Higher Average Scores Research Articles

청각 소음이 읽기 수행에 미치는 영향

Objectives The purpose of this study was to investigate the effect of auditory noise on the reading performance of high school students. Methods To this end, 171 high school students were divided into three groups according to auditory noise conditions to perform a reading task asking for word, factual, inferential, and critical comprehension. The effect of auditory noise on reading performance was analyzed through the effect size between groups. Also, the difference in reading performance according to gender and grade was analyzed through the effect size. Results First, the average score of the reading task was the lowest in the group that heard construction noise, and the highest in the group that listened to popular songs, but the effect size between the groups without noise in both groups was small. Second, female students had a greater positive effect on reading task when they listened to popular songs than male students. Third, in the case of 1st and 2nd graders, regardless of the noise source, higher average scores were obtained when performing the reading task in an environment in which auditory noise was heard than when performing it in a quiet environment. On the other hand, in the case of 3rd graders, unpleasant noise had a negative effect on reading task, which was found to have a medium effect size. In addition, the positive influence of popular songs was smaller in the 3rd grade compared to the 1st and 2nd graders. Conclusions It is necessary to investigate the effect of the reader's external environment, such as auditory noise, on reading in more detail, and to explore clues to establish a physical environment in which the reader can fully demonstrate reader's reading ability.

Assessment of Emicizumab Adherence: Psychometrics and Applications of Novel Self-Report Measure Veritas-Nexgen

Background: Patients with severe hemophilia are at risk for musculoskeletal bleeding that can result in arthropathy and disability. Prophylactic treatment of hemophilia prevents bleeding and joint damage and is recommended as the standard of care for persons with severe hemophilia. Non-adherence to a prophylactic regimen can limit treatment effectiveness and result in adverse health outcomes. Emicizumab, a self-administered subcutaneous treatment, is available for prophylactic therapy of persons with hemophilia A with inhibitors and without inhibitors. This therapy is expected to enhance treatment satisfaction and adherence in hemophilia A. Aims: We completed a pilot study on the initial development and preliminary psychometrics of a new self-report adherence scale for emicizumab titled VERITAS-NEXGEN, modeled on the VERITAS-Pro hemophilia clotting factor adherence scale. In this current study, we investigated a broader set of psychometrics supporting this novel measure of emicizumab adherence in a larger sample. We also sought to describe self-reported adherence using this measure in the larger sample of patients with hemophilia. Methods: The VERITAS-NEXGEN scale consisted of five 5-item subscales (dosing, injection, timing, planning, and bleeds) and an aggregate total score. Items were rated on a 1-9 scale (higher values indicate greater adherence), and subscale and total scores were derived as average scores of constituent items. Participants (N=69 males) with factor VIII deficiency from two hemophilia treatment centers and an active prescription for emicizumab for at least four months were then recruited to complete the scale for psychometric analysis and investigation of self-reported adherence. A subset of the participants (N=20) completed a second adherence scale within one month to provide an estimate of test-retest reliability. The adherence scale was validated against two global patient-ratings of adherence: an established 1-10 rating scale of global adherence (global adherence rating; GAR) and a new 1-10 rating scale of familiarity with treatment. Results: Using the VERITAS-NEXGEN scale, total self-reported adherence was high (average total item score of 8.3 on a 1-9 scale; 9% of patients reporting perfect mean adherence scores of 9, and 87% of patients reporting strong mean adherence scores of 7-8). Based on subscale scores, dosing and injection domains (mean scores of 8.6 and 8.7, respectively; 97% of patients reporting scores of 7 or greater) had greater adherence than the timing and planning domains (mean scores of 7.8 and 8.4, respectively; 14% and 7% of patients reporting scores under 7, respectively). Adherence related to Bleeds also was lower than dosing and injections (mean score=8.1; 14% of patients reporting scores under 7). Internal consistency values for the dosing, injection, bleeds, and total scores were excellent (alpha 0.81-0.91), while alpha values for planning (alpha=0.73) and timing (alpha=0.57) fell in a fair to moderate range. Test-retest reliability for all subscales was good (Planning, r=0.61) to excellent (all other subscales and Total r=0.72-0.83). Dosing, injection, planning, and total scores correlated significantly with global ratings of adherence and treatment familiarity. Timing scores also correlated significantly with global ratings of adherence. Conclusions: Results from this study supported the reliability and validity of subscale and total scores from this new emicizumab adherence scale and provide new insights into adherence strengths and weaknesses in a sample of patients with hemophilia. Overall, self-reported emicizumab adherence was excellent in the sample, with 86-97% of the sample reporting strong to excellent adherence depending on adherence domain. In addition to providing a rapid, easy-to-obtain estimate of patient-rated adherence in the clinical setting, this new adherence scale will allow for investigation of specific adherence domains that are most challenging for patients taking emicizumab, allowing for targeted interventions.

