve the quality of learning, develop student skills, and develop student character. PBL takes longer to complete than traditional learning. This is because PBL involves students in a more complex process. PBL requires greater resources, such as equipment, materials, and time. This is because PBL involves students in a more complex process. Teachers who implement PBL must have higher skills in planning, implementing, and assessing projects. This is because PBL involves students in a more complex process. To overcome these challenges, proper planning and support are needed. Schools need to adapt the curriculum and provide the resources needed for PBL. Teachers need to receive training or support to develop the skills they need to implement PBL effectively.
Pelatihan dan Pendampingan Literasi Bahasa Inggris pada Kelompok Anak-Anak di Desa Pudun Julu
Authors: Khairunnisah Khairunnisah - , Purba Happy Sri Rezeki , Pulungan Husniah Ramadhani
Published: December 2023

Abstract This topic was chosen because of a forum for children in Pudun Julu to explore English literacy in the surrounding environment is still limited. The team of dedication for society offers a method of service with material related to time in two stages. Phase I includes providing material, reading practice, and material comprehending. Furthermore, phase II includes assistance by practicing every child to read, pronouncing vocabulary well, answering the quiz, and speaking practices alternately. The Result of this dedication for society activity is in increase understanding of insight and motivation of children’s English literacy in Telling Time. The urgency of the results of this study is awareness of children about the importance of English literacy for their future through discipline in respecting time. Thus, the children has gained a reinforcement of literacy in the form of the application of time discipline in English appropriately, properly, and correctly. Keywords: training; accompaniment; literacy; English Language; children   AbstrakTopik ini dipilih karena wadah bagi kelompok anak di Desa Pudun Julu untuk mendalami literasi bahasa Inggris di lingkungan sekitarnya masih terbatas. Tim PKM menawarkan metode pengabdian dengan materi yang terkait dengan waktu dalam dua tahap. Tahap I meliputi pemberian materi, praktik membaca, dan pendalaman materi. Selanjutnya, Tahap II mencakup pendampingan dengan melatihkan setiap anak untuk membaca, melapalkan dengan baik, menuliskan jawaban kuis, dan praktik percakapan secara bergantian. Hasil dari pengadian kepada masyarakat ini adalah bertambahnya pemahaman wawasan dan motivasi kelompok anak dalam berliterasi bahasa Inggris dengan materi Telling Time. Urgensi dari hasil penelitian ini berupa kesadaran kelompok anak akan pentingnya literasi bahasa Inggris untuk masa depannya melalui disiplin dalam menghargai waktu. Dengan demikian, kelompok anak telah memperoleh penguatan literasi berupa penerapan disiplin waktu dalam bahasa Inggris dengan tepat, baik, dan benar.Kata Kunci: pelatihan; pendampingan; literasi; bahasa Inggris; kelompok anak.
THE ROLE OF THE FACULTY IN THE DEVELOPMENT OF THE ENTREPRENEURIAL SPIRIT AMONG YOUTH IN THE REPUBLIC OF SRPSKA
Authors: Božić Katarina
Published: December 2023

Entrepreneurship plays a very important role in the progress of society and the economy, and the study of entrepreneurship at universities is one of the important factors in the development of the economy of the Republic of Srpska. This paper attempts to explore the role of the faculty in the development of the entrepreneurial spirit of young people in the Republic of Srpska. The sample consists of students from the Faculty of Business Economics in Bijeljina. The research refers to the analysis of attitudes, experiences, and opinions of students when it comes to starting a business. The goal of the research is to examine the entrepreneurial potential of students and determine whether education in the field of entrepreneurship helps young people in the Republic of Srpska to start their businesses. For this research, a survey questionnaire was used as a data collection technique, then a review of current literature in the field of entrepreneurship was carried out, and other secondary sources were also used. The results of the research showed that faculties play an important role in the development of the entrepreneurial spirit among young people, which manifests itself in the form of starting business ventures.
ANALYSIS OF TRADE PERFORMANCE IN SERBIA BASED ON INTEGRATED METHODS OF MULTI-CRITERIA DECISION-MAKING
Authors: Lukić Radojko
Published: December 2023

