Continuous Support Research Articles

Harnessing AI

Integrating digital tools in education is essential for innovative teaching and learning (Msafiri et al., 2023). However, their mere availability does not ensure effective implementation. This presentation explores the development of an AI-powered chatbot designed to assist academics and learning designers in effectively using digital tools. Guided by the Technological Pedagogical Content Knowledge (TPACK) model and the Teaching Enhanced Learning Accreditation Standards (TELAS) framework, this project aims to bridge the gap between tool availability and effective usage. Effective implementation of digital tools begins with human factors, precisely the vision and expertise of educators. To achieve this, the TPACK model highlights three critical domains: technological knowledge, content knowledge, and pedagogical knowledge (Mishra & Koehler, 2006). These domains are critical to the effective and successful implementation of digital tools in the teaching-learning ecosystem. Our AI-powered chatbot leverages the TPACK model to connect educators’ pedagogical and content knowledge by conducting a needs assessment based on user-provided inputs and recommending suitable tools for enhanced teaching and learning. The chatbot interacts with users through precise, conversational inquiries, gathering detailed information on course titles, learning objectives, students' expectations, delivery methods, interaction types, desired tool functionalities, and accessibility considerations. This comprehensive approach ensures the chatbot provides well-informed, contextually relevant responses and resources to the users, thereby enhancing instructional effectiveness. By offering continuous support through our self-enrolled teaching support Canvas site, the chatbot ensures educators have access to assistance when needed, making it particularly beneficial for busy academics and learner designers. This then breaks the traditional barriers of time and place and offers users flexibility and real-time quality digital tool solutions. The chatbot knowledge base is built from a comprehensive tool document that maps each available tool at the [university name] to the TELAS framework. This framework sets rigorous standards and criteria for evaluating the quality of online environments, making it ideal for assessing tools across critical domains, including the online learning environment, learner support, learning and assessment tasks, and learning resources. By configuring this quality resource, the chatbot empowers educators to develop a deeper understanding of effectively integrating technology into their teaching practices for a successful learning experience Additionally, the chatbot provides real-time solutions on available tools, supporting continuous professional development and helping educators stay updated with the latest digital tools for their teaching needs. It offers use cases and knowledge base articles, addressing fragmented knowledge, time constraints, and technical expertise gaps, making it a valuable resource for newly recruited learning designers or academics to easily familiarise and induct themselves in the digital tool space. It offers quality assurance in tool usage by employing the TELAS framework. Moreover, the user data collection can provide insight for organising tailored training and support for academics. In conclusion, this presentation demonstrates the practical application and benefits of our AI-powered chatbot to improve digital tool integration in education. Using the TPACK and TELAS frameworks, the chatbot provides personalised support, helping educators seamlessly incorporate technology into their teaching and offering real-time recommendations to address digital tool challenges. It helps both new and experienced educators enhance their teaching, combining technology, pedagogy, and content knowledge for effective learning.

The modern role of paraprofessionals in delivering brief psychological interventions

AbstractThe increasing global demand for mental health services, compounded by the COVID‐19 pandemic, has spurred innovative approaches. Among these, the utilisation of paraprofessionals for delivering brief psychological interventions (BPIs) is gaining significant traction across diverse settings and populations. Paraprofessionals (individuals equipped with specialised mental health training but lacking formal qualifications) have emerged as a valuable resource. They have the potential to offer cost‐effective, culturally sensitive and readily accessible support. The integration of paraprofessionals into various healthcare settings, such as inpatient psychiatric units and primary care clinics, underscores their potential to enhance holistic well‐being and early intervention. This integration not only lightens the load on licensed therapists but also broadens access to services while reducing treatment costs. At a global scale, paraprofessionals, armed with local knowledge and community connections, play a pivotal role in improving mental health outcomes among underserved populations. Furthermore, the rise of telemental health, an increasingly crucial aspect of mental healthcare, presents new avenues for paraprofessionals to deliver psychological care. Despite their potential, paraprofessionals encounter challenges related to work‐life balance, boundary‐setting and the stigma attached to their roles. Their integration into healthcare systems requires clear roles and responsibilities, along with continuous support to ensure effective intervention and the well‐being of both providers and recipients. Further research and development are necessary to harness their full potential and meet the increasing demand for accessible mental health services.