Admission Criteria as Predictors of Licensure Performances among Graduates of a State University in the Philippine Cordillera Administrative Region

Proficiency in licensure examinations has emerged as a foundation of pride for graduates and an attraction for potential students to higher education institutions (HEIs). Therefore, the purpose of this study was to uncover the admission criteria that confidently predicted the licensure performance of graduates of a state institution in the Philippine Cordillera Administrative Region. This study used correlation research and 654 randomly selected graduates of Ifugao State University (IFSU) who took and eventually passed their licensure tests. The records of the university registrar and the Professional Regulations Commission (PRC) were the primary sources of data. To comply with research ethics and standards, written permission from university officials was obtained. The mean, standard deviation, and frequency were used to describe the descriptive variables. Multiple regression analysis was utilized to identify the significant set of predictors of license performance per licensure examination. A stepwise procedure was used to select the best model. The study concludes that the performance of graduates in the fields of agriculture, criminology, and teacher education in their respective licensure examinations can best be predicted by their high school grade point average and admission test scores, whereas the performance of graduates in the field of forestry in their licensing exam is best explained by their performance in their secondary education curriculum.
 
 Received: 25 August 2022 / Accepted: 20 October 2022 / Published: 5 November 2022

A Comprehensive Evaluation of Quality of Life in Turkey and East European Countries during the COVID-19 Pandemic

The COVID-19 pandemic has deeply affected societies. This study aims to evaluate the quality of life of Hungary, Slovakia, Latvia, Poland, and Estonia in comparison with Turkey during the COVID-19 pandemic and to make recommendations to policymakers. The results of the “Living, Working and COVID-19 Survey” implemented by Eurofound in European countries at the beginning of the pandemic were compared between Hungary, Slovakia, Latvia, Poland, Estonia, and Turkey, and the economic, social, health and psychological impact of the pandemic on societies were examined. It has been found that the countries with the highest happiness mean scores were Latvia and Estonia, the countries with the lowest happiness mean scores were Turkey and Hungary, the countries with the highest mean satisfaction score were Estonia and Latvia, the countries with the lowest mean satisfaction score were Turkey and Slovakia. In the study, it was also determined that the countries with the highest mean score of trust in the healthcare system and government institutions were Estonia and Latvia. The results of the study indicate that the factors affecting the quality of life of the people during the pandemic differ between countries. In the study, it was determined that the countries with a high average of trust in government institutions and health systems also have high average scores of satisfaction and happiness. It is important for policymakers to have information about the factors affecting the quality of life of the society to be prepared for pandemics.

Differentially Private Tripartite Intelligent Matching Against Inference Attacks in Ride-Sharing Services

In intelligent transportation systems, the key issue of the Ride-Sharing Service (RSS) is to find proper drivers for the passengers by Intelligent Matching (IM) of two or three objects, including the positions of drivers, the travel information of passengers, and the spots where passengers and drivers meet and separate. Unfortunately, the exposure of travel plans of passengers in the IM process due to inference attacks has raised concerns about the privacy violation. To resist the inference attacks, we propose a Differentially Private Tripartite IM (DPTIM) protocol for RSS. DPTIM is based on the tripartite IM process, which intelligently finds the suitable threshold to filter out the matched objects with satisfaction scores below the threshold, so as to provide the high average satisfaction score of matched passengers. Compared to existing relevant mechanisms, DPTIM is distinguished by the feature that it leverages the inference error and differential privacy techniques to prevent the prior-information-based inference attacks and constrain the posterior information leakage, while providing satisfactory matching results. Furthermore, DPTIM meets the personalized demand of location privacy by using the passenger-specific tolerance estimation on inference errors and the personalized privacy budget. Finally, we implement DPTIM on real-world datasets, and demonstrate the satisfactory performance of DPTIM in terms of the average satisfaction score of passengers, the anti-inference-attack capability, and the passenger-specific privacy requirement.