Research into the dynamics of trade performance positioning is a very challenging, continuously current, significant, and complex issue, especially in the conditions of integrated application of multi-criteria decision-making methods. Based on that, this paper investigates the dynamics of the performance positioning of trade in Serbia for the period 2013 - 2022 using different methods for determining the weighting coefficients of the criteria (AHP, LMAW, MEREC, DIBR), and the TOPSIS method. The goal of this, among other things, is to assess the impact of evaluation criteria on the dynamics of the performance positioning of trade in Serbia by using the TOPSIS method. In the specific case, therefore, the influence of the different evaluations of the criteria on the results of the ranking of the alternatives according to the TOPSIS method is negligible. In the trade of Serbia, the best results according to all used multi-criteria decision-making methods (AHP-TOPSIS, LMAW-TOPSIS, MEREC-TOPSIS, and DIBR-TOPSIS) were achieved in 2022, and the worst in 2014. They continuously improved from year to year in the observed period results of trade in Serbia. Effective management of key macro and micro factors contributed to this. Taken as a whole, the performance of Serbian trade continuously improved. The factors that influenced the improvement of the dynamics of the performance positioning of trade in Serbia are geopolitical situation, economy, inflation, interest rate, employment, the standard of living of the population, trade policy and strategy, foreign direct investments, new business models (multichannel sales - store and electronic, private label, sale of organic products, etc.), concept of sustainable development, energy crisis, management of human resources, asset, capital, sales and profit, digitization of the entire business, and others. The target dynamics of the performance positioning of trade in Serbia can be achieved by effective control of human resources, assets (investments), capital, sales, profits, labor productivity, and financial indebtedness.
[IAH Italy’s national and international appointments upon the resumption of activities in September]
Authors: Da Pelo Stefania , Lasagna Manuela , Piscopo Vincenzo , Rusi Sergio , Vincenzi Valentina
Published: December 2023

Come di consueto il mese di settembre è stato ricco di eventi organizzati o co-organizzati da IAH Italia.
[Article in Italian]
Downregulation of Dickkopf-3, a Wnt antagonist elevated in Alzheimer’s disease, restores synapse integrity and memory in a disease mouse model
Authors: Martin-Flores Nuria , Podpolny Marina , McLeod Faye , Workman Isaac , Crawford Karen , Ivanov Dobril , Leonenko Ganna , Escott-Price Valentina , Salinas Patricia C.
Published: December 2023

Increasing evidence supports a role for deficient Wnt signaling in Alzheimer’s disease (AD). Studies reveal that the secreted Wnt antagonist Dickkopf-3 (DKK3) colocalizes to amyloid plaques in AD patients. Here, we investigate the contribution of DKK3 to synapse integrity in healthy and AD brains. Our findings show that DKK3 expression is upregulated in the brains of AD subjects and that DKK3 protein levels increase at early stages in the disease. In hAPP-J20 and hAPP
NL-G-F/NL-G-F
AD models, extracellular DKK3 levels are increased and DKK3 accumulates at dystrophic neuronal processes around plaques. Functionally, DKK3 triggers the loss of excitatory synapses through blockade of the Wnt/GSK3β signaling with a concomitant increase in inhibitory synapses signaling via activation of the Wnt/JNK pathway. In contrast, DKK3 knockdown restores synapse number and memory in hAPP-J20 mice. Collectively, our findings identify DKK3 as a novel driver of synaptic defects and memory impairment in AD.
A high-throughput platform for single-molecule tracking identifies drug interaction and cellular mechanisms
Authors: McSwiggen David Trombley , Liu Helen , Tan Ruensern , Agramunt Puig Sebastia , Akella Lakshmi B , Berman Russell , Bretan Mason , Chen Hanzhe , Darzacq Xavier , Ford Kelsey , Godbey Ruth , Gonzalez Eric , Hanuka Adi , Heckert Alec , Ho Jaclyn J , Johnson Stephanie L , Kelso Reed , Klammer Aaron , Krishnamurthy Ruchira , Li Jifu , Lin Kevin , Margolin Brian , McNamara Patrick , Meyer Laurence , Pierce Sarah E , Sule Akshay , Stashko Connor , Tang Yangzhong , Anderson Daniel J , Beck Hilary P
Published: December 2023

The regulation of cell physiology depends largely upon interactions of functionally distinct proteins and cellular components. These interactions may be transient or long-lived, but often affect protein motion. Measurement of protein dynamics within a cellular environment, particularly while perturbing protein function with small molecules, may enable dissection of key interactions and facilitate drug discovery; however, current approaches are limited by throughput with respect to data acquisition and analysis. As a result, studies using super-resolution imaging are typically drawing conclusions from tens of cells and a few experimental conditions tested. We addressed these limitations by developing a high-throughput single-molecule tracking (htSMT) platform for pharmacologic dissection of protein dynamics in living cells at an unprecedented scale (capable of imaging >106 cells/day and screening >104 compounds). We applied htSMT to measure the cellular dynamics of fluorescently tagged estrogen receptor (ER) and screened a diverse library to identify small molecules that perturbed ER function in real time. With this one experimental modality, we determined the potency, pathway selectivity, target engagement, and mechanism of action for identified hits. Kinetic htSMT experiments were capable of distinguishing between on-target and on-pathway modulators of ER signaling. Integrated pathway analysis recapitulated the network of known ER interaction partners and suggested potentially novel, kinase-mediated regulatory mechanisms. The sensitivity of htSMT revealed a new correlation between ER dynamics and the ability of ER antagonists to suppress cancer cell growth. Therefore, measuring protein motion at scale is a powerful method to investigate dynamic interactions among proteins and may facilitate the identification and characterization of novel therapeutics.
Enhanced KNa1.1 Channel Underlies Cortical Hyperexcitability and Seizure Susceptibility after Traumatic Brain Injury
Authors: Liu Ru , Sun Lei , Du Le , Guo Xi , Jia Meng , Wang Qun , Wu Jianping
Published: December 2023

