Individual Criteria Research Articles

Prevalence of potentially inappropriate medications among newly treated patients with type 2 diabetes in UK primary care.

The aim of this study was to estimate the prevalence of potentially inappropriate prescriptions (PIPs) in patients starting their first noninsulin antidiabetic treatment (NIAD) using two explicit process measures of the appropriateness of prescribing in UK primary care, stratified by age and polypharmacy status. A descriptive cohort study between 2016 and 2019 was conducted to assess PIPs in patients aged ≥45 years at the start of their first NIAD, stratified by age and polypharmacy status. The American Geriatrics Society Beers criteria 2015 was used for older (≥65 years) patients and the Prescribing Optimally in Middle-age People's Treatments criteria was used for middle-aged (45-64 years) patients. Prevalence of overall PIPs and individual PIPs criteria was reported using the IQVIA Medical Research Data incorporating THIN, a Cegedim Database of anonymized electronic health records in the UK. Among 28 604 patients initiating NIADs, 18 494 (64.7%) received polypharmacy. In older and middle-aged patients with polypharmacy, 39.6% and 22.7%, respectively, received ≥1 PIP. At the individual PIP level, long-term proton pump inhibitors (PPI) use was the most frequent PIP among older adults, and strong opioid without laxatives was the most frequent PIP in middle-aged patients with polypharmacy (11.1% and 4.1%, respectively). This study revealed that patients starting NIAD treatment receiving polypharmacy have the potential for pharmacotherapy optimization.

Identifying Company Selection Criteria applied by Maritime Transportation Engineering Students for Career Planning

Increasing global trade volumes require more and more seafarers to be employed on ships. The reports by international organizations and institutions frequently indicate a shortage of onboard officers, as well as that this deficit will keep increasing gradually. Given all these international reports, businesses need to adopt strategies that will make seafaring more attractive to avoid future issues with the employment of competent seafarers. Such strategies would give them competitive advantage by attracting qualified officers to their ranks. This study aims to determine which criteria officers consider when choosing their future employers and the weight they attribute to individual criteria in making such decisions. The criteria were identified by brainstorming of study subjects (n=8) using the focus group method. The weight ratio of the criteria obtained through focus group and Delphi study results was calculated using the fuzzy AHP (FAHP) method (n=32), and the relevance of individual criteria for the selection decision determined. As a result of the research, 18 sub-criteria have been identified under the main criteria of "Operational factors", "Living conditions onboard", "Personal benefits" and "Personnel management policies" and their weight on the selection decision determined. The study contributed to the literature on identifying company selection criteria for officers. These criteria give businesses and international organizations a scientific perspective that will assist them in identifying new policies that will ensure the sustainability of the maritime profession and the employment of seafarers.

Electrocardiography versus Echocardiography in Severe Aortic Stenosis with the Consideration of Coexistent Coronary Artery Disease.

(1) Background: Coexistent coronary artery disease (CAD) might influence the ability of electrocardiogram (ECG) to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) in patients with aortic stenosis (AS). We aimed to assess the relation between ECG-LVH (by the Sokolov-Lyon or Cornell criteria) and ECHO-LVH considering coexistent CAD. (2) Methods: We retrospectively analyzed the medical records of 74 patients (36 males) with severe AS who were hospitalized in the University Hospital in Cracow from 2021 to 2022. (3) Results: ECHO-LVH was present in 49 (66%) patients, whereas 35 (47.3%) patients had ECG-LVH. There was no difference between the rate of ECG-LVH in patients with vs. without ECHO-LVH. Single-vessel and multi-vessel CAD were diagnosed by invasive coronary angiography in 18% and 11% of patients, respectively. The sensitivity of the classical ECG-LVH criteria with regard to ECHO-LVH was low, reaching at best 41% for the Sokolov-Lyon and Cornell criteria. The results were similar and lacked a pattern when considering patients without significant stenosis, with single- and multi-vessel disease separately. Correlations between the left ventricular mass index and ECG-derived parameters were weak and present solely for the Lewis index (r = 0.31), R wave's amplitude >1.1 mV in aVL (r = 0.36), as well as the Cornell (r = 0.32) and Sokolov-Lyon (r = 0.31) voltage criteria (p < 0.01). The presence, location of stenoses, and CAD extent were not associated with the presence of either ECHO-LVH or ECG-LVH, irrespective of individual ECG-LVH criteria. (4) Conclusions: The sensitivity of classical ECG criteria for echocardiographic LVH in severe AS is low, regardless of coexistent CAD or its angiographic extent.