Melanoma Detection using Convolutional Neural Network with Transfer Learning on Dermoscopic and Macroscopic Images

Background: Melanoma is a skin cancer that starts when the melanocytes that produce the skin color pigment start to grow out of control and form a cancer. Detecting melanoma early before it spreads to the lymph nodes and other parts of the body is very important because it makes a big difference to the patient's 5-year life expectancy. Screening is the process of conducting a skin examination to suspect a mole is melanoma using dermoscopic or macroscopic images. However, manual screening takes a long time. Therefore, automatic melanoma detection is needed to speed up the melanoma detection process. The previous studies still have weakness because it has low precision or recall, which means the model cannot predict melanoma accurately. The distribution of melanoma and moles datasets is imbalanced where the number of melanomas is less than moles. In addition, in previous study, comparisons of several CNN transfer learning architectures have not been carried out on dermoscopic and macroscopic images.
 Objective: This study aims to detect melanoma using the Convolutional Neural Network (CNN) with transfer learning on dermoscopic and macroscopic melanoma images. CNN with Transfer learning is a popular method for classifying digital images with high accuracy.
 Methods: This study compares four CNN with transfer learning architectures, namely MobileNet, Xception, VGG16, and ResNet50 on dermoscopic and macroscopic image. This research also uses black-hat filtering and inpainting at the preprocessing stage to remove hair from the skin image.
 Results: MobileNet is the best model for classifying melanomas or moles in this experiment which has 83.86% of F1 score and 11 second of training time per epoch.
 Conclusion: MobileNet and Xception have high average F1 scores of 84.42% and 80.00%, so they can detect melanoma accurately even though the number of melanoma datasets is less than moles. Therefore, it can be concluded that MobileNet and Xception are suitable models for classifying melanomas and moles. However, MobileNet has the fastest training time per epoch which is 11 seconds. In the future, oversampling method can be implemented to balance the number of datasets to improve the performance of the classification model.

The Importance of Measuring Local Governments’ Information Disclosure: Comparing Transparency Indices in Spain

Transparency is considered a key element for developing a reliable government; it is the ability that all public entities have to provide access to all their information. The main objective of this work is to test the differences in the transparency of municipalities between the main indices and a new index made following the regulatory advances in this area at the national level. Called BTI, this new index aims to measure in the best possible way the degree of compliance of Spanish municipalities, through two dimensions (depth and breadth), which measure the quality and the quantity of the information. This work makes a comparison of the BTI with three of the main existing transparency indexes in Spain, to a sample of Spanish provincial capitals. The results obtained reveal clear differences between the indices, where three of the four indices analyzed show that most municipalities only fulfil the Transparency Act at the minimum level, with only a few municipalities reaching the maximum rating range. This work concludes that the BTI index is more demanding than the rest of the indexes. However, ITA stands out with a higher average score than the rest, which indicates that transparency portals are designed to obtain a good score in this index, being less objective. Finally, this paper remembers the importance of having an objective tool to measure transparency, as it can show notable differences with respect to reality.

Students’ Learning Strategies in Public Speaking Class at Higher Education Level

Public speaking is the capability to speak in public with learning activities that occur through experiences and speaking practices in front of audiences. Different learning strategies the students apply in improving their speaking ability surely result in diverse speaking mastery and performances. This research aims to discover and explore what kind of learning strategies university students use in a public speaking course. Three students from the same class of public speaking course were selected as the subjects of the study. They are selected based on the score criteria: high-average score, medium-average score, and low-average score students. It was a descriptive qualitative study using questionnaires and interviews as the main instruments. The result shows that three types of students use three kinds of learning strategies: cognitive, socio-affective, and meta-cognitive strategies, but the main differences are in the factors of frequency and consistency of using the strategies. The researcher found that the high-average score student mostly used cognitive strategies to support their mastery of public speaking. The high-achieving student regularly watches and listens to English speeches on YouTube and Instagram, which cover the specific strategy: auditory representation of cognitive strategy aspects. This study concludes that the student with a high-average score employs more cognitive techniques to promote mastery of public speaking. It also recommends more frequent language exposure to improve public speaking skills.