Pathogenic variants of the sodium-activated potassium channel K
Na
1.1, have been reported in multiple epileptic disorders. However, whether and how K
Na
1.1 channel is involved in epileptogenesis after traumatic brain injury (TBI) remains unknown. Firstly, we used behavioral monitoring and EEG recording to examine physiological property, spontaneous seizure activity, and seizure susceptibility after TBI. We explored the changes of K
Na
1.1 channel following TBI, including changes of subcellular distribution and expression pattern. Meanwhile, we performed patch-clamp recording to detect the neuronal excitability. Furthermore, we built TBI model using
kcnt1

−/−

mice and compared seizure activity with those on wild- type mice. We found severity-dependent seizure susceptibility in different degree of injured mice. Meanwhile, increased neuronal expression of K
Na
1.1 channel, especially in inhibitory neurons, around the lesion was also observed following TBI with increased neuronal excitability including reduced firing rate of interneurons and imbalanced excitation and inhibition (E/I). Although the maximum frequency of action potential of
kcnt1

−/−

neurons was increased,
kcnt1

−/−

mice displayed decreased seizure susceptibility to the pentylenetetrazole (PTZ) after TBI. Taken together, this study suggests that pathologically enhanced expression and abnormally distributed K
Na
1.1 channel after TBI contribute to disputed E/I and seizure susceptibility, which might provide a potential therapeutic target on the epileptogenesis after TBI.
Performance of Kisan Credit Card Scheme: An Empirical Evidence from Karnataka, India
Authors: Sheela B.  , Rajashekar H.
Published: December 2023

This paper analyzed the period-wise and agency-wise growth of the Kisan Credit Card scheme in Karnataka. The study examined the performance of the KCC scheme by considering the number of operative cards and the amount outstanding from the financial year 2017 to 2022. The paper is based on both descriptive as well as inferential in nature. Statistical tools like mean, Compounded Annual Growth Rate, Chi-square, Correlation, etc, have been used to analyze the data. It is found that the number of operative KCCs and the amount outstanding has grown by 2.98 percent and 31.26 percent on an annual basis respectively over a period of five years. Co-operative banks were found to be ranked first having 66 percent of operative KCCs and 82 percent of the amount outstanding during the year 2021-22. The study suggested that outreach of the KCC scheme should be improved in terms of card issuance as the CAGR is only 2.98 percent during the study period.
Land Acquisition Authority Dispute Model: Case Study of the Construction of the Makassar–Parepare Railway in Pangkajene Regency and the Islands of South Sulawesi Province
Authors: Mahendra R. Agus , Rifdan  , Gani Hamsu Abdul
Published: December 2023

This research aims to create an effective dispute resolution model for land acquisition authority. Qualitative research design with a case study approach. Data collection techniques through interview observation and document study. The informants consisted of leading and supporting stakeholders, analyzed using a qualitative descriptive method with content analysis techniques through in-depth interpretation and meaning by simplifying data, presenting data and conclusions and validating the data-by-data triangulation. The researchers' findings show that the mechanism for obtaining authority from the parties in land acquisition can be through attribution, Delegation, and mandate. So that an effective SENADA model can be created that can help resolve land acquisition authority disputes. It is essential to involve all relevant parties in the implementation and development of this model. It is hoped that it can speed up the performance of land acquisition; the same model is effective and can be improved.
Evaluation of Proximate Composition and Seasonal Variations of the Muscle Tissue of Mouth-Brooding Tilapia Oreochromis mossambica from Meghadrigedda Reservoir, Visakhapatnam, Andhra Pradesh, India
Authors: Krishna P. V.  , Varalakshmi P. , Sarma B. V. L. Aradhya , Dedeepya P. , Rao K. Durga
Published: December 2023

