Clear Instructions Research Articles

The Role of Micronutrients in Immune Function and Health: Insights from Healthcare Professionals on Multivitamin-Multimineral Supplementation

Aims: Despite the inconsistent findings in existing literature, micronutrients such as vitamins A, C, D, and E, and trace elements like zinc and selenium, are crucial for sustaining immune competence. The study aimed to capture valuable insights from healthcare professionals (HCPs) about their perceptions with a multivitamin multimineral supplement (MVMS) in making informed decisions regarding the use, benefits, applicability and integration in clinical practice. Study Design: A retrospective real-world data survey. Place and Duration of Study: Across India, from September 10 to October 16, 2024. Methodology: A digital survey platform with a 23-question close ended questionnaire was developed, that provided a secure, user-friendly interface, and was shared as a link with clear instructions and objectives among 250 HCPs of different specialities. Upon completion, data obtained was collated and compiled into a comprehensive report, highlighting the key trends, insights, and actionable findings, and subsequently recommendations were developed, focusing on clinical performance across acute illnesses. Results and Discussion: This study explores the growing evidence linking micronutrients to immune function and health, and focuses on the role of MVMS in enhancing immune responses and overall well-being. The HCPs reported calcium deficiency in 61.2% of women, while fatigue emerged as the most common and debilitating symptom of iron deficiency, reported by 80.4% HCPs. 98% of HCPs agreed that MVMS helps reduce fatigue and enhances energy within 2-3 weeks, while 95% confirmed its role in accelerating recovery from acute illnesses. Furthermore, 94.4% of HCPs acknowledged that MVMS helps boost immunity, reduces the frequency of illnesses, improves productivity and quality of life. Notably, 82% of HCPs recognized that MVMS helps in speeding the recovery from illnesses in their patients by 50%. 89.6% of HCPs believed that MVMS helps their patients gain energy in 2-3 weeks/a month of daily consumption by upto 50%. Beyond physical health, 87.6% of HCPs recognized that MVMS helps improve mental alertness, stress, enhances cognitive and mental health, and aspects of daily functioning by reducing mental fatigue and improving stamina. Additionally, 94.4% of HCPs affirmed that MVMS helps patients return to their normal routines faster, typically within 2-3 weeks, reducing infection rates and absenteeism. Conclusion: During acute illness, a depleted state of micronutrients is observed, thus adding MVMS may help restore the depleted micronutrients and support immune health. MVMS has emerged as a scientifically validated intervention to address micronutrient deficiencies, helps contribute to improve immunity, accelerate recovery, improve energy levels, reduce fatigue, and support cognitive and mental health. The insights obtained offer valuable guidance for individualized patient care and highlights the importance of micronutrient supplementation in supporting immune health. The balanced composition of 12 vitamins, 2 minerals, 5 trace elements, and an amino-acid, was well-tolerated across diverse populations, making it an integral component of preventive and therapeutic healthcare strategies.

Assisted Suicide in Austria: Nurses’ Understanding of Patients’ Requests and the Role of Patient Symptoms

This study explores Austrian palliative and hospice care nurses’ experiences regarding assisted suicide (AS). Following its legalization in 2022, occupational groups affected by the legislation, such as nurses, have been left without clear guidance or instructions on how to navigate this new landscape. This study aimed to explore how nurses perceive their patients’ desire to die and its connection to the symptoms experienced by the patients. A cross-sectional online questionnaire survey was disseminated to all palliative and hospice care facilities in Austria and was eventually completed by 145 nurses, focusing on their understanding of patients’ requests for AS and the severity of patients’ symptoms. Factor analysis was used to identify symptom clusters, and Spearman rank correlations were employed to explore associations between nurses’ understanding of AS and factors such as patient symptoms, nurse demographics, and attitudes toward AS. The results indicate that psychosocial factors, particularly loss of dignity (63.6%) and autonomy (76.4%), were the most frequently reported severe symptoms. Understanding patients’ decisions was significantly associated with nurses’ general support for AS (r = 0.34, p < 0.001) but not with age, work experience, or religious beliefs. Factor analysis revealed four symptom clusters, with ’loss of dignity’ showing a small but significant correlation with nurses’ understanding of patients’ requests (r = 0.17, p = 0.044). The present findings highlight the importance of integrating psychosocial support into palliative care and emphasize the need for clear guidelines and training to better support nurses in managing AS-related challenges.