Practicing Collaborative Teachers to Strengthen Student’s Visionary Leadership Skills

This research aimed at strengthening the visionary leadership skills of students through Participatory Action Research (PAR) methodology, which is a spiral cycle of Planning, Acting, Observing, and Reflecting (PAOR). In this study, the researchers conducted this investigation over the course of two cycles (each lasting one semester) in the Academic Year of 2021. The three expected outcomes of the development were as follows: 1) there would be changes from both anticipated and unanticipated practices; 2) the learning would be obtained from the practices at the research level, the group level (co-researchers), and at the organizational level (school); and 3) there would be knowledge gained from the practices in the specific context of Phayakkhaphumwittayakarn School (the research area). There were 12 teachers, who were the co-researchers, and 425 students, who comprised the target group for the development. The research results contributed to the anticipated changes. In other words, the students had higher average scores from the visionary leadership skills assessment results when the 3 phases were compared (before and after the 1st cycle and after the 2nd cycle). In addition, the co-researchers and the students were exposed to unanticipated effects. In addition, the research team, the co-researchers, and the school also learned the lessons from the practice considered as the knowledge, which is a model called Six Driving Forces that Affect the Success of the Project entitled ‘Practicing Collaborative Teachers to Strengthen Student's Visionary Leadership Skills.’

Якість життя дітей після хірургічної корекції вродженої колоректальної патології

The main problems that arise in children operated on for Hirschsprung's disease (HD) or anorectal malformations (ARM) in the long term are persistent defecation disorders manifested in the form of constipation or fecal incontinence (FI), as well as their combination. Violation of the act of defecation, regardless of its cause, contributes to the formation of a number of complex psychological, medical and social problems that affect the moral and physical condition of children, resulting in reduced quality of life (QoL). The purpose - to study QoL in children operated on in the clinic for congenital colorectal pathology and to evaluate the objectivity of the pathology-specific QoL questionnaire. Materials and methods. Clinical examination and treatment of 92 children with HD and ARM were performed. Questionnaires to determine the level of QoL were conducted in 79 operated children 6-17 years, including 51 (64.56%) children with HD and 28 (35.44%) patients with ARM. These patients formed the main group. Questionnaires were also conducted in 30 somatically healthy children without colorectal pathology of the same age. They formed a control group. Children who had postoperative complications were additionally interviewed before and after treatment of these complications (conservative or surgical). We selected the Hirschsprung’s disease Anorectal malformation QoL questionnaire (HAQL). We translated the HAQL questionnaire into Ukrainian and adapted it to the social, educational and cultural characteristics of Ukrainian people. We also modified it, simplified the issues a bit and integrated it into one form for better comparison of QoL between different groups of patients. Results. We identified 4 degrees of QoL violation in children of the main group: mild - with a sum of 74-105, moderate - with a score of 38-73, severe - with a score of 10-36, very severe - 0-9 points. In 19 children (24.05%) QoL was not violated, the average score was 108.4±2.5. The majority (39 patients, 49.37%) had a mild degree of QoL violation, the mid degree was in 17 (21.52%) children, severe QoL violation was found in 4 (5.06%) patients. There were no children with very severe QoL disorders. In children, the level of QoL was slightly higher after correction of ARM. The severity of QoL disturbance depended on the form of congenital colorectal pathology and the presence of pre- and postoperative complications. Among children with ARM, more severe QoL disorders were observed in high forms, among patients with HD more severe disorders were found in patients with a long zone of agangliosis, with acute and subacute forms of the disease and in children with serious preoperative complications. There were no significant gender differences in the violation of QoL in children of the main group. The level of QoL was higher in children aged 12-17 years than in patients aged 6-11 years. In older children, a higher average score was observed in the sections of the questionnaire related to defecation control. At the same time, children in this age group have lower scores in the sections on emotional and social functioning and body sensation. When re-interviewing 45 (56.96%) patients who had distant postoperative complications and defecation disorders, after conservative or surgical treatment, the level of QoL was increased in all cases. Conclusions. QoL disorders of varying severity were found in 60 (75.95%) of children operated on for HD and ARM. The majority of patients (39 children, 49.37%) had a mild degree, and 4 (5.06%) of children had a severe degree of QoL violation. The proposed HG and ARM-specific child quality of life questionnaire is a convenient and objective tool for assessing the quality of life of operated children. It allows you to assess not only postoperative functional outcomes, but also psychosocial and emotional aspects of the lives of operated children. It also allows you to compare the results of treatment in different clinics and makes these comparative results transparent. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Survey of individual readiness of the emergency department nurses in dealing with disasters