This study aimed to investigate the proximate composition and seasonal variations in the muscle of mouth-brooding tilapia O. mossambica from Meghadrigedda reservoir, Visakhapatnam. The bio-chemical analysis such as total protein, total fat, total carbohydrates, ash and moisture content in the muscle of fish was taken for seasonal variations in relation to reproductive characters during 2021-22.The total protein percent of the fish O. mossambica ranged from 24.5 to 36.8 in females and males was 24.5 and 37.5. The total fat percentage ranged from 5.4 to 8.6 in females and males was 6.4 to 8.7. Total Carbohydrates percentage was 4.1to 5.5 in females and males was4.8 and 5.9. Moisture percentage was 80.2 to 84.5 in females and males was 75.5 to 85.5. Ash percentage was 4.1 to 4.9 in females and males was 4.1 to 4.8. The results of the present clearly indicate that there was differences in the proximate composition of the male and female species.
Lung Ultrasound Findings in the Diagnosis of Transient Tachypnea of Newborn in Late Preterm and Term Neonates
Authors: EL-Fattah Nagwa Mohamed Abd , EL-Mahdy Heba Saied , Hamisa Manal Fathy , Ibrahim Ashraf Mohamed
Published: December 2023

Background: Transient tachypnea of the newborn (TTN) is a prevalent etiology of respiratory distress (RD) in neonates. The condition is a result of the accumulation of fetal lung fluid owing to defective processes responsible for its removal. However, differentiating TTN from various etiologies of RD may provide challenges. Lung ultrasound (LUS) has effectively been used to diagnose and differentiate infant RD. The objective of this research was to evaluate the ultrasonographic findings in the diagnosis of TTN in late preterm and full-term neonates.

Methods: All neonates had been exposed to full taking of history, full clinical assessment, chest X-ray, routine laboratory tests, and LUS assessment was performed on 80 late preterm and full-term neonates diagnosed with TTN by clinical and radiological findings and performed on control group.

Results: Among 80 neonates who were diagnosed to have TTN, double lung point sign (DLP) was present in 62 (77. 5 %), pleural line abnormalities had been observed in 80 (100%), alveolar interstitial syndrome (AIS) was observed in 68 (85.0%), while white lung was present only in 12 TTN cases (15%), and no pleural effusion was found in any of the patients. While these findings weren’t detected in the control group.

Conclusion: LUS could be accurately and reliably used in the diagnosis and screening of TTN. Most common findings in TTN were pleural line abnormalities followed by AIS and DLP.
The Influence of Dwarfing Interstock on Biometric Growth Parameters of Apple
Authors: Ganai N. A. , Rasool Khalid , Ali Angrej , Hassan G. I. , Javeed Kounsar , Wani A. H.
Published: December 2023

Apple trees grown on seedling rootstock often develop into large and vigorous trees making its management difficult. By using vigorous rootstocks only few trees can be accommodated per hectare making the productivity less profitable. Several dwarfing rootstocks of apple are available which need support system and incur heavy investment during orchard establishment.  It would be ideal to obtain a tree with very good root system, to avoid the need for supporting systems and also with a low height, which can be achieved using the interstem. Therefore, in the present investigation M9 clonal interstem comprised of 2,4,6 and 8inches length were grafted between seedling rootstock and scion of two  cultivars i.e., Red Delicious and American Apirouge which are most common and predominant cultivars in orchards of Kashmir. The average sapling height was to the tune of 38.85cm and 41.01 cm in Red Delicious and American Apirouge during first year of study. There was a progressive increase in the height of plant with decreasing interstem length. In both the apple cultivars  stem diameter increased with decrease in interstem length but was lower than control during both the years of study, The rootstock influences the biometric parameters of the grafted trees. The results showed that increased interstem length significantly decreased sapling height and growth whereas, days taken to sprouting and survival per cent were non significant. Thus, it appeared as if the dwarfing rootstock genotype used as an inter-stem functioned as  a kind of physical restriction to water movement and probably reduced the hydraulic conductance  of the whole tree.
Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use
Authors: Lapointe-Shaw Lauren , Salahub Christine , Austin Peter C. , Bai Li , Bhatia R. Sacha , Bird Cherryl , Glazier Richard H. , Hedden Lindsay , Ivers Noah M. , Martin Danielle , Shuldiner Jennifer , Spithoff Sheryl , Tadrous Mina , Kiran Tara
Published: December 2023

Importance

Virtual visits became more common after the COVID-19 pandemic, but it is unclear in what context they are best used.

Objective

To investigate whether there was a difference in subsequent emergency department use between patients who had a virtual visit with their own family physician vs those who had virtual visits with an outside physician.

Design, Setting, and Participants

This propensity score–matched cohort study was conducted among all Ontario residents attached to a family physician as of April 1, 2021, who had a virtual family physician visit in the subsequent year (to March 31, 2022).

Exposure

The type of virtual family physician visit, with own or outside physician, was determined. In a secondary analysis, own physician visits were compared with visits with a physician working in direct-to-consumer telemedicine.