The role of big data in transforming financial management in U.S. healthcare: A conceptual framework

This paper explores the transformative role of big data in financial management within the U.S. healthcare sector, highlighting its capacity to address long-standing financial inefficiencies, enhance decision-making, and improve regulatory compliance. Big data technologies, such as predictive analytics and real-time financial reporting, provide healthcare institutions with the tools to forecast financial trends, optimize budgeting, and mitigate risks. Despite the significant benefits, the adoption of big data in healthcare finance faces challenges, including data privacy concerns, regulatory complexities, and technological limitations. The paper examines these barriers and enablers, offering strategic recommendations for healthcare institutions and policymakers to optimize the use of big data. By improving data governance, upgrading infrastructure, and fostering collaboration across departments, healthcare organizations can maximize the impact of big data on their financial operations. The review concludes with a call for continued policy support and financial incentives to encourage the broader adoption of big data in healthcare finance, ultimately promoting cost efficiency and operational resilience in the sector. Keywords: Big Data, Healthcare Financial Management, Predictive Analytics, Data Governance, Regulatory Compliance, Financial Decision-Making.

Long-term monitoring of citizen science: driving factors and pandemic impacts

ABSTRACT In recent years, the importance of citizen science in biodiversity monitoring has become increasingly evident. Citizen science provides valuable data to understand the dynamic changes in biodiversity across different cities. Although long-term monitoring is crucial for understanding these dynamic changes, previous research has primarily focused on short-term data analysis. Therefore, this study analysed data from the iNaturalist platform for 11 Japanese cities from 2016 to 2023, focusing on the driving factors of observation changes and the impact of the COVID-19 pandemic using the Logarithmic Mean Divisia Index (LMDI) method. The results revealed that the population (total number of active users) metric had the greatest impact, followed by intensity (the number of observations per active day), frequency (active days per active user), and structure (proportion of regular users). To ensure data continuity and reliability, optimizing user structure by increasing the proportion of regular users is essential. Although observation volumes fluctuated during the pandemic, they rebounded significantly post-pandemic, demonstrating the resilience, and adaptability of citizen science projects. The iNaturalist platform provides a stable foundation for long-term data collection, aiding in the comprehensive understanding of biodiversity dynamics. Our study also highlighted differences in citizen science participation and biodiversity monitoring across cities, indicating the need for tailored biodiversity conservation policies. To effectively address similar crises in the future, developing contingency plans is recommended to provide continuous support for biodiversity conservation and public engagement in environmental management.

Barriers and facilitators to implementation of a national antimicrobial stewardship toolkit for inpatient settings