Background and aims: Examining the preparedness of nurses, including the individual preparedness of emergency nurses, has yet to be investigated. Given the hypocrisy of emergency nurses as the first group of the treatment team in responding to accidents and disasters and reducing the amount of damage to patients, the present study aims to investigate the individual preparedness of emergency nurses of Iran University of Medical Sciences in facing disasters in 2019. Methods: The present study was descriptive-cross-sectional in which the preparedness of 190 nurses in the emergency departments of the teaching and therapeutic hospital affiliated with the Iran University of Medical Sciences was investigated. Data collection was done using a demographic characteristics checklist and the 37-item questionnaire on than individual preparedness of nurses in disasters. Data analysis was done by SPSS version 21 using descriptive statistics (frequency, percentage, mean±standard deviation) and to determine statistical significance, inferential statistics (independent t-test, analysis of variance, Spearman’s correlation coefficient, Tukey’s test) at a significance level (P value) of<0.05 was used. Results: The study’s results showed that nurses’ preparedness was at a reasonable level. The highest average score was obtained for the teamwork communication skills domain (86.35±14.01), and the lowest average score for the clinical skills in the disaster response phase domain (10.55±20.50) based on 0 to 100 was obtained (P<0.001). Among the demographic variables, age (31.84±5.81 years) and nursing experience in the emergency department (7.02±5.24) had a significant relationship with nurses’ preparedness (P<0.001). Conclusion: Having experience in nursing work and working in the emergency department plays a role in increasing the level of individual preparedness of nurses in disasters. Therefore, the recruitment of experienced staff in the emergency department and their hiring to training less professional staff should be encouraged. Implementing educational programs in the form of theoretical training and the performance of practical programs can effectively improve the level of preparedness of nurses, especially novice and apprenticeship ones, in facing disasters.

A Survey of Vascular Surgery Program Directors: Perspectives following USMLE Step 1 Conversion to Pass/Fail and Virtual Only Interviews