Main Outcome and Measure

The primary outcome was an emergency department visit within 7 days after the virtual visit.

Results

Among 5 229 240 Ontario residents with a family physician and virtual visit, 4 173 869 patients (79.8%) had a virtual encounter with their own physician (mean [SD] age, 49.3 [21.5] years; 2 420 712 females [58.0%]) and 1 055 371 patients (20.2%) had an encounter with an outside physician (mean [SD] age, 41.8 [20.9] years; 605 614 females [57.4%]). In the matched cohort of 1 885 966 patients, those who saw an outside physician were 66% more likely to visit an emergency department within 7 days than those who had a virtual visit with their own physician (30 748 of 942 983 patients [3.3%] vs 18 519 of 942 983 patients [2.0%]; risk difference, 1.3% [95% CI, 1.2%-1.3%]; relative risk, 1.66 [95% CI, 1.63-1.69]). The increase in the risk of emergency department visits was greater when comparing 30 216 patients with definite direct-to-consumer telemedicine visits with 30 216 patients with own physician visits (risk difference, 4.1% [95% CI, 3.8%-4.5%]; relative risk, 2.99 [95% CI, 2.74-3.27]).

Conclusions and Relevance

In this study, patients whose virtual visit was with an outside physician were more likely to visit an emergency department in the next 7 days than those whose virtual visit was with their own family physician. These findings suggest that primary care virtual visits may be best used within an existing clinical relationship.
Prenatal Exposure to Severe Stress and Risks of Ischemic Heart Disease and Stroke in Offspring
Authors: Yang Fen , Janszky Imre , Roos Nathalie , Li Jiong , László Krisztina D.
Published: December 2023

Importance

Prenatal stress is associated with increased risks of several cardiovascular risk factors later in life. However, knowledge regarding the role of prenatal stress in the development of ischemic heart disease (IHD) and stroke is very limited.

Objective

To examine prenatal stress, defined as maternal bereavement, and risks of IHD and stroke in the offspring.

Design, Setting, and Participants

A cohort study was conducted using data from Danish and Swedish registries. Live singleton births during calendar years 1973-2016 in Denmark (followed up until December 31, 2016) and during calendar years 1973-2014 in Sweden (followed up until December 31, 2021) were included in the analysis.

Exposure

Maternal loss of a close family member (partner, older children, parents, or siblings) the year before or during the pregnancy.

Main Outcome and Measures

Diagnoses of IHD and stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for IHD and stroke in the offspring according to maternal bereavement.

Results

The study included 6 758 560 births (39.4% from Denmark; 51.4% boys). During the median follow-up of 24.6 (IQR, 13.9-35.1) years, 8664 offspring (0.1%) were diagnosed with IHD and 13 094 with stroke (0.2%). Overall, maternal bereavement the year before or during pregnancy was not associated with IHD (adjusted HR [AHR], 0.98; 95% CI, 0.85-1.13) or stroke (AHR, 1.04; 95% CI, 0.94-1.16) in offspring. Similarly, no associations were observed when exposure was classified by the mother’s relationship to the deceased individual, ie, loss of older child or partner (HR, 0.85; 95% CI, 0.64-1.14 for IHD and 0.98; 95% CI, 0.77-1.25 for stroke) or loss of parent or sibling (HR, 1.03; 95% CI, 0.87-1.21 for IHD and 1.06; 95% CI, 0.94-1.19 for stroke). However, associations between loss in the third trimester and IHD (AHR, 1.50; 95% CI, 1.06-2.13), and loss due to cardiovascular disease and stroke (AHR, 1.22; 95% CI, 1.03-1.44) were identified when exposure was classified by time of loss or the relative’s cause of death.

Conclusions and Relevance

The findings of this study provide little support for the hypothesis that prenatal stress is associated with risks of IHD and stroke in the first 5 decades of life. However, the association observed between stress in the third trimester and IHD warrants further investigation.
Sociocultural Risk and Resilience in the Context of Adverse Childhood Experiences
Authors: VanBronkhorst Sara B. , Abraham Eyal , Dambreville Renald , Ramos-Olazagasti Maria A. , Wall Melanie , Saunders David C. , Monk Catherine , Alegría Margarita , Canino Glorisa J. , Bird Hector , Duarte Cristiane S.
Published: December 2023

Importance

Knowledge about childhood resilience factors relevant in circumstances of marginalization and high numbers of adverse childhood experiences (ACEs) can improve interventions.

Objective

To identify sociocultural resilience factors in childhood that are associated with better young adult mental health in the context of ACEs.