Abstract Introduction Antimicrobial stewardship (AMS) is vital for combating antimicrobial resistance (AMR). The updated 2023 "Start Smart Then Focus" (SSTF) national antimicrobial stewardship (AMS) toolkit1, designed for inpatient settings, supports optimising prescribing of antimicrobials. Aim This project was designed to identify the barriers and facilitators to implementing the national toolkit to improve patient outcomes and reduce AMR. Method An online training workshop was conducted for healthcare professionals across England, focusing on the SSTF toolkit. Before the workshop, participants completed a survey that included consent and gathered information on their roles, familiarity with AMS principles, current practices, and perceived barriers and facilitators to AMS implementation. This information in this survey was used to form basis for the workshop and it was helpful in developing content appropriate for the target audience, which will be delivered during the session. The workshop included discussions on knowledge mobilisation, behavioural science using the COM-B model, and SSTF implementation case studies. Participants engaged in breakout sessions to identify implementation challenges at their organisations. Post-workshop surveys collected feedback on learning outcomes. Collaboration with NHS England AMS leads and UKHSA behavioural scientists was integral. The NHS Health Research Authority tool confirmed the project did not require ethical approval as the surveys were service evaluation. Data were analysed using descriptive statistics for quantitative responses and thematic analysis for qualitative feedback, tailoring workshop content to address specific needs. Results The workshop attracted 57 out of 71 (80%) registered healthcare professionals, including pharmacists (n=45), doctors(n=3), and nurses(n=4). Post-workshop surveys received a 28%(n=16) response rate. Feedback was positive, with 14 out of 16 (88%) of participants expressing high satisfaction. Highlights included SSTF development, e-prescribing implementation, and sessions on barriers and facilitators.Key barriers identified were lack of time, competing priorities, data complexity, insufficient organisational support, and limited resources3. Facilitators included engaging microbiology consultants and the ePMA team, raising awareness through AMS ward rounds, and embedding the SSTF toolkit into guidelines and education. Participants suggested further support from UKHSA and NHSE, including more teaching sessions, workshops, educational materials, and e-learning resources. Practical tools like posters, lanyard cards, infographics, and virtual sessions were recommended to reinforce implementation. The survey responses were analysed using descriptive statistics for quantitative data, such as satisfaction ratings, and thematic analysis for qualitative feedback. This analysis evaluated the workshop's impact on participants' understanding and readiness to implement the toolkit and provided insights for enhancing future training activities. Discussion/Conclusion The workshop identified key facilitators and barriers to SSTF implementation. While the toolkit offers a comprehensive framework for AMS, overcoming barriers requires a multifaceted approach involving education, stakeholder engagement, and continuous support. Clearer role definitions and improved support structures are essential. Limitations include limited participant representation and reliance on self-reported data, which may introduce bias. The study lacks long-term follow-up data to assess sustained impact, and feedback might be influenced by personal experiences or organisational culture, affecting generalisability. Future studies could expand participant diversity, incorporate longitudinal assessments, and explore additional AMS aspects.

IMPACT OF QUALITY CERTIFICATION ON THE VISIBILITY AND COMPETITIVENESS OF COFFEE PRODUCTION IN CERRADO MINEIRO

The demand for sustainable agricultural practices and products that meet ethical criteria has grown among consumers, making certifications such as Fair Trade, Rainforest Alliance and UTZ essential for producers seeking to stand out in the market. This study is justified by the need to understand how certifications can add value to coffee and influence the profitability of producers, in addition to promoting practices that guarantee the economic and social sustainability of rural communities. The general objective was to investigate the impact of certifications on the visibility and competitiveness of coffee from the Cerrado Mineiro region. The methodology adopted was qualitative, with documentary analysis and literature review, following ethical guidelines and without direct interaction with producers. Data were collected from reports, academic articles and statistics from relevant institutions. The results indicated that certified coffees tend to achieve prices up to 30% higher than non-certified coffees, reflecting the willingness of consumers to invest in products that meet quality and sustainability standards. In addition, certifications encouraged the adoption of more responsible agricultural practices, generating social and environmental benefits for producing communities. The study concludes that quality certifications are essential for the competitiveness of coffee farming in Cerrado Mineiro, recommending continued support for these practices to promote a sustainable and ethical production model.

Beyond Recommendations: From Backward to Forward AI Support of Pilots' Decision-Making Process

AI is anticipated to enhance human decision-making in high-stakes domains like aviation, but adoption is often hindered by challenges such as inappropriate reliance and poor alignment with users' decision-making. Recent research suggests that a core underlying issue is the recommendation-centric design of many AI systems, i.e., they give end-to-end recommendations and ignore the rest of the decision-making process. Alternative support paradigms are rare, and it remains unclear how the few that do exist compare to recommendation-centric support. In this work, we aimed to empirically compare recommendation-centric support to an alternative paradigm, continuous support, in the context of diversions in aviation. We conducted a mixed-methods study with 32 professional pilots in a realistic setting. To ensure the quality of our study scenarios, we conducted a focus group with four additional pilots prior to the study. We found that continuous support can support pilots' decision-making in a forward direction, allowing them to think more beyond the limits of the system and make faster decisions when combined with recommendations, though the forward support can be disrupted. Participants' statements further suggest a shift in design goal away from providing recommendations, to supporting quick information gathering. Our results show ways to design more helpful and effective AI decision support that goes beyond end-to-end recommendations.