Step 1 of the United States Medical Licensing Examination (USMLE), a historically important factor in the selection of vascular surgery residents and fellows, transitioned to completely pass/fail on January 26, 2022. Due to the COVID-19 pandemic, residency and fellowship interviews were conducted virtually during the 2020-21 and 2021-22 application cycles. Given these significant changes in the evaluation of candidates for residency training, we sought to understand vascular surgery program directors' (PDs) perspectives regarding the change in step 1 scoring and use of virtual interviews as well as determine which factors will assume importance when applying to vascular surgery training programs in the future. A 26-item survey questionnaire was created using Qualtrics survey tools with questions regarding attitudes toward the change in step 1 scoring and virtual interviews, the importance of additional factors utilized by programs in selecting candidates for interviews and ranking applicants for residency/fellowship selection, and programmatic demographics. This was distributed anonymously to all vascular surgery training programs over a 2-week period using a comprehensive list of 249 unique email addresses created by cross-referencing the Accreditation Council for Graduate Medical Education list of certified vascular training programs with email addresses from individual program websites identifying current program leadership. Responses were analyzed with descriptive statistics with values listed as average Likert scale weight±standard deviation (SD) or percentages. Sixty-eight of 249 (27.3%) program and associate PDs responded to the survey. Of which, 33.9% of respondents strongly disagreed with step 1 going completely pass/fail. In the absence of a scored USMLE step 1, letters of recommendation (average Likert scale weight±SD, 4.43±0.92), dedication to specialty (4.14±1.03), and USMLE step 2 CK (4.06±0.92) had the highest average scores for deciding which applicants to interview for integrated vascular surgery residency. For determining which candidates to interview for vascular surgery fellowship, letters of recommendation (4.51±0.84), dedication to specialty (4.12±0.90), and research (4.10±0.80) had the highest average scores. For ranking residency candidates, the interviewee's perceived "fit" (4.61±0.55), letters of recommendation (4.53±0.76), and an overall interview experience (4.47±0.62) had the highest average scores. Similarly, the factors with the highest average Likert scores for ranking fellowship candidates included the interviewee's perceived "fit" (4.69±0.51), letters of recommendation (4.65±0.52), and an overall interview experience (4.51±0.59). The majority (72.2%) of PDs preferred in-person interviews; however, 50% of respondents were at least "somewhat satisfied" with virtual interviews during the 2021-22 application cycle as they could judge applicants' interview skills at least "moderately well." The minority (18.8%) who preferred virtual interviews most commonly noted a "reduction of the financial burden for applicants" as the reason for this preference. Most vascular surgery program and associate PDs were dissatisfied with USMLE step 1 going pass/fail with most indicating prescreening applicants using both step 1 and step 2 clinical knowledge (CK) during the residency and fellowship selection processes. In the absence of a scored step 1, the top factors for interviewing and ranking integrated vascular surgery residency and fellowship candidates included letters of recommendation, dedication to specialty, research, USMLE step 2 CK, the interviewee's perceived "fit," and overall interview experience. Though most PDs preferred face-to-face interviews, they were overall at least "somewhat satisfied" with the virtual format that took place during the 2021-22 cycle.

Implementation of Islamic Business Ethics in Persis Banjaran Jam'iyah Enterprises

This study aims to determine the application of Islamic business ethics and dimensions based on four traits of the Apostle (Shiddiq, Amanah, fathonah, and Tabligh) to Jam'iyyah Persis Banjaran business actors. The research method is a descriptive qualitative analysis method carried out on independent variables without making comparisons or connecting with other variables to obtain an overview of the research variables. The results showed that the four qualities of the Apostle had been applied very well, especially in Shiddiq and Amanah. The results of processed data showed that the highest average score in Islamic business ethics was 4.58. Judging from the four qualities of the Apostle applied by business actors in Persis Banjaran, the Shiddiq dimension value is the highest, 4.68. Meanwhile, the value of the Amanah dimension is 4.59.

The Effect of Simulation Games in Improving Grade XII Students’ Academic Performance in Economics: An Action Research

This study investigated the effect of simulation games as an intervention strategy in the teaching-learning process to enhance performance of grade XII students in economics. The study adopted a mixed method research approach. A total of 27 (14 girls and 13 boys) grade XII students from one of the higher secondary schools participated in the study. The students were selected through non-probability convenient sampling techniques. The data sources include students class test score, narratives from the classroom observations and survey data. The findings revealed that the students were very positive about the use of simulation games as a classroom pedagogy. Simulation games help students comprehend concepts, ideas, and hypotheses easily besides making teaching-learning interesting, enjoyable, and fun as evident from the increase in mean marks in the class test 2 and high mean average score of 4.5 in the survey rating. However, the study also cautions that the simulation games are time-consuming and teachers need more time and effort to prepare and implement in the class.

Nurses' Involvement in the Development and Usability Assessment of an Innovative Peripheral Intravenous Catheterisation Pack: A Mix-Method Study.