Patients with Achilles tendinopathy use compensation strategies to reduce tendon load during rehabilitation exercises

BackgroundThis study aimed to determine differences in the Achilles tendon loading during rehabilitation exercises for Achilles tendinopathy and the ranking of these exercises, based on load, in patients with tendinopathy and controls. MethodsSixteen patients with Achilles Tendinopathy (5F & 11 M, 44.1 ± 12.9 yr) and sixteen controls (4F & 12 M, 39.4 ± 15.6 yr) performed rehabilitation exercises while 3D motion and ground reaction forces were measured. Musculoskeletal modeling was used to compute joint kinematics and estimate Achilles tendon load by summing the forces of individual triceps surae muscles. Subsequently, peak Achilles tendon loading, loading impulse, loading rate, loading indexes (a combination of the previous parameters), and joint angles at the time of peak loading were determined and compared between patients and controls. FindingsPatients with tendinopathy exhibited significantly reduced peak Achilles tendon loading compared to controls during the exercises with the highest peak loading: unilateral heel drop with flexed knee (3.66 ± 0.90BW [AT] vs. 4.65 ± 1.10BW [Control], p = 0.003, d = 0.979) and walking (3.37 ± 0.49BW [AT] vs. 3.68 ± 0.33BW [Control], p = 0.044, d = 0.742). Additionally, during the heel drop exercise, patients with tendinopathy showed reduced ankle dorsiflexion and knee flexion. The ranking of exercises by peak loading or loading index was similar for both groups but varied depending on which loading parameter was used to define Achilles tendon loading. InterpretationDuring the highest load-imposing exercises, patients with tendinopathy employ compensatory strategies to reduce the load on their Achilles tendon. Clear instructions and feedback on the patient's performance are crucial as altered exercise execution influences Achilles tendon loading.

A Solution Approach on Reducing Defects in Batik Tanah Liek Production Process of a Small and Medium-sized Enterprise

Small and medium enterprises (SMEs) often struggle with implementing effective quality management practices, especially in traditional industries like batik production. These challenges include ensuring consistent product quality to differentiate from competitors and attract customers. This study focuses on addressing quality control issues in small-scale Batik Tanah Liek production, where significant defects persist. The research aims to assess existing practices, identify defect causes, and propose solutions to enhance product quality and reduce rejection rates. These efforts contribute to improving production efficiency and supporting the sustainability of this traditional craft. The study employs a systematic approach combining quality management methodologies, including data collection, problem identification, brainstorming, the Failure Mode and Effects Analysis (FMEA) approach, and actionable recommendations. Data was gathered through a questionnaire to capture perspectives on defects and quality control issues in batik production. Key quality challenges identified include faded batik, torn fabric, and incorrect motifs. Analysis revealed that the primary cause of incorrect motifs is the malfunctioning canting tool, which hinders proper wax application. Additionally, defects in dyeing and boiling processes contribute to fabric fading and tearing, exacerbating quality issues. The findings underscore the need for systematic solutions, such as creating clear work instructions, designing Standard Operating Procedures (SOPs) for process consistency, and implementing preventive maintenance schedules for equipment. By addressing these issues, the study provides practical interventions to improve production quality. These measures not only enhance the economic viability of SMEs but also play a crucial role in preserving the cultural heritage of Batik Tanah Liek. The implications of this research highlight the potential for broader adoption of quality management practices in traditional industries to ensure their sustainability in competitive markets.

Journal instructions to authors submitting veterinary systematic reviews are inconsistent and often inadequate.

To survey academic journals for the presence and clarity of author instructions for submitting veterinary systematic reviews. Instructions to authors for submitting systematic reviews were surveyed across the 10 academic journals publishing the greatest number of veterinary systematic reviews listed in VetSRev, a citation database exclusively listing systematic reviews of topics relevant to veterinary medicine. Two investigators independently reviewed each author instructions section to answer predetermined survey questions. Data were collected and reviewed from October 21, 2023, through April 9, 2024. Instructions to authors varied across journals, and the requirements for compliance with established reporting guidelines (eg, Preferred Reporting Items for Systematic Reviews and Meta-Analyses) were inconsistent. Four of 10 journals clearly stated the need to follow systematic reporting guidelines, 4 recommended or encouraged the use of guidelines, and 2 had no specific instructions for systematic reviews or reporting guidelines. Instructions for authors submitting veterinary medical systematic reviews are often incomplete or unclear. In the absence of clear and consistent journal requirements for compliance with established systematic review reporting guidelines, the risk of publishing bias or misleading systematic reviews may be increased, which may negatively impact clinical decision making. Ensuring clear and concise instructions for authors will improve the quality of evidence and reporting. Greater clarity and consistency of author instructions and reporting requirements across all journals and increasing author awareness of the need to use reporting guidelines will improve the quality of veterinary systematic reviews.