Continuous Labor Support on Maternal Outcomes and Experiences

Continuous Labor Support on Maternal Outcomes and Experiences

The Public Service Digitalization in the Philippines Towards a National Program to Capacitate Digital Frontliners

The rapid advancement of technology has driven a global transformation in public service delivery. In the Philippines, efforts to digitalize public services are crucial for inclusive development and efficient governance. This study, titled "The Public Service Digitalization in the Philippines Towards a National Program to Capacitate Digital Frontliners," examines this transformation through the experiences of government employees, known as digital frontliners. These individuals are key to implementing and managing digital technologies across public sectors.Using a mixed-method research design, the study integrates descriptive, correlative-comparative, and phenomenological approaches to gather quantitative and qualitative data. A total of 400 digital frontliners participated in a survey, while 10 key informants were interviewed. This approach provides a comprehensive analysis of the digitalization process, focusing on demographic profiles, challenges, job satisfaction, and service effectiveness.The theoretical framework includes the Theory of Digital Government Transformation, the Unified Theory of Acceptance and Use of Technology (UTAUT), and Capacity Building and Development Theory. These frameworks help understand the dynamics of public service digitalization, technology acceptance, and the importance of capacity building.Key findings reveal a diverse workforce among digital frontliners, significant challenges such as infrastructure limitations and digital literacy disparities, and varying levels of job satisfaction. The research underscores the need for robust digital infrastructure, tailored training programs, and streamlined administrative processes. It also highlights the importance of public-private collaboration.The study proposes a national program to enhance the capabilities of digital frontliners through continuous professional development and innovation support. This program aims to improve digital public services, making them more efficient, transparent, and accessible. The findings provide a foundation for evidence-based policymaking and strategic planning, contributing to the Philippines' digital transformation and inclusive growth.

Turning Science Lessons Inside Out: Professional Development for Elementary School Teachers' Outdoor Instruction

Despite the growing field of research focusing on the benefits of learning science in the outdoors where students have direct connections with the natural world, teachers report that challenges such as time and test preparation discourage outdoor science instruction. Additionally, many teachers feel ill-equipped and a lack of support from administrators to teach science and enact outdoor instruction. We present research collected during a series of professional development workshops at two elementary schools designed to help teachers recognize the potential for teaching science outdoors and provide strategies for adapting their existing lessons to include schoolyard experiences. Through observation and interview data with teachers and school leaders, we document teachers’ views of and experiences with outdoor teaching and learning. Interview data document four major themes that include teachers’ outdoor experiences, outdoor connections with science and other subjects, benefits and barriers of outdoor teaching and learning, and teachers’ impressions of students and outdoor science. While teachers report that the year-long professional development experience provided a strong introduction to outdoor instruction, they need continued support to enact authentic science instruction situated in the schoolyard.

Operation of Photoeelectron Spectrometers for Non-Invasive Photon Diagnostics at the European X-Ray Free Electron Laser

Angle-resolved photoelectron spectrometers with microchannel plate detectors and fast digitizer electronics are versatile and powerful devices for providing non-invasive single-shot photon diagnostics at a MHz repetition rate X-ray free-electron lasers. In this contribution, we demonstrate and characterize the performance of our two operational photoelectron spectrometers for the application of hard X-rays and soft X-rays as well as new automation tools and online data analysis that enable continuous support for machine operators and instrument scientists. Customized software has been developed for the real-time monitoring of photon beam polarization and spectral distribution both in single-color and two-color operation. Hard X-ray operation imposes specific design challenges due to poor photoionization cross-sections and very high photoelectron velocities. Furthermore, recent advancements in machine learning enable resolution enhancement by training the photoelectron spectrometer together with an invasive high-resolution spectrometer, which generates a response function model.