Guaranteeing peripheral venous access is one of the cornerstones of modern healthcare. Recent evidence shows that the lack of adequate clinical devices can result in the provision of substandard care to patients who require peripheral intravenous catheterization (PIVC). To address this challenge, we aimed to develop a PIVC pack for adult patients and assess the usability of this new device. Methods: Following a mix-method design, the PIVC pack development and usability assessment were performed in two phases with the involvement of its potential end-users (nurses). In phase one (concept and semi-functional prototype assessment), focus group rounds were conducted, and a usability assessment questionnaire was applied at each stage. In phase two (pre-clinical usability assessment), a two-arm crossover randomised controlled trial (PIVC pack versus traditional material) was conducted with nurses in a simulated setting. Final interviews were conducted to further explore the PIVC pack applicability in a real-life clinical setting. Results: High average usability scores were identified in each study phase. During the pre-clinical usability assessment, the PIVC pack significantly reduced procedural time (Z = −2.482, p = 0.013) and avoided omissions while preparing the required material (Z = −1.977, p = 0.048). The participating nurses emphasised the pack’s potential to standardise practices among professionals, improve adherence to infection control recommendations, and enhance stock management. Conclusions: The developed pack appears to be a promising device that can assist healthcare professionals in providing efficient and safe care to patients requiring a PIVC. Future studies in real clinical settings are warranted to test its cost-effectiveness.

Generation of Game Stages With Quality and Diversity by Reinforcement Learning in Turn-Based RPG

Many recent studies in procedural content generation (PCG) are based on machine learning. One of the promising approaches is generative models, which have shown impressive results in generating new pictures and videos from existing ones. However, it is usually costly to collect sufficient content for training on PCG. To address this issue, we consider reinforcement learning (RL), which does not need to collect training data in advance but learns from its interaction with an environment. In this work, RL agents are trained to generate stages, which we define as series of events in turn-based role playing games. It is a challenging task since several events in a stage are usually highly correlated to each other. We first formulate the stage generation problem into a Markov decision process. A hand-crafted evaluation function, which simulates players’ enjoyment, is defined to evaluate generated stages. Two RL algorithms are selected in the experiments, which are deep Q-network for discrete action space and deep deterministic policy gradient for continuous action space. The generated stages from both models receive evaluation values indicating good quality. To solve the delayed reward problem and further improve the quality of the stages, we employ virtual simulations (VS) to give rewards to intermediate actions and get stages with higher average scores. In addition, we introduce noise to avoid generating similar stages while trying to keep the quality as high as possible. The proposed methods succeed in generating good and diverse stages.

ATAXIC: An Algorithm to Quantify Transcriptomic Perturbation Heterogeneity in Single Cancer Cells.

The single-cell RNA sequencing (scRNA-seq) has recently been widely utilized to quantify transcriptomic profiles in single cells of bulk tumors. The transcriptomic profiles in single cells facilitate the investigation of intratumor heterogeneity that is unlikely confounded by the nontumor components. We proposed an algorithm (ATAXIC) to quantify the heterogeneity of transcriptomic perturbations (TPs) in single cancer cells. ATAXIC calculated the TP heterogeneity level of a single cell based on the standard deviations of the absolute z-scored gene expression values for tens of thousands of genes, reflecting the asynchronous degree of transcriptomic alterations relative to the central (mean) tendency. By analyzing scRNA-seq datasets for eight cancer types, we revealed that ATAXIC scores were likely to correlate positively with the enrichment scores of various proliferation and oncogenic signatures, DNA damage repair, treatment resistance, and unfavorable phenotypes and outcomes in cancer. The ATAXIC scores varied among different cancer types, with lung cancer and melanoma having the lowest average scores and clear cell renal cell carcinoma having the highest average scores. The low TP heterogeneity in lung cancer and melanoma could bestow relatively higher response rates to immune checkpoint inhibitors on both cancer types. In conclusion, ATAXIC is a useful algorithm to quantify the TP heterogeneity in single cancer cells, as well as providing new insights into tumor biology.

Tıpta Uzmanlık Sınavı Temel Hekimliği Ne Kadar Ölçer?