Surgical Outcome Reporting. Moving From a Comic to a Tragic Opera?

To assess the current quality of surgical outcome reporting in the medical literature and to provide recommendations for improvement. In 1996, The Lancet labeled surgery as a "comic opera" mostly referring to the poor quality of outcome reporting in the literature impeding improvement in surgical quality and patient care. We screened 3 first-tier and 2 second-tier surgical journals, as well as 3 leading medical journals for original articles reporting on results of surgical procedures published over a recent 18-month period. The quality of outcome reporting was assessed using a prespecified 12-item checklist. Six hundred twenty-seven articles reporting surgical outcomes were analyzed, including 125 randomized controlled trials. Only 1 (0.2%) article met all 12 criteria of the checklist, whereas 356 articles (57%) fulfilled less than half of the criteria. The poorest reporting was on cumulative morbidity burden, which was missing in 94% of articles (n=591) as well as patient-reported outcomes missing in 83% of publications (n=518). Comparing journal groups for the individual criterion, we found moderate to very strong statistical evidence for better quality of reporting in high versus lower impact journals for 7 of 12 criteria and strong statistical evidence for better reporting of patient-reported outcomes in medical versus surgical journals ( P <0·001). The quality of outcomes reporting in the medical literature remains poor, lacking improvement over the past 20 years on most key end points. The implementation of standardized outcome reporting is urgently needed to minimize biased interpretation of data thereby enabling improved patient care and the elaboration of meaningful guidelines.

Barriers to Enrollment in a Post-Stroke Neuromodulation and Walking Study: Implications for Recruiting Women

Background Women have a higher risk of stroke and related disability than men but are underrepresented in stroke clinical trials. Identifying modifiable recruitment and enrollment barriers for women can improve study generalizability, statistical power, and resource utilization. Objective In a post-stroke neuromodulation study, we determined the impact of sex on the occurrence of exclusion criteria and compared the sex distribution of screened and enrolled individuals with a broader stroke-affected population. Methods A total of 335 individuals with chronic stroke were screened for a study examining how neuromodulation and high-intensity treadmill training affect walking speed and corticomotor excitability. Demographics and exclusions were retrospectively gathered as a secondary dataset. Exclusion criteria consisted of 6 categories (not target population, unable to do treadmill protocol, unable to do non-invasive brain stimulation, insufficient ankle motion and disinterest, and cognitive impairment). Incidence of each exclusion criterion was compared between women and men. The sex distribution was compared to a dataset from Chicago primary stroke centers. Results A total of 81 individuals were enrolled and 254 were not. The percentage of women excluded was significantly greater than that of men (P = .04). No individual exclusion criterion or categories excluded women more frequently than men. Screened and enrolled individuals had a lower proportion of women and younger age than a representative stroke population (P < .001). Conclusions We identified exclusion criteria (ie, headaches, cognitive scores, and age) that are modifiable barriers to enrollment of women in this post-stroke neuromodulation study. Addressing underrepresentation of women in stroke research is pivotal for enhancing generalizability, achieving statistical power, and optimizing resources.