P-155. Challenges with Artemether and Lumefantrine in the Management of Uncomplicated Malaria Infection

Abstract Background Annually there are approximately 1,500 cases of imported malaria in the UK, with the majority being falciparum infection in African diaspora visiting friends and relatives (VFR). The management of uncomplicated falciparum infection usually entails a treatment course of artemether and lumefantrine. However, this medication can pose challenges to prescribers and patients alike due to the dosing schedule and administration requirements. We assessed the management of uncomplicated falciparum malarial infection in the emergency department and designed a tailored treatment package for patients being managed in an outpatient setting in order to improve medication compliance and clinical outcome for this cohort. Compliance Aid for Artemether/Lumafantrine - Patient Information Leaflet Customised patient information leaflet to be completed by prescriber and given to patient to improve medication adherence Methods A retrospective audit was conducted at a hospital in London from December 2021 to January 2023. The management of uncomplicated falciparum malarial infections and the adequacy of existing clinical pathways were assessed using electronic patient records.. Patients that presented to the emergency department, diagnosed with uncomplicated falciparum infection and discharged home with oral treatment with subsequent outpatient clinic follow-up were included Results A total of 17 patients were included in the audit. 41% (7/17) patients were identified as experiencing issues with medication including confusion regarding when to take tablets, not taking medication with food and not completing the course due to symptom resolution. 3 patients consequently required further course of Riamet and 1 person required admission to hospital due to rising parasitaemia as a result of not taking artemether and lumefantrine correctly. As a result of these findings, a customised patient information leaflet and artemether and lumefantrine prepacks were created and made available in the emergency room. Conclusion This study demonstrates the challenges posed by artemether and lumefantrine for prescribers and patients. Patients with falciparum infection are at risk of rapid deterioration and therefore clear instructions on when and how to take the medication are needed. Follow-up is essential in this cohort and medication compliance issues should be considered in persistent/rising parasitaemia or ongoing symptoms. Disclosures All Authors: No reported disclosures

The Use of The Dictation Strategy to Improve The Listening Skill of The Tenth-Grade Students at SMAS Santo Gabriel Maumere

This study explores the effectiveness of dictation techniques in enhancing the listening skills of tenth-grade students at SMAS Katolik Santo Gabriel Maumere. Recognizing the significance of English as a global language and Indonesian learners' challenges, the research employs a classroom action research design comprising two cycles. The data collection method included observations, questionnaires, interviews, and tests. Initial findings revealed that no one student met the success criteria for listening test in pre-cycle. In cycle 1, the result of test show that only 54,54% students meet the success criteria. After making the Cycle 1, indicating low interest and engagement in learning English. In response, the researcher-teacher implemented modifications in Cycle 2, such as clearer instructions, increased student engagement, and the use of audio recordings. This led to a remarkable improvement, with 90,90% of students achieving the success criteria. The study concludes that the dictation method, when effectively applied, significantly enhances students listening abilities and overall engagement in the learning process. Recommendations for educators are provided to encourage the adoption of similar strategies to foster improved listening skills among students.

Accurate urine sodium measurements at home using Point of Care Testing in patients with Short Bowel Syndrome.