Aim: Doctors who want to receive expertise training have to take the Medical Specialty Exam (TUS). That’s why they have to study for TUS in the last period of their undergraduate medical education. However, the content of TUS is different from the undergraduate medical education content (UÇEP) which is determined by the national core education program. This situation causes physicians preparing for TUS to ignore basic medical knowledge. This study aims to determine how much TUS, which is the main purpose of undergraduate medical education, measures basic medicine. Our study is the first research on this subject.Methods: In this study, a descriptive scanning model and document analysis method were used. The sample of the study consists of TUS clinical science questions belonging to the years 2009-2018. The 2009-2018 basic medical sciences TUS questions and all TUS questions asked in 2019-2020 were not included in the study. After the 2280 questions that could be reached from this sample were evaluated by a commission formed by the faculty members of Ankara Yıldırım Beyazıt University Faculty of Medicine, Department of Family Medicine, the data obtained were analyzed with the SPSS 23.0 package program.Results: In the study, 3 different faculty members were asked to score all questions between 0 and 9 according to the degree of basic medicine measurement. The average of the scores given by the three faculty members was found as 1.64 ± 3.02. All 3 faculty members gave 0 points to 1622 questions and 9, which is considered full points, to 177 questions. When the change in the average scores according to the exams was examined, it was seen that the highest average score was the spring TUS of 2009 with 3.2 points. The lowest score was the 2018 autumn TUS, with a score of 0.8. It was seen that the scores given by the three faculty members independently were compatible with each other and showed a strong positive correlation (r=0,970; p <0.001).Conclusions: Even though undergraduate education is tried to be standardized with the National Core Education Program (UCEP), as a result of our research, it has been seen that the content of the questions asked in TUS is incompatible with UÇEP and therefore basic medicine. As the years progressed, it was determined that the questions measuring basic medicine were replaced by questions containing detailed information of the branches. We think that this situation will constitute an obstacle for undergraduate medical education students to acquire fundamental medical proficiency.

Quality of Life among Methadone Maintenance Patients after the 4th Wave of COVID-19 in Ho Chi Minh City, Vietnam

INTRODUCTION: This study aimed to assess the quality of life (QOL) of methadone maintenance patients in Ho Chi Minh City after the most devastating wave of COVID-19 and to explore factors that influence their QOL. 
 
 METHODS: A cross-sectional study was conducted on 230 people who were in a methadone maintenance phase at the Tan Binh methadone treatment clinic using WHOQoL-BREF questionnaires. Ten in-depth interviews were carried out with patients and health staff, who were purposely selected. 
 
 RESULTS: The overall QOL score of study participants according to the 100-point WHOQoL-BREF scale was 64.6 ± 9.8, in which the highest average score was the physical health domain (68.3 ± 11.1 points) and the lowest was the social relationship domain (59.1 ± 13.5 points). MMT patients’ employment was found to be strongly affected by the COVID-19 epidemic, with higher unemployment or unstable jobs that negatively influence their QOL. In contrast, the take-home dose policy applied during lockdown was reported as a positive factor and well accepted. Family support and marriage also positively affected their QOL scores, whereas those with positive urine test results reported lower QOL scores. 
 
 CONCLUSION: Employment and social support for MMT patients has emerged, and further studies should be carried out to provide adequate evidence for methadone treatment improvement, including a multi-day take-home dose initiative.

Functional Activity After Flatfoot Reconstruction With Lateral Column Lengthening.

The objective of this study was to evaluate return to activity following flatfoot reconstruction with lateral column lengthening (LCL) by assessing functional postoperative data and identifying patient characteristics associated with poor function following surgery. Consecutive patients that underwent operative flatfoot correction including LCL and other necessary procedures from 2014 to 2019 by 3 fellowship trained foot and ankle orthopedic surgeons were retrospectively administered Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and FAAM Sports questionnaires with no preoperative scoring available. Patient demographic factors, comorbidities, and radiographic features were evaluated as predictors of outcome scores to simulate return to activity. Statistical analysis, including student's t-tests and analysis of variance, was performed. A total of 54 patients were included. A body mass index (BMI) of 30 kg/m2 or greater was associated with a lower ADL score (P = .002) and Sports score (P = .002). Preoperative hindfoot valgus of 9° or higher was associated with higher ADL scores (P = .040). Neither age nor any flatfoot radiographic parameters yielded significant differences in functional scores. This study demonstrated relatively high average FAAM scores in both the ADL and the sports subscales, consistent with previous studies. This study also identified lower BMI and greater preoperative hindfoot valgus as potential predictors of improved functional outcome following reconstruction. Level III: Retrospective case control.