Continuous improvement through differential trajectories of individual minimal disease activity criteria with guselkumab in active psoriatic arthritis: post hoc analysis of a phase 3, randomized, double-blind, placebo-controlled study

BackgroundTo explore the trajectory of, and factors contributing to, achievement of individual criteria of minimal disease activity (MDA) in patients with active psoriatic arthritis (PsA) treated with guselkumab.MethodsThe Phase 3, randomized, placebo-controlled DISCOVER-2 study enrolled adults (N = 739) with active PsA despite standard therapies who were biologic/Janus kinase inhibitor-naive. Patients were randomized 1:1:1 to guselkumab 100 mg every 4 weeks; guselkumab 100 mg at week 0, week 4, then every 8 weeks; or placebo. In this post hoc analysis, patients randomized to guselkumab were included and pooled (N = 493). Longitudinal trajectories of achieving each MDA criterion through week 100 were derived using non-responder imputation. Time to achieve each criterion was estimated with Kaplan-Meier analysis. Multivariate regression for time to achieve each criterion (Cox regression) and achievement at week 100 (logistic regression) was used to identify contributing factors.ResultsContinuous improvement across all MDA domains was shown over time. ~70% of patients achieved near remission in swollen joint count (SJC), Psoriasis Area and Severity Index (PASI), and enthesitis through week 100. Median times to achieve individual criteria differed significantly (p < 0.0001), with SJC ≤ 1 (20 weeks), PASI ≤ 1 (16 weeks), and ≤ 1 tender entheses (16 weeks) being faster than patient-reported criteria (pain ≤ 15 mm, patient global assessment of arthritis and psoriasis ≤ 20 mm, Health Assessment Questionnaire-Disability Index ≤ 0.5) and tender joint count ≤ 1. Higher baseline domain scores, older age, worse fatigue, and increased body mass index were significant predictors of longer time to achieve minimal levels of disease activity assessed via patient-reported criteria.ConclusionsSubstantial proportions of guselkumab-treated patients achieved individual MDA criteria, each showing continuous improvement through week 100, although with distinct trajectories. Median times to achieve physician-assessed MDA criteria were significantly faster compared with patient-driven criteria. Identification of modifiable factors affecting the time to achieve patient-reported criteria has the potential to optimize the achievement and sustainability of MDA in the clinic via a multidisciplinary approach to managing PsA, involving both medical and lifestyle interventions.Trial registration numberNCT03158285.Trial registration dateMay 16, 2017.

A randomized controlled clinical study to evaluate the efficacy of Aragwadha Pushpa Lepa (Cassia fistula Linn.) in the management of Vyanga with special reference to Melasma

Vyanga is one of the Kshudraroga mentioned in the classics which are having Lakshana like Niruja, Tanu and Shyava Mandala. It can be correlated with Melasma in modern terms, which is also known as Chloasma. Melasma is an acquired pigmentary disorder, causing hyper-pigmented patches to appear on the facial skin. The prevalence varies between 1.5 % and 33.3 % in India. Female to male ratio in India is 4:1, indicating the high prevalence rate among females. Aragwadha Pushpa Churna along with Nimbuka Swarasa is applied over the hyper-pigmented patches in the condition of Vyanga in Cauvery river stretch of Namakkal district of Tamil Nadu as a folklore practice. A randomized clinical study was carried out to compare the efficacy with Varnya Gana Churna. The clinical study in the sample size of 30 was carried out in 2 groups with the intervention of Group A being Aragwadha Pushpa Churna Lepa and that of Group B being Varnya Gana Churna Lepa, with 30 days of drug application period and 15 days of drug-free follow up period. Differential diagnosis was ruled out with the help of Wood’s lamp. Assessment was done with the help of criterias like Amount of discolouration, Arbitrary grading and Area of the lesion. Various statistical tests like Parametric, Non-parametric, Friedman repeated measures ANOVA on ranks, etc. were carried out to analyse the results of the study. Both Aragwadha Pushpa Churna and Varnya Gana Churna have significant effect in the management of Vyanga with special reference to Melasma. When improvement in the individual criteria was compared, Aragwadha Pushpa Churna showed better results in reducing the amount of discolouration &amp; the number of lesions. Whereas, Varnya Gana Churna showed better results in reducing area of the lesion.