Performance analysis of Entrepreneurs in the implementation of SVEP at Chumukedima and Jakhama blocks of Nagaland

The study highlights that education, income and the support provided by the Startup Village Entrepreneurship Programme (SVEP) ecosystem were the significant factors influencing the performance of entrepreneurs. Those enrolled in the program outperformed pre-SVEP entrepreneurs. Continuous support in the form of mentorship, access to finance and marketing linkages and capacity-building training played crucial roles in enhancing entrepreneurs' performance and income. Nevertheless, overall, there has been growth in income, fixed assets, and employment opportunities in sectors such as manufacturing, trading, and services. Furthermore, the introduction of technological interventions for monitoring, bookkeeping and online platforms tailored for SVEP entrepreneurs, as well as marketing consortiums and scheme convergence is expected to have a significant impact on the scheme and rural entrepreneurs. Key words: SVEP, Ecosystem. Manufacturing, Trading and Services.

TRANSFORMASI DIGITAL DAN PENGARUHNYA TERHADAP BUDAYA ORGANISASI: TINJAUAN LITERATUR SISTEMATIS

Digital transformation has become a global phenomenon reshaping how organizations in Indonesia operate and compete. This study aims to analyze the impact of digital transformation on organizational culture through a systematic literature review (SLR), focusing on aspects of collaboration, structural flexibility, resistance to change, and value adaptation. The results indicate that digital transformation enhances collaboration and flexibility within organizations, fostering better cross-departmental communication and responsiveness to market changes. However, resistance to change emerges as a significant challenge, particularly among employees concerned about their roles. Adapting organizational values towards a more open and innovative culture also requires continuous support from leadership. In conclusion, the success of digital transformation depends on a holistic and comprehensive change management approach. This study provides guidance for organizations to design cultural strategies that support the sustainability of digital transformation in Indonesia.

An Interview with National Leaders in the Arts and Humanities

Abstract The President’s Committee on the Arts and the Humanities (PCAH) has played a significant role in American government since its establishment by President Reagan in 1982. Although not part of the President’s Cabinet, the PCAH serves as an advisory body directly appointed by the president to support and promote arts and humanities across the nation. Despite its non-partisan mission, the PCAH has not been immune to political turmoil. In 2017, following President Trump’s controversial comments on the Charlottesville violence, the PCAH members resigned en masse, leading to the committee’s temporary disbandment. President Biden reinstated the PCAH in 2022, emphasizing its importance in fostering civic engagement, social cohesion, and equity through the arts and humanities. This article features an interview with current PCAH members, including National Endowment for the Humanities Chair Shelly C. Lowe, Oscar- and Tony-award winner and PCAH Co-Chair Bruce Cohen, and PCAH member and interdisciplinary artist Amanda Phingbodhipakkiya. The discussion highlights their personal and professional journeys within the arts and humanities, underscoring the profound impact of cultural experiences on their lives. They advocate for continued government support, citing the arts and humanities as essential for a functioning democracy.

Peningkatan Akses dan Peluang Kewirausahaan Mahasiswa melalui Pembelajaran Fotografi Berbasis Proyek Industri di Sistem Pembelajaran Jaringan

The program to enhance student access and entrepreneurial opportunities through industry-based photography project learning in an online learning system aims to develop students' technical and managerial skills. This program combines theory and practice through real industry-relevant projects, providing a comprehensive and interactive learning experience. Results show significant improvements in students' skills and motivation. With continued support from various parties, this program is expected to sustain improvements in education quality and entrepreneurial opportunities.