Measurement of the urine sodium concentration (USC) is a simple procedure that in many patients adequately indicates their hydration status. This is of particular importance in patients suffering from short bowel syndrome (SBS), who may very rapidly dehydrate and are at risk for permanently compromising their kidney function. A point of care test (POCT) that allows reliable measurement of USC would enable these patients to effectively evaluate their sodium- and water balance in the at home setting, thereby avoiding hospital visits and delayed test results. In this study, a POCT device to assess USC was first analytically validated after which it was applied for the at home evaluation of the hydration status in patients with SBS. First, we validated the imprecision, bias and limit of quantification of USC as measured with the Fisic Medimate POCT device in comparison to an automated routine chemistry system. Next, the device was used for monitoring USC at home in 21 patients with SBS, including an evaluation of user friendliness System Usability Scale (SUS) and accuracy for detecting low sodium levels as compared to the routine chemistry system. The imprecision of the POCT device at low USC was 6.1 %. In samples at the clinical decision threshold to identify patients at the verge of dehydration of 20 mmol/l as measured by routine chemistry USC, the POCT device demonstrated a mean estimation of USC of 20.6 mmol/l (95% CI 18.8-22.4). Dehydration was detected with a sensitivity of 95% when the medical decision limit for urinary sodium on the POCT device was set at a safe concentration of 30 mmol/l. Using the device was straightforward and easy to learn for patients with an overall System Usability Scale (SUS) score of 86. USC measurements using this POCT device can be safely integrated into daily practice for early detection of dehydration in patients with SBS. Clear patient instructions to ensure accurate drop dispensing and a higher clinical decision threshold of USC of 30 mmol/l will allow a high sensitivity for detecting dehydration in patients with short bowel syndrome.

Case Report: Button battery ingestion—an underestimated emergency in children

In general, the battery-related emergency department visit rate has continued to rise in the last decade. We present two cases of previously healthy toddlers (14 and 24 months old) with unwitnessed battery ingestion, who presented with massive, hematocrit-relevant hematemesis. Initially, both children showed stable vital signs. Following a symptom-free interval, both had a recurrence of massive hematemesis, which could not be controlled despite a multidisciplinary approach with pediatric, radiology, ENT specialists, endoscopy and anesthesia. Pathological workup showed necrosis with secondary aortoesophageal fistula due to battery-induced colliquation necrosis caused by caustic soda produced at the minus pole. We conclude, that preclinical risk scores, excellent clinical pathways (e.g., from Children's Hospital of Philadelphia) and detailed approaches from the National Capital Poison Center in the USA and also the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) offer clear and concise instructions for the management of button battery ingestion, but clinical awareness for vascular complications must be heightened. A multidisciplinary treatment algorithm for this fatal complication should be implemented and trained in pertinent hospitals. Moreover, it is of great importance to raise awareness for button battery ingestion in educational campaigns for parents and caregivers.

IMPLEMENTASI KETERAMPILAN MENGELOLA KELAS MAHASISWA PENDIDIKAN BIOLOGI UNIVERSITAS TANJUNGPURA DALAM PRAKTIK MENGAJAR

Teachers play an important role in the development of students' potential and abilities through their responsibilities as professional educators. The success of teaching depends on the teacher's teaching skills. This study aims to describe the classroom management skills of fourth semester Biology Education A2 class FKIP Tanjungpura University academic year 2023/2024. Data were collected quantitatively through observation of 25 learning videos using a checklist table. The results showed the percentage of components of classroom management skills including responsiveness (96%), dividing attention (88%), focusing group attention (88%), giving clear instructions (100%), providing reinforcement (100%), modifying behavior (96%), group management (88%), finding and solving behavior that causes problems (4%), and reprimanding (4%). Of the nine components of classroom management skills, seven were rated excellent and two were rated deficient. Although the majority of skills were rated as excellent, there are some aspects that still need improvement. Keywords: Skills, Components, Classroom Management.

Octodon degus laboratory colony management principles and methods for behavioral analysis for Alzheimer's disease neuroscience research.

The Chilean degu (Octodon degus) is a medium sized, long-lived rodent with traits that make them a natural model for neuroscience research. Their social behaviors, diurnality, and extended developmental time course, when compared to other rodents, make them useful for social behavioral, chronobiology, and developmental research. Lab-kept degus have a long lifespan (5-8 years) and may naturally develop age-related diseases that resemble Alzheimer's disease. While there is significant interest in using the Octodon degus for neuroscience research, including aging and Alzheimer's disease studies, laboratory management and methods for degus research are currently not standardized. This lack of standardization potentially impacts study reproducibility and makes it difficult to compare results between different laboratories. Degus require species-specific housing and handling methods that reflect their ecology, life history, and group-living characteristics. Here we introduce major principles and ethological considerations of colony management and husbandry. We provide clear instructions on laboratory practices necessary for maintaining a healthy and robust colony of degus for Alzheimer's disease neuroscience research towards conducting reproducible studies. We also report detailed procedures and methodical information for degu Apoe genotyping and ethologically relevant burrowing behavioral tasks in laboratory settings.