PENERAPAN MODEL EXPERIENTAL LEARNING MELALUI METODE DISKUSI PADA MATERI PENGELOLAAN KEUANGAN SEDERHANA UNTUK MENINGKATKAN HASIL BELAJAR SISWA KELAS XII MANAJEMEN PERKANTORAN1 SMK NEGERI 1 TASIKMALAYA

The problem in this research is whether the application of the Experiential Learning Model through the Discussion Method can improve the learning outcomes of class XII MP1 students at SMK Negeri 1 Tasikmaya. The aim of the research is to increase the effectiveness of implementing the Experiential Learning Model through the Discussion Method in an effort to improve learning outcomes for Simple Financial Management Material. Perpetual Assessment Method for class The subjects in this research were 35 students of Class XII Office Management1 at SMK Negeri 1 Tasikmalaya for the 2022/2023 academic year. Student learning effectiveness is measured based on individual learning completeness criteria. The results of the research show that through the application of the Experiential Learning Model through the Discussion Method it can increase student activity and competence in simple Financial Management subjects. . This can be seen from: (1) there is an increase in student activity in each cycle. Student activity in cycle I was 37.13%, and cycle II was 76.16%; (2) there is an increase in class averages and student learning completeness. The class average in cycle I was 80 and cycle II was 87. Student learning completeness as measured by the cognitive competency test in cycle I was 66%, and cycle II was 91.62%. The conclusion from the research results regarding the Application of the Experiential Learning Model Through the Discussion Method in Class XII Office Management 1 SMK Negeri 1 Tasikmalaya was declared successful

Advanced renal cell carcinoma - an overview of current systemic therapy

Renal cell carcinoma (RCC) is one of the more common tumor diseases in older adults. The only curative treatment method is surgical resection in the localized stage. Based on current study data, drug (combination) therapy in the metastatic stage is the most effective treatment option for non-resectable/metastatic RCC (mRCC). Immuno-oncological combinations of 2 Checkpoint-Inhibitors (CPI) or CPIs and Tyrosine kinase inhibitors (TKI) are now standard in the first-line treatment of metastatic RCC. Since the results of foundational combination therapy studies are not fully comparable due to different study design and patient populations, additional clinical and patient-related criteria are required when making individual treatment decisions. The systemic therapy of advanced RCC is therefore based on tumor extent, treatment pressure, concomitant diseases, and personal circumstances. A decision on first-line therapy should be made individually as part of a "shared decision" with the patient. The selection of a second-line systemic therapy is based on individual criteria; the data available for a well-founded classification of a possible therapy sequence after progression to first-line therapy is sparse. Further investigations to optimize systemic therapy (expansion of combination therapy to triple combination of CPI+CPI+TKI) or evaluation of therapy in other histological subtypes of renal cell carcinoma are the subject of ongoing clinical studies.

Penerapan Metode Weighted Product Pada Sistem Pendukung Keputusan Pemilihan Calon Dosen Pembimbing Skripsi

Decision Support System is a computer system that processes data into information to make decisions regarding specific semi-structured problems. It is specially developed to support solutions for unstructured management issues to enhance the quality of decision-making. The selection of potential thesis advisors at Hamzanwadi University's Informatics Engineering program is currently done by directly choosing an advisor while considering individual criteria or by seeking advice from peers. However, this direct selection method sometimes overlooks crucial aspects that should be prioritized. This research aims to construct a web-based Decision Support System (DSS) to assist final-semester students in the Faculty of Engineering at Hamzanwadi University in selecting their thesis advisors. The methodology employed in this Decision Support System is the Weighted Product method, which enables the calculation and comparison of multiple factors during the decision-making process. Factors analyzed in this study encompass the instructors' competency areas and the number of students they supervise. The utilization of this Decision Support System is expected to aid students in choosing an appropriate and fitting thesis advisor according to their needs. Moreover, the Decision Support System is anticipated to aid the faculty in providing information about potential thesis advisors before students finalize their choices. This research is expected to contribute to and benefit the development of information technology in the education sector

An extended approach to impact assessment in the Horizon 2020 digital manufacturing domain.