Design, Setting, and Participants

This cohort study examined 4 waves of data from the Boricua Youth Study, which included Puerto Rican children from the South Bronx, New York, and San Juan, Puerto Rico. Participants were aged 5 to 17 years at waves 1 through 3 (2000-2003) and aged 15 to 29 years at wave 4 (2013-2017). Linear and logistic regression models tested the associations of 7 childhood resilience factors and their interaction with ACEs on young adult mental health outcomes. Data were analyzed from June 2021 to October 2023.

Main Outcomes and Measures

Perceived stress, major depressive disorder and/or generalized anxiety disorder (MDD/GAD), and substance use disorder (SUD) in young adulthood.

Results

Among a total 2004 participants, the mean (SD) age at wave 4 was 22.4 (2.9) years; 1024 participants (51.1%) were female, and 980 (48.9%) were male. Positive parent-child relationships and nonparental adult support during childhood were associated with both lower perceived stress (β = −0.14; SE = 0.02;P < .001; β = −0.08; SE = 0.03;P = .003, respectively) and lower odds of MDD/GAD (adjusted odds ratio [aOR], 0.84; 95% CI, 0.73 to 0.97; aOR = 0.81; 95% CI, 0.69 to 0.95, respectively) in young adulthood. Maternal warmth reported during childhood was also associated with lower young adult perceived stress (β = −0.11; SE = 0.02;P < .001). None of the resilience factors were associated with SUD. The resilience factors familism, friendships, and family religiosity were not associated with any of the mental health outcomes. ACEs were associated with poorer mental health outcomes; however, none of the resilience factors exhibited interactions consistent with being protective for ACEs. Unexpectedly, higher family religiosity was associated with more perceived stress in the presence of higher ACEs.

Conclusions and Relevance

The results of this study suggest that promoting positive relationships with adults during childhood may reduce later young adulthood stress and MDD/GAD. However, there is still a need to identify sociocultural childhood protective factors for ACEs. Caution should be taken in assuming what resilience factors are relevant for a given group, as higher family religiosity (one postulated resilience factor) was unexpectedly associated with a stronger, rather than a weaker, association between ACEs and perceived stress in young adulthood.
Benzodiazepine Use During Pregnancy and Risk of Miscarriage
Authors: Meng Lin-Chieh , Lin Chih-Wan , Chuang Hui-Min , Chen Liang-Kung , Hsiao Fei-Yuan
Published: December 2023

Importance

Benzodiazepine use during pregnancy has raised significant concerns due to the potential harmful effects of this drug class on neonates. Studies on the association between benzodiazepine use and the risk of miscarriage are limited.

Objective

To quantify the risk of miscarriage associated with benzodiazepine use during pregnancy after controlling for unmeasured confounders and exposure time trends.

Design, Setting, and Participants

This was a nationwide, population-based case-time-control study using Taiwan’s National Birth Certificate Application database and the National Health Insurance database. Pregnancies resulting in miscarriage between 2004 and 2018 were included in the case group and were 1:1 matched with exposure time-trend control individuals using disease risk score, considering demographic characteristics and prepregnancy comorbidities. Data were analyzed from August 2022 to March 2023.

Exposures

Discordant exposures to benzodiazepines during risk period (1-28 days before miscarriage) and 2 reference periods (31-58 days and 181-208 days before the last menstrual period) were compared for each pregnancy.

Main Outcomes and Measures

Miscarriage was defined as any pregnancy loss occurring between the first prenatal care visit (usually 8 weeks) and the 19th completed week of pregnancy.

Results

This study comprised a total of 3 067 122 pregnancies among 1 957 601 women, 136 134 of which (4.4%) resulted in miscarriage. The mean (SD) age of the study population was 30.61 (5.91) years. The use of benzodiazepines during pregnancy was associated with an increased risk of miscarriage (odds ratio [OR], 1.69; 95% CI, 1.52-1.87), and consistent findings were observed across multiple sensitivity analyses considering different time windows and accounting for misclassification. In subgroup analyses, an increased risk of miscarriage was associated with each commonly used individual benzodiazepine, ranging from case-time-control ORs of 1.39 (95% CI, 1.17-1.66) for alprazolam to 2.52 (95% CI, 1.89-3.36) for fludiazepam.