Prescription opioid dispensing rates in the 12-months post-discharge after acute spinal cord injury: An observational study

Objectives To determine rates of opioid and concomitant antidepressant, anticonvulsant and benzodiazepine dispensing in the post-discharge period, after acute spinal cord injury (SCI). Design Single-center prospective cohort study with 12-month linked pharmaceutical data. Setting Community pharmaceutical dispensing. Participants Patients ≥18 who were diagnosed with a SCI between March 2017 and March 2018. Outcome measures Rates of dispensing of opioid and concomitant antidepressant, anticonvulsant and benzodiazepine medications in the 12-month post-discharge from a specialist inpatient Spinal Injuries Unit. Results Sixty-eight participants volunteered for the study. Of the medications dispensed in the 12-months after discharge, 16% were opioids, which were supplied to 56% of participants. Forty-six percent of participants had concurrent dispensing of at least one other medication class of interest (antidepressants, anticonvulsants, or benzodiazepines). Participants with opioids prescribed at discharge were 6.5 times more likely to have been dispensed opioids in the 12-months following discharge compared to those who did not have opioids listed at discharge (OR = 6.5, 95% CI = 2.2, 19.0, P < .001). Conclusions Longer-term opioid prescribing plus concomitant analgesia and sleep medications in the post-acute period after SCI were common. Chronic opioid use and the polypharmacy observed is concerning, given the potential for dependence, tolerance and increased drug interactions and associated adverse effects. Both issues point to the need for clear discharge instructions for primary care prescribers and regular monitoring to manage pharmacotherapy therapeutic benefits and risks alongside non-medication therapies.

Modern Information and Communication Mechanisms for Adaptation of Foreign Labor Migrants in Russia

Introduction. The article examines the existing mechanisms of adaptation of labor migrants in Russia. Based on the analysis of regulatory documents and the practice of implementing various solutions (from migrant cards to special information applications), conclusions are drawn about successes and shortcomings, and recommendations are given for the further development and improvement of these mechanisms.Materials and methods. The theoretical and methodological basis of the research is the works of domestic and foreign scientists, as well as reports and datasets from leading international organizations, in particular the International Organization for Migration (IOM) and the Advisory Committee on Migration Policy of the EEC. The work uses elements of the theory of digital communication, as well as classical theories of migration. In particular, the theories of Everett S.Lee, M. Prior, H.G. Duncan, V. Zelinsky and S.N. Eisenstadt used methods of induction, deduction, generalization, synthesis, and comparison to conduct system analysis.Research results. During the conducted research, an analysis of the regulatory framework was carried out, in particular, the provisions of Decree of the President of the Russian Federation dated October 31, 2018 No. 622 "On the Concept of the State Migration Policy of the Russian Federation for 2019-2025" (recent amendments and additions dated May 12, 2023)In addition, it was found that the main digital Mobile and Internet applications are the tools for the adaptation of migrants to Russian society. Among the most successful projects, it is worth noting the work of multifunctional centers and the creation of an electronic migrant card. It has been established that many tools do not work effectively enough. The main reasons are the complex legal language and the lack of translation, the applications are fragmented, there are no clear methodological instructions, there are regulatory and technical limitations.Discussion and conclusion. All the tools and resources used today for the adaptation of migrants in Russia operate separately. It is important to emphasize that increasing the number of platforms and applications will not solve the problem of effective use of digital technologies in this matter. It is necessary to create a network of quality resources linked to each other, each resource must provide a certain direction (legislative information, migrant status, access to services, etc.) so that when using them, a foreign citizen understands the relevance of the information provided and easily gets access to the services offered.

PARENTING STYLES, SELF-ESTEEM AND ACADEMIC PERFORMANCE IN SCIENCES IN UGANDA: A CASE OF SELECTED SECONDARY SCHOOLS IN KABALE DISTRICT.