This paper presents an extended approach to Impact Assessment (IA) within European Union funded large-scale projects within the manufacturing domain, which may offer value to other research projects and SME organisations seeking to develop detailed organizational reporting. It details the six-phase process that forms the framework for this extended approach, demonstrating how project Outcome Indictors and impact assessment criterion can be aligned through an extensive review and integration of existing impact domains, objectives, measures and evidence sources with project documentation to provide the detailed individual impact assessment criteria for this extended IA approach. It also reports on the application of the approach in the EC-funded digital manufacturing project, European Connected Factory Platform for Agile Manufacturing (EFPF), finding that 24 of the 27 IA criteria were met or exceed, suggesting that the project made an important contribution to the EU Industry4.0 ecosystem through furthering the key priorities of Industrial Leadership, Data Integration, Uptake of New Technologies, Open Science, the Circulation of Knowledge, and a minor contribution to Climate Change Mitigation.

Potentially Inappropriate Prescribing and Potential Prescribing Omissions and Their Association with Adverse Drug Reaction-Related Hospital Admissions.

This study aimed to determine the prevalence of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) and their association with ADR-related hospital admissions in patients aged ≥ 65 years admitted acutely to the hospital. Information on medications and morbidities was extracted from the Adverse Drug Reactions in an Ageing Population (ADAPT) cohort (N = 798: N = 361 ADR-related admissions; 437 non-ADR-related admissions). PIP and PPOs were assessed using Beers Criteria 2019 and STOPP/START version 2. Multivariable logistic regression (adjusted odds ratios (aOR), 95%CI) was used to examine the association between PIP, PPOs and ADR-related admissions, adjusting for covariates (age, gender, comorbidity, polypharmacy). In total, 715 (90%; 95% CI 87-92%) patients had ≥1 Beers Criteria, 555 (70%; 95% CI 66-73%) had ≥ 1 STOPP criteria and 666 patients (83%; 95% CI 81-86%) had ≥ 1 START criteria. Being prescribed at least one Beers (aOR = 1.66, 95% CI = 1.00-2.77), or meeting STOPP (aOR = 1.07, 95% CI = 0.79-1.45) or START (aOR = 0.72; 95%CI = 0.50-1.06) criteria or the number of PIP/PPO criteria met was not significantly associated with ADR-related admissions. Patients prescribed certain drug classes (e.g., antiplatelet agents, diuretics) per individual PIP criteria were more likely to have an ADR-related admission. There was a high prevalence of PIP and PPOs in this cohort but no association with ADR-related admissions.

Synthesis of relevant information around non-core domains to support Multi-Criteria Decision Analysis (MCDA) for decision making.

Countries fundamentally base macro and micro decision making in the field of health on economic considerations, the budgetary impact of technologies being a major criterion. Nevertheless, the value of the technology of interest and its dimensions are more complex if we seek to take decisions based on the value itself. The use of structured and explicit approaches that require the assessment of multiple criteria that reflect the dimensions of this value may significantly improve the quality of the decision making. Multi-criteria decision analysis (MCDA) is a complementary decision-making tool that is able to systematically incorporate dimensions or domains such as ethical, organisational, legal, environmental and social considerations, as well as costs and benefits of medical interventions, together with the distinct perspectives of the interested parties. The objective of this article is to propose the implementation of analysis of non-core domains, in reports of Health Technology Assessment (HTA) agencies/units. To assess the scientific evidence on MCDA techniques a systematic review was conducted using structured searches in biomedical databases and websites of various HTA organisations. A consensus group was held using the nominal group technique and involving users of healthcare services, providers, managers and academics. Complementary, a survey was sent to HTA agencies to ascertain the degree of implementation of MCDA in their methods. 42 articles reporting the use of non-core criteria for the assessment of health technologies were included in the analysis. From these articles, a total of 216 non-core criteria were retrieved and categorised into domains by the researchers, and of these, 56 were classified as socioeconomic, 59 as organisational, 10 as legal, 8 as environmental and 47 as ethical, while 36 were considered to relate to other domains. The consensus group, based on the 216 non-core criteria obtained from the systematic review, proposed, and defined 26 criteria that participants considered necessary for decision making in healthcare. The consensus group did not consider that any of the domains should be given more weight than others or that any individual criteria should dominate. These approaches can serve as a framework of reference for a well-structured systematic discussion concerning the basis of individual criteria and the evidence supporting them.