OA23 A complex case of psoriatic juvenile idiopathic arthritis

Abstract Introduction This patient demonstrates many of the challenges that can be faced when treating juvenile idiopathic arthritis (JIA). The combination of difficult to treat disease, together with her social situation has made her case a particularly challenging one. Her case outlines the necessity of a multidisciplinary, and multi-agency, approach to treatment to ensure patient’s needs are met. Case description This patient presented at five years old with a several year history of swelling in her knees and feet. On examination she had a polyarthritis affecting bilateral metacarpal-phalangeal joints, both wrists, both elbows, and both knees. She is ANA negative and RF negative. She was initially treated with intravenous methylprednisolone (IVMP), methotrexate and joint injections. This patient’s disease has been very difficult to treat, with inadequate response to multiple medications (see table 1). She has had multiple flares, required 12 General anaesthetics for joint injections, as well as several pulses of IVMP to help control her inflammation. The patient has persistent effusion of her knees, not responsive to intra-articular steroids and the presence of significant crepitus. An MRI of her right knee showed 14 mm loose bony fragment, in addition to synovitis and effusion. The orthopaedic team were not keen to manage this surgically. She was discussed with other centres, following which combination of biologics / biologic with small molecule (JAK inhibitors) was felt to be the next option. Adalimumab was added to Tofacitinib in June 2024 due to inadequate control. Discussion The difficulty in treating this patient have made us consider alternative diagnosis. MRI scans of her hips done in April 2023 showed bilateral coxa vara. This, along with no evidence of erosions and poor response to treatment, raised the possibility of Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome. However, she did not have camptodactyly, her echocardiogram did not show pericardial effusion and the genetic testing was negative. This patient has a complex social background. She lives with her mother, and no longer has contact with her father, or his side of the family. Her mother was involved in a car accident many years ago and due to a traumatic brain injury has difficulty with memory. Her mother has also suffered with depression. This, together with financial difficulties, have led to many missed appointments and concerns around compliance, despite continuous support from our specialist nursing team. The patient has poor school attendance- more than can be accounted for by her disease. Her current school are very supportive. They give reminders about appointments, and a teacher collects her from home and takes her to school each day. When she starts secondary school this level of support will not be available. Providing psychological support has been challenging due to her age and available resources. However, now she is 11 years old she will be able to get involved with our youth team. She struggles with needle phobia, and is very self-conscious about her swollen knees, and the sound they make when she moves. At various times, safeguarding referrals have been made to try to support the family, none of which were accepted. Her mother’s reluctance to accept support from social services did not help either. This has presented the team with many challenges. Key learning points • This is a challenging case of psoriatic JIA, unresponsive to multiple biologic agents, complicated by difficult social situation influencing care decisions. Non-attendance to clinics has contributed to delay in escalation of treatment at times. She was discussed at various regional and national MDT meetings, both in terms of diagnosis and management plans. Other differential diagnoses were considered and ruled out. • The importance of addressing all the biopsychosocial aspects of care are highlighted in this case. The difficulty of balancing ongoing rapport and trust with the family, and ensuring safeguarding for the patient has been challenging. Learning points: • Importance of multi-agency and multi-centre working in management of patients with complicated JIA. • Importance of difficult social situation affecting timely management decisions and the role of family support in optimising medical care. • Even with newer treatments being approved on regular basis for JIA, it is important to recognise there are patients who prove resistant to many of these and more evidence is needed for combining biologics in such patients.

P50 Systemic lupus erythematous presenting as Kikuchi-Fujimoto disease complicated with haemophagocytic lymphohistiocytosis: a case report and review of the literature