Background The root cause of this underperformance is intricately linked among other things to the influence of parenting styles on children's self-esteem, subsequently impacting their academic achievements. The study aims to assess the relationship between permissive parenting styles and academic performance in the sciences among high school students in Kabale District. Methodology A cross-sectional design in which a sample of 201 respondents was that consisted of both male and female students from the selected secondary schools. A simple random sampling technique was employed in both the selection of schools and participants. The study applied Pearson product-moment correlation to examine the relationship among the variables. Results The grand mean for all items related to permissive parenting was 2.84. A considerable proportion of respondents (M = 2.13, SD = 1.37) expressed disagreement with the notion that their parents encounter difficulties when disciplining them. A significant number of participants (M = 3.36, SD = 1.39) exhibited uncertainty regarding whether their parents expected them to adhere to certain expectations solely out of respect. The majority of respondents (M = 4.04, SD = 1.05) agreed that their parents usually provided clear instructions about what they wanted them to do and how they expected them to do it. Concerning the directiveness of their parents' desires, respondents were unsure (M = 3.01, SD = 1.42), yet they acknowledged that their parents allowed their opinions on family matters (M = 2.42, SD = 1.18). Conclusion There is a statistically significant positive relationship between Permissive Parenting and Academic Performance. Recommendations Parents and caregivers should focus on praising effort, progress, and personal growth rather than solely on achievements.

Exploring a Software Framework for Posture Tracking and Haptic Feedback Control: A Virtual Reality-Based Approach for Upper Limb Rehabilitation on the Oculus Quest 2.

Virtual reality (VR) has gained significant attention in various fields including healthcare and industrial applications. Within healthcare, an interesting application of VR can be found in the field of physiotherapy. The conventional methodology for rehabilitating upper limb lesions is often perceived as tedious and uncomfortable. The manual nature of the process, performed by physicians, leaves patients in an environment lacking motivation and engagement. This presents an opportunity for implementing VR as a tool to enhance the rehabilitation process and improve the quality, efficiency, and evolution of recovery. However, physiotherapy often lacks relevant data to track the recovery process effectively, further compounding concerns about its efficacy. To address this, we propose the development of a posture control system using the Oculus Quest 2, a VR device. Our primary objective was to validate the performance aspects of this device and assess its potential as a rehabilitation tool, providing valuable support to healthcare professionals. Through a series of tests, we evaluated the effectiveness of our VR solution by integrating it into specific therapeutic exercises. This approach enhances patient involvement by offering real-time feedback on exercise execution and providing clear instructions for posture correction. The results demonstrate a notable impact on exercise performance, highlighting the feasibility of developing physiotherapeutically adapted solutions utilizing VR technology. By leveraging the Oculus Quest 2 system and the proposed framework, our research contributes to the advancement of VR-based rehabilitation practices. The findings offer valuable insights into the potential benefits of integrating immersive technologies into the field of physiotherapy, empowering healthcare professionals in their treatment approaches.

COMMUNITY PHARMACISTS RECOMMENDATIONS ON SELF-MEDICATION FOR GASTROINTESTINAL PROBLEMS: A VIGNETTE CASE STUDY IN EAST SURABAYA

Background: Self-medication is a common approach to managing uncomplicated health issues, including gastrointestinal disorders. Community pharmacists are essential in facilitating successful self-medication by thoroughly evaluating patient information, offering rational suggestions, and delivering clear instructions regarding medication administration. Objective: This study aims to characterize pharmacists' abilities in gathering information on patient symptoms and providing appropriate treatment recommendations for self-medication cases of diarrhea and constipation. Methods: This study employed a cross-sectional methodology accompanied by descriptive analysis. Data was collected using two validated vignette case studies: one for measuring information-gathering competencies and another for assessing the correctness of therapy recommendations. Results: 35 pharmacists participated, most of whom had finished professional pharmacist education (88.6%) and had been practicing in pharmacies for 1 to 7 years (40%). The results showed that 66.0% of pharmacists demonstrated moderate information-gathering skills for diarrhea cases and a lower proportion for constipation cases (45.7%). Only 51.4% of pharmacists could provide correct recommendations for diarrhea and constipation cases. Conclusion: These findings highlight the importance of interventions to enhance pharmacists' roles in providing patients with appropriate, safe self-medication services. Keywords: self-medication; community pharmacists; diarrhea; constipation

Audible tremor: Analysis of the validity of audible information in assessing tremor severity.