The History of Macrophage Activation Syndrome in Autoimmune Diseases.

In 1979, it became recognized in the literature that what we call hemophagocytic lymphohistiocytosis (HLH) was a nonmalignant disease of histiocytes. Subsequently a familial form and a secondary form of HLH were differentiated. When HLH is secondary to an autoimmune disease, rheumatologists refer to this entity as macrophage activation syndrome (MAS) to differentiate it from HLH itself. Although the first cases of MAS likely appeared in the literature in the 1970s, it was not until 1985 that the term activated macrophages was used to describe patients with systemic juvenile idiopathic arthritis (sJIA) complicated by MAS and the term macrophage activation syndrome first appeared in the title of a paper in 1993.MAS is one of the many types of secondary HLH and should not be confused with primary HLH. Experience has taught that MAS secondary to different autoimmune diseases is not equal. In the 30years since initial description in patients with sJIA, the clinical spectrum, diseases associated with MAS, therapy, and understanding the pathogenesis have all made significant gains. The diagnostic/classification criteria for MAS secondary to sJIA, SLE, RA, and KD differ based on the different laboratory abnormalities associated with each (Ahn et al., J Rheumatol 44:996-1003, 2017; Han et al., Ann Rheum Dis 75:e44, 2016; Ravelli et al., Ann Rheum Dis 75:481-489, 2016; Borgia et al., Arthritis Rheumatol 70:616-624, 2018). These examples include the thrombocytosis associated with sJIA, a chronic generalized activation of the immune system, leading to elevations of fibrinogen and sIL-2R, low platelet count associated with SLE, and more acute inflammation associated with KD. Therefore, individual diagnostic criteria are required, and they all differ from the diagnostic criteria for HLH, which are based on a previously non-activated immune system (Ahn et al., J Rheumatol 44:996-1003, 2017; Han et al., Ann Rheum Dis 75:e44, 2016; Ravelli et al., Ann Rheum Dis 75:481-489, 2016; Borgia et al., Arthritis Rheumatol 70:616-624, 2018; Henter et al., Pediatr Blood Cancer 48:124-131, 2007). This helps to explain why the HLH diagnostic criteria do not perform well in MAS.The initial treatment remains high-dose steroids and IVIG followed by the use of a calcineurin inhibitor for resistant cases. IVIG can be used if there is a concern about malignancy to wait for appropriate investigations or with steroids. Interluekin-1 inhibition is now the next therapy if there is a failure to respond to steroids and calcineurin inhibitors. Advances in understanding the mechanisms leading to MAS, which has been greatly aided by the use of mouse models of MAS and advances in genome sequencing, offer a bright future for more specific therapies. More recent therapies are directed to specific cytokines involved in the pathogenesis of MAS and can lead to decreases in the morbidity and mortality associated with MAS. These include therapies directed to inhibiting the JAK/STAT pathway and/or specific cytokines, interleukin-18 and gamma interferon, which are currently being studied in MAS. These more specific therapies may obviate the need for nonspecific immunosuppressive therapies including high-dose prolonged steroids, calcineurin inhibitors, and etoposide.

Modelling the probability of meeting IUCN Red List criteria to support reassessments.