Abstract Introduction Kikuchi-Fujimoto disease (KFD) or histiocytic necrotising lymphadenitis is a rare, self-limiting inflammatory condition that can be associated with autoimmune connective tissue disorders (CTD) especially systemic lupus erythematosus (SLE). The aetiopathogenesis remains unclear but it is thought to be triggered by an infection in individuals with autoimmune predisposition leading to T-cells mediated apoptosis and inflammatory cascade. This condition most commonly affects children and young adults of Asian descent with a slight female preponderance although it can affect any age and ethnic groups. Cervical lymphadenopathy and fever are the salient manifestations, and it can be fatal if complicated with haemophagocytic lymphohistiocytosis (HLH). Case description A 16 year old girl presented with a 2-month history of persistent fever, progressive bilateral cervical lymphadenopathy, generalised maculopapular rash, angioedema-like facial swelling, oral ulcers and B symptoms. Laboratory investigations revealed pancytopaenia, profound acute phase response and abnormalities consistent with HLH with an HScore of 200 points. A thorough infectious workup was unrevealing apart from serological evidence of past Epstein-Barr virus (EBV) infection. ANA, anti-Sm, anti-RNP and anti-B2GP1 IgG were positive. An ultrasound of her neck showed bilateral multilevel cervical lymphadenopathy and the excision biopsy of her lymph node confirmed features of histiocytic necrotising lymphadenitis and ruled out lymphoma. Notably, there were scattered EBV-positive blasts and the special staining for mycobacteria was negative. A CT scan has also demonstrated bilateral axillary and abdominal lymphadenopathy with no hepatosplenomegaly. There was thrombosis in her right internal jugular vein with no intracranial or cardiac extension of the thrombus. The patient was admitted to ITU for close monitoring due to concerns about possible airway compromise but she did not require any respiratory support. She received intravenous (IV) methylprednisolone pulses for three consecutive days, mycophenolate mofetil, hydroxychloroquine and treatment dose of enoxaparin with good response and did not require IV immunoglobulins (IVIG) and/or interleukin-1 receptor antagonists. However, she subsequently developed an abscess in her neck which was complicated by Staphylococcus aureus bacteraemia and underwent an emergency incision and drainage of the abscess. She recovered well with IV antibiotics and was followed up in the CTD clinic with continuous psychological support from the rheumatology clinical nurse specialists. Discussion KFD most commonly presents with acute to subacute tender cervical lymphadenopathy and fevers which can be associated with other systemic features such as arthralgia, various cutaneous manifestations with great histologic heterogeneity, and neurological manifestations including aseptic meningitis, meningoencephalitis, acute cerebellar syndrome and optic neuritis. Generalised lymphadenopathy has been reported in 22% of cases but hepato- and/or splenomegaly is uncommon (3-5% of cases). Various infectious agents including the EBV have been implicated as the potential trigger of this condition but the evidence remains inconclusive. Our patient’s lymph node biopsy has demonstrated EBV-positive blasts with serological evidence of past EBV infection but a causal relationship between these findings and KFD cannot be established with certainty. It remains a diagnostic challenge to differentiate KFD from the other more sinister pathologies such as lymphoma, various infectious lymphadenitis and autoimmune conditions such as sarcoidosis and Kawasaki disease. Therefore, early excisional biopsy of the affected lymph nodes is essential for establishing the correct diagnosis and may obviate the need for inappropriate treatments. Both KFD and SLE share a complex clinicopathological relationship as SLE may precede, occur concurrently as in this case or develop later following the diagnosis of KFD. Moreover, lupus lymphadenitis can mimic KFD clinically and these two entities can only be distinguished histologically by the demonstration of haematoxylin bodies in lupus lymphadenitis. Our patient developed thrombosis in her right internal jugular vein which was thought to be secondary to the compressive effect from her cervical lymphadenopathy rather than due the antiphospholipid syndrome as her repeat antiphospholipid screen was negative. Key learning points • Clinicians should be aware of this rare clinical entity to make an early diagnosis and avoid unnecessary investigations. Differentiating KFD from the other sinister conditions such as lymphoma remains a diagnostic challenge therefore an early excisional biopsy of the affected lymph nodes would avoid delayed diagnosis and obviate the need for potentially risky treatments. Patients with KFD should be carefully screened and monitored for SLE as it can precede, occur in conjunction with or follow the diagnosis of SLE. Most cases of KFD resolve within 1-6 months although recurrence has been reported in 3-4% and the mortality rate is estimated to be 2.1%. It is crucial to follow up these patients given the increased risk of recurrence which can continue for many years. Despite having a good response to treatments, our patient suffered from significant alopecia and post-inflammatory hyperpigmentation in her skin which has had a great impact on her self-esteem and mental well-being. We would like to highlight in this case the biopsychosocial ramifications of this condition and demonstrate the importance of a multidisciplinary approach in the management of young people with CTD.