Conclusions and Relevance

This nationwide case-time-control study revealed an increased risk of miscarriage associated with benzodiazepine use during pregnancy after accounting for measurable confounders, and results were unlikely to be due to unmeasured confounding. These findings underscore the necessity for health care professionals to meticulously balance the risk-benefit ratio when considering the use of benzodiazepines to treat psychiatric and sleep disorders during pregnancy.
Postoperative Regret Among Transgender and Gender-Diverse Recipients of Gender-Affirming Surgery
Authors: Barbee Harry , Hassan Bashar , Liang Fan
Published: December 2023

This Viewpoint examines prevalence of and factors associated with surgical regret among transgender and gender-diverse individuals who undergo gender-affirming surgery.
Amaravati
Authors: Shimada Akira
Published: December 2023

Amaravati is the archaeological remains of a Buddhist
stupa
in the Guntur district of modern Andhra Pradesh in southeast India. Several excavations and explorations at the
stupa
and its surrounding areas from the early nineteenth century yielded more than three hundred inscriptions and abundant pieces of sculptures, dated to between the third century
bce
and the twelfth century
ce
.
River Ordeal
Authors: Badamchi Hossein
Published: December 2023

The river ordeal is a form of divine judgment. It applies a physical test intended to reveal which litigant is telling the truth. In the Akkadian texts from Susa it is principally a judicial institution. In the contracts it might only be a curse, while the real ordeal appears in the trial documents.
Ratnagiri (Orissa)
Authors: Shimada Akira , Mishra Umakanta
Published: December 2023

Ratnagiri is a Buddhist archaeological site located on a hillock of the Assia group of hills in Jajpur district in the eastern littoral state of Odisha (N 20° 38′ 32.85′′, E 86° 20′ 11.83′′). Along with the nearby sites of Lalitagiri and Udayagiri, it constitutes a cluster of the large Buddhist monastic sites in the Cuttack region. The Archaeological Survey of India (ASI) excavated the site in 1958–61 and revealed an extensive monastic complex consisting of a main
stupa
, residential monasteries, brick temples, numerous smaller
stupa
s, and numerous sculptures. Subsequent ASI excavation in 1999–2002 at the area underneath the Mahākāla temple further revealed more structures. The excavation data show that the monastery was founded around the fifth century
ce
and flourished between the eighth and eleventh century
ce
. The inscribed seals and sealings found at the site attest that the monastery was called Śri‐Ratnagiri‐mahāvihāra.
Qi (State)
Authors: Fu Wentian
Published: December 2023

The Qi state (1046–221
bce
) was a regional state in early China. At the zenith of its power, it ruled the eastern edge of the Central Plain plus the coastal region in eastern China (present‐day southeastern Hebei province and most of Shandong province). Throughout its history, it played a crucial role in the interstate relations of the Zhou community because of its strategically important location and special relation to the Zhou kingdom. In the Spring and Autumn period, especially during the reign of Lord Huan of Qi (r. 685–643
bce
), known as the first of the five hegemons, the Qi state became the leader of the Zhou community under the banner of “honor the King and repel the barbarians.” In the Warring States period, it remained one of the seven major regional states. The Qi state was also known for its regional culture, its sponsorship of intellectual activities, and its economic prosperity.
O, N‐Codoped, Self‐Activated, Holey Carbon Sheets for Low‐Cost And High‐Loading Zinc‐Ion Supercapacitors
Authors: Xu Zhixiao , Sun Zhe , Shan Janay , Jin Song , Cui Jiayao , Deng Zhiping , Seo Min Ho , Wang Xiaolei
Published: December 2023

Low‐cost and high‐loading cathodes are crucial for practical application of zinc‐ion supercapacitors (ZICs) but achieving optimal performance in high‐loading electrodes faces challenges due to sluggish ion transport, increased resistance, and unstable structure. Guided by theoretical calculations, high‐loading carbon cathodes based on holey activated carbon sheets (HACS) are fabricated from a carefully chosen molecule. A simple pyrolysis‐leaching treatment transformed the molecule into HACS with large surface area, hierarchical porous structure, and electroactive oxygen/nitrogen dopants. When combined with an aqueous binder, the optimized HACS‐based high‐loading electrode (16.1 mg cm−2) exhibits high‐capacitance (454 F g−1 ) and fast‐rate (1 A g−1) characteristics under lean electrolyte (6.2 µL mg−1). More impressively, HACS is dry‐pressed into free‐standing thick electrodes up to 35.4 mg cm−2 and corresponding practical ZIC under limited Zn and low N/P ratio demonstrates ultrahigh areal capacitance (9 F cm−2) and energy density (3.47 mWh cm−2). The outstanding performance can be attributed to fast ion transport enabled by through‐plane pores of HACS, as well as abundant double‐layer and redox‐active surfaces from favorable heteroatom‐doped porous nanosheets. With its cost‐effectiveness, elemental abundance, and structural tunability, this molecular carbon strategy offers a platform for making self‐activated carbon electrodes at the molecular level towards practical supercapacitors.
Size‐Selective Capture of Fluorocarbon Gases and Storage of Volatile Halogenated Organic Vapors with Low Boiling Points by Molecular‐Scale Cavities of Crystalline Pillar[n]quinones
Authors: Ohtani Shunsuke , Onishi Katsuto , Wada Keisuke , Hirohata Tomoki , Inagi Shinsuke , Pirillo Jenny , Hijikata Yuh , Mizuno Motohiro , Kato Kenichi , Ogoshi Tomoki
Published: December 2023