Comparative extinction risk analysis-which predicts species extinction risk from correlation with traits or geographical characteristics-has gained research attention as a promising tool to support extinction risk assessment in the IUCN Red List of Threatened Species. However, its uptake has been very limited so far, possibly because existing models only predict a species' Red List category, without indicating which Red List criteria may be triggered. This prevents such approaches to be integrated into Red List assessments. We overcome this implementation gap by developing models that predict the probability of species meeting individual Red List criteria. Using data on the world's birds, we evaluated the predictive performance of our criterion-specific models and compared it with the typical criterion-blind modelling approach. We compiled data on biological traits (e.g. range size, clutch size) and external drivers (e.g. change in canopy cover) often associated with extinction risk. For each specific criterion, we modelled the relationship between extinction risk predictors and species' Red List category under that criterion using ordinal regression models. We found criterion-specific models were better at identifying threatened species compared to a criterion-blind model (higher sensitivity), but less good at identifying not threatened species (lower specificity). As expected, different covariates were important for predicting extinction risk under different criteria. Change in annual temperature was important for criteria related to population trends, while high forest dependency was important for criteria related to restricted area of occupancy or small population size. Our criteria-specific method can support Red List assessors by producing outputs that identify species likely to meet specific criteria, and which are the most important predictors. These species can then be prioritised for re-evaluation. We expect this new approach to increase the uptake of extinction risk models in Red List assessments, bridging a long-standing research-implementation gap.

К ВОПРОСУ О СООТНОШЕНИИ ЭТНИЧЕСКОЙ, РЕГИОНАЛЬНОЙ И МАКРОРЕГИОНАЛЬНОЙ ИДЕНТИЧНОСТИ В ПОЛИКУЛЬТУРНОМ ПРОСТРАНСТВЕ

The scientific article clarifies the concepts of ethnic, regional and macro-regional identity. The article substantiates the possibility and expediency of their distinction and delimitation as independent types of social identity of a person. The question of correlation and interrelation of ethnic identity with regional and macro-regional identity, the possibility of their hierarchical consideration is discussed. Ethnic, regional and macro-regional identity is considered as socio-psychological categories within the framework of the article. Ethnic identity is interpreted as a dynamic and multidimensional formation, which characterizes the feeling (implicit component) and awareness (explicit component) of a person as a member of a certain ethnic group/community. Regional identity is considered as a dynamic and multidimensional formation that characterizes the feeling (implicit component) and awareness (explicit component) of a person as a resident of a certain region. Macro-regional identity is considered as a dynamic and multidimensional formation, which characterizes the feeling (implicit component) and awareness (explicit component) of a person as a representative of a certain macro-regional association of territories. The close interrelation between the concepts, their consistency and complementarity, as well as the impossibility of their unambiguous hierarchical consideration due to individual criteria of importance of each type of identity, depending on the structure of self-concept and the system of values of a person are established. Using the historical and socio-cultural context, we substantiate the possibility and expediency of studying macro-regional identity for people living in the Middle Volga region, including the Ulyanovsk, Samara, Saratov regions, as well as the Republics of Tatarstan and Chuvashia. Prospects for research on ethnic, regional and macro-regional identity for the education of interethnic tolerance in a multicultural macro-region are outlined.

Crisis-ready educational skills of life support in newborns and adults' scenarios: the impact of simulation-based training on student proficiency.

Aim: To assess the impact of multidisciplinary simulation training on the educational outcomes of medical students in the emergency care of adults and newborns and implement changes in the curriculum to master simulation scenarios more. Materials and Methods: To assess the differences in learning outcomes between medical students who study the same curriculum without simulation interventions and those who undergo multidisciplinary emergency care simulation training. A quasi-experimental approach was used to assign students to the Intervention Group or the Control Group. Results: According to individual criteria, the lowest scores in both groups were obtained for the stages that required the greatest accuracy and correct technique. After the appropriate cycle of initiation, the results in both groups improved significantly, but the results of students from the first group were significantly higher than those of students from the second group. Despite the absence of a significant difference in the average overall score for the skills, students in the first group significantly improved the accuracy and correctness of the criteria that assess the technical aspects of performance, while students in the second group mainly improved the quality of the descriptive and communicative parts of the practical skill. Conclusions: We believe that reallocating curricular time to additional hours dedicated to simulation scenarios will better prepare aspiring healthcare professionals for the demanding and dynamic nature of their career, as we continue to increase our understanding of the potential of simulation-based education.