Progressive Encephalomyelitis With Rigidity and Myoclonus With Glycine Receptor and GAD65 Antibodies: Case Report and Potential Mechanisms.

Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a severe form of stiff-person spectrum disorder that can be associated with antibodies against surface antigens (glycine receptor (GlyR), dipeptidyl-peptidase-like-protein-6) and intracellular antigens (glutamate decarboxylase (GAD65), amphiphysin). We report clinico-pathologic findings of a PERM patient with coexisting GlyR and GAD65 antibodies. A 75-year-old man presented with myoclonus and pain of the legs, subsequently developed severe motor symptoms, hyperekplexia, a pronounced startle reflex, hallucinations, dysautonomia, and died 10 months after onset despite extensive immunotherapy, symptomatic treatment, and continuous intensive care support. Immunotherapy comprised corticosteroids, IVIG, plasmapheresis, immunoadsorption, cyclophosphamide, and bortezomib. Intensive care treatment and permanent isoflurane sedation was required for more than 20 weeks. CNS tissue revealed neuronal loss, astrogliosis and microgliosis, representing a pallido-nigro-dentato-bulbar-spinal degeneration pattern, specifically along GlyR and GAD expression sites. Neurons showed pSTAT1, MHC class I, and GRP78 upregulation. Inflammation was moderate and characterized by CD8+ T cells and single CD20+/CD79a+ B/plasma cells. Focal tau-positive thread-like deposits were detected in gliotic brainstem areas. In the spinal cord, GlyR, glycine transporter-2, and GAD67 expression were strongly reduced. A possible potentiating effect of pathogenic GlyR antibodies together with T cells directed against neurons may have led to the severe and progressive clinical course.

Teachers' Strategies for Managing Disruptive Behavior in The Classroom During The Learning Process

This study aims to examine the strategies employed by teachers at Madrasah Ibtidaiyah Negeri 2, Banjarmasin to manage disruptive behavior in the classroom during the learning process. The research employs a qualitative methodology, utilizing descriptive analysis based on data gathered from semi-structured interviews with teachers and a review of related literature. This approach allows for a comprehensive understanding of the practical techniques used by educators in real-time classroom settings and assesses their effectiveness in creating a conducive learning environment. The findings reveal that teachers at Madrasah Ibtidaiyah Negeri 2 effectively utilize a combination of behaviorist and constructivist strategies to manage and mitigate disruptive behaviors. Key strategies include the application of positive reinforcement to encourage desirable behaviors and the establishment of clear, consistent rules to provide structure. Additionally, the use of engaging and interactive teaching methods has been shown to significantly reduce instances of disruptive behavior by maintaining high levels of student involvement and interest. Despite these positive outcomes, challenges such as the diverse nature of the student body and varying degrees of parental support pose obstacles to the uniform application of these strategies. The research indicates that while the employed strategies are generally effective, they require continuous adaptation and support to address these challenges adequately.

The Evolution Of Organizational Energy Management: Developed Methodologies And The ISO 50001 Standard

This article presents the evolution of practices and procedures developed and applied in energy management in organizational environments. The global evolution of energy management and the evolution of guidelines applied in organizational energy management are discussed, which were consolidated in norms and standards, whose peak was reached with the international standard ISO 50001. This article reviews the published works that bring with them some contribution related to the methods developed and applied in conducting the process of implementing an energy management system, where the implementation of the ISO 50001 standard stood out, mainly in industrial environments. In all the works reviewed, it is clear that the success in implementing energy management through the ISO 50001 standard was achieved due to the continuous support of the organization's top management and the involvement and commitment of all members of the organization