Fluorocarbon gases are regarded as one of the largest contributors to serious environmental problems such as ozone‐depletion and global warming, and thus, the development of reclamation technologies is in great demand for reducing emission of such harmful compounds. So far, porous materials such as zeolites, activated carbons, and metal‐organic frameworks (MOFs) have been examined as solid‐state absorbents for fluorocarbon gases. However, such porous materials often suffer from a lack of size‐selectivity in fluorocarbon gas uptakes due to the large‐sized cavities (>1 nm). Herein, it is reported that macrocyclic pillar[n]quinones (P[n]Q, n = 5 or 6) in crystalline state show size‐selective uptake for fluorocarbon gases owing to their molecular‐scale cavities (<1 nm). The P[n]Q also show uptake behaviors for volatile halogenated organic compounds (VHOCs), which are highly toxic. Interestingly, the volatilities of VHOCs within the 1D channels of P[5]Q are drastically reduced compared with those of the bulk VHOC solvents. Experimental results and computational analyses revealed that the excellent storage abilities of the crystalline P[n]Q are a synergic result of their electron‐deficient macrocyclic scaffolds and the basic carbonyl oxygen atoms on their rims.
An Adhesive Immune‐Stimulating Multifunctional Hydrogel for Potent Tumor Chemoimmunotherapy and Postoperative Wound Healing Promotion
Authors: Wang Tianran , Ding Junfeng , Liang Shuang , Lin Zhiqiang , Yang Jiaxuan , Zhang Zhen , Zou Zheng , Li Gao , Chen Xuesi , He Chaoliang
Published: December 2023

Surgical excision is the first choice for clinical cancer therapy. However, major challenges, such as postoperative tumor recurrence and unsatisfactory wound healing after surgery, remain. In this study, an adhesive hydrogel is developed as a multifunctional platform for antitumor chemoimmunotherapy and postoperative wound treatment. The hydrogel adheres firmly to diverse tissues and degrades within 4 weeks in vivo with good histocompatibility. The immune‐stimulating hydrogel ((DOX+R837@HN)@Gel) is fabricated by encapsulating doxorubicin (DOX) and imiquimod‐loaded HSA nanoparticles (R837@HNs) into the hydrogel. When combined with immune checkpoint blockade (ICB) therapy, intratumorally administering (DOX+R837@HN)@Gel exhibits markedly enhanced systemic antitumor efficacy and strengthened antitumor immunity. For tumor surgical resection, (DOX+R837@HN)@Gel can adhere to the wounds and effectively prevents tumor recurrence and achieves long‐term immune memory with ICB therapy. Moreover, the hydrogel achieves rapid hemostasis and promotes wound healing after treating surgical wound models. Therefore, this multifunctional hydrogel has great significance for clinical postsurgical cancer treatment.
Coordination Engineering Based on Graphitic Carbon Nitrides for Long‐Life and High‐Capacity Lithium‐Sulfur Batteries
Authors: Sun Wenhao , Xu Lingyong , Song Zihao , Lin Hai , Jin Zhaoqing , Wang Weikun , Wang Anbang , Huang Yaqin
Published: December 2023

Lithium‐sulfur (Li‐S) batteries have received tremendous academic and industrial attentions owing to their ultrahigh energy density. However, technical challenges including lithium dendrite formation, polysulfide shuttling and sluggish sulfur reaction kinetics limit their cycle life, rate capability and areal capacity, especially at practically high sulfur loadings. Here, coordination‐engineered graphite carbon nitrides is proposed to effectively address these challenges. On the anode a layer of novel N‐rich graphitic carbon nitride (g‐C3N5) is applied, in which tricoordinated N atoms display strong affinity to Li+, to guide lithium deposition and efficiently inhibit dendrite formation. Besides, a layer of defective g‐C3N5 carrying highly active bicoordinated N vacancies and cyano N atoms is applied on the cathode, which significantly adsorb polysulfides and catalyze the reversible conversion, as well as the nucleation and dissolution of Li2S thereby outcompeting polysulfide shuttling and raising kinetics at high sulfur loading. This coordination‐engineering strategy based on g‐C3N5 enables Li‐S batteries exhibiting high stability and low capacity‐fading‐rate (0.03% per cycle) in 400 cycles at the high current rate of 4 C, as well as Li‐S pouch cells showing a high areal capacity of 11.69 mAh cm−2 at a high sulfur loading of 9.02 mg cm−2, demonstrating the feasibility of Li‐S batteries in practical applications.