Mapping groundwater potential zone in the subarnarekha basin, India, using a novel hybrid multi-criteria approach in Google earth Engine

Assessing groundwater potential for sustainable resource management is critically important. In addressing this concern, this study aims to advance the field by developing an innovative approach for Groundwater potential zone (GWPZ) mapping using advanced techniques, such as FuzzyAHP, FuzzyDEMATEL, and Logistic regression (LR) models. GWPZ was carried out by integrating various primary factors, such as hydrologic, soil permeability, morphometric, terrain distribution, and anthropogenic influences, incorporating twenty-seven individual criteria using multi-criteria decision models along with a hybrid approach for the Subarnarekha River basin, India, in Google earth engine (GEE). The predictive capability of the model was evaluated using a Multi-Collinearity test (VIF <10.0), followed by applying a random forest model, considering the weighted impact of the five primary factors. The hybrid model for GWPZ classification showed that 21.97 % (4256.3 km2) of the area exhibited very high potential, while 11.37 % (2202.1 km2) indicated very low potential for GW in this area. Validation of the groundwater level data from 72 observation wells, performed by the Area under receiver operating characteristic (AUROC) curve technique, yielded values ranging between 75 % and 78 % for different models, underscoring the robust predictability of GWPZ. The hybrid and LR-FuzzyAHP models demonstrated remarkable effectiveness in GWPZ mapping, indicating that the downstream and southern regions boast substantial groundwater potential attributed to alluvial soil and favorable recharge conditions. Conversely, the central part grapples with a scarcity of groundwater. It holds the potential to assist planners and managers in formulating strategies for managing groundwater levels and alleviating the impacts of future droughts.

Balkhash-Alakol Basin animal world database creation process for the purpose of cadastre maintenance

This paper describes the database (DB) development process of the cadastre of the fauna of the Balkhash-Alakol Basin that will be used for analyzing the spatial and temporal dynamics of population status and the graphical display of spatial data. The data was organized using the methods of relational database organization (SQL) with sets of individual criteria adapted for different groups of animals (parasitofauna, malacofauna, arachnofauna, entomofauna, ichthyofauna, herpetofauna, ornithofauna, and theriofauna). This database considers several additional technical aspects of its further integration with other databases, for example, geographical, climatic, etc., which allows for a deep analysis of the relationship between various environmental factors and population dynamics. For the functioning of the user interface, server architecture, and program interface, an application on the Django framework was developed, which simplified the processes of software development and allowed specialists to flexibly adapt the database to the own needs and project goals while simultaneously increasing the autonomy, security, and stability of the database.

Pengaruh Faktor Pendidikan dan Ekonomi Terhadap Keputusan Perempuan dalam Berwirausaha di Kota Magelang

&lt;em&gt;Gender inequality often creates significant challenges for women in finding work and receiving equal treatment in the world of work. In various regions, including Magelang City, quite a few women choose to become entrepreneurs with self-employed status as an alternative to earn a living and support their family's economic needs. This research aims to determine the influence of educational and economic factors on decisions. women in entrepreneurship in Magelang City. This research uses quantitative methods, collecting data through questionnaires with a Likert scale approach. The type of data produced in this research is cross section data with the individual criteria of a woman who lives in the city of Magelang and owns a business. The research results show that economic factors have a significant influence on women's decisions to become entrepreneurs, while educational factors have no significant influence. With a coefficient of determination (R2) of 0.699, this means that around 69.9 percent of women's entrepreneurial decisions are influenced by educational and economic factors, while the remaining 30.1 percent are influenced by other factors outside the model. These results reflect the positive role of women in driving the local and national economy. Steps are needed to increase women's access to economic resources, such as business loans and financial management training, to help them start and manage their businesses well. &lt;/em&gt;