Assessing the severity of kinetic tremor is important in clinical and research settings. Archimedes spirals are often used to assess tremor severity. Rating tremor from spirals has been based solely on visual information. However, one can often "hear" tremor. We evaluated the type of information that could be gained from hearing tremors and assessed its validity using visualized tremor as a gold standard. 52 essential tremor cases (94 spirals), 11 Parkinson's disease patients and 11 controls (20 spirals each) were enrolled. During videotaping, cases drew Archimedes spirals in a standardized manner. Three experienced movement disorders neurologists first listened to videotaped spiral drawing (no visual) and assigned a tremor severity rating using Washington Heights Inwood Genetic Study of Essential Tremor (WHIGET) ratings (0, 0.5, 1, 1.5, 2, 3). Later, the neurologist rated the physical (i.e., visual) spiral and assigned a WHIGET tremor rating. The Spearman's correlation coefficient (visual vs. auditory rating) was 0.721 (p<0.001) and the weighted kappa statistic was 0.674, a level of agreement that is considered good. Auditory information provides in-time synchronous corroboration of what the rater is seeing. That is, it informs the visual data and provides construct validity. The results of this study have ramifications for observational and experimental therapeutic studies, which commonly rely on videotaped tremor examinations. Additional corroborative information is available if the sound is left on. Regardless of the decision to present sound to the rater or not, clear instructions and a standardized practice within the study are imperative.

Supply Chain Risk Management of Aftermarket Products in Automotive Spare Parts Manufacturing Companies Using the House of Risk (HoR) Method

This study was conducted at an automotive component manufacturing company that produces aftermarket products. This study aims to identify risk events and agents that occur in the supply chain and develop strategies to control existing risks so as to minimize losses. The method used is the House of Risk (HoR). In HoR phase 1, 19 risk events were identified, with 38 risk agents as risk causes. From HoR phase 1, eight priority risks were selected. HoR phase 2 was carried out by determining a mitigation strategy plan with 16 mitigation actions, and then 7 priority mitigation actions were selected based on the effectiveness ratio obtained from the level of difficulty in realizing the mitigation action. Priority mitigation actions that will be carried out include conducting technology evaluations, providing supporting tools such as barcode scanners, creating clear work instructions, reviewing and updating SOPs, conducting three-point checks, conducting systematic quality control, and setting quality limits.

Building Character Through the Qur’an and Hadith: Hadith’s Review the Wisdom Behind the Invisibility of God, Heaven and Hell

Character formation in Islam plays a very important role in shaping the attitudes and morals of Muslims to be in accordance with religious teachings. This study aims to analyze how the concept of the invisibility of God and the afterlife taught in the hadith of the Prophet Muhammad saw can contribute to the development of good character. Using a qualitative approach and library research method, this study reveals the relationship between belief in the invisibility of God and the afterlife with the formation of a Muslim’s character. The belief that God is invisible teaches Muslims to be humble, patient, and obedient to His commands, while belief in the afterlife encourages them to do good, maintain morals, and focus on the afterlife. The hadiths of the Prophet Muhammad saw provide clear instructions on how Muslims can live a life that focuses on happiness in this world and the hereafter. This study shows that belief in the invisibility of God and the afterlife plays a major role in shaping better character and providing encouragement to do good in everyday life. The author also suggests that Muslims deepen their understanding of the hadiths and apply them in everyday life to improve morals and achieve happiness in the hereafter.

CT IMAGING IN THE ELDERLY: ADDRESSING CHALLENGES AND ENHANCING DIAGNOSTIC ACCURACY

The increasing proportion of elderly individuals globally presents challenges in healthcare. Computed tomography (CT) is a widely utilized radiological modality valued for its rapid acquisition capabilities and accessibility. CT interpretation in elderly patients might be complicated due to age-related physiological changes: decreased bone density, organ elasticity, and increased calcifications. These factors, along with comorbidities like cardiovascular disease, diabetes, and cognitive impairments, complicate CT interpretation. Elderly people are at increased risk of contrast-induced nephropathy due to reduced renal function. Metal fragments, such as pacemakers, coronary stents and stent-grafts, are additional artefacts during CT. Moreover, patient cooperation can be limited by conditions such as dementia or hearing loss, leading to issues with motion and positioning during scans. Considering age-related changes and comorbidities, the solutions in CT scanning might be personalized and specific to the elderly CT protocols. Pre-CT preparation, including clear instructions and strategies for patients with cognitive impairments or physical limitations, is beneficial. Multidisciplinary collaboration among radiologists, geriatricians, and specialists enhances diagnostic accuracy and cooperation. Technological advancements reduce artefacts, enhance image quality, and lower radiation exposure. Educating medical staff on the needs of elderly patients ensures better comfort and care. Implementing complex solutions for optimizing CT imaging might improve the diagnostic outcomes and patient experience.