High Grade Research Articles

Awareness Regarding Adolescent Sexual and Reproductive Health Among School Students in Nepal: A Cross-Sectional Study

Adolescent sexual and reproductive health (ASRH) is a priority program in Nepal, yet significant knowledge gaps persist among adolescents. This study aimed to assess the awareness of ASRH among school adolescents and identify factors that influence their knowledge. A cross-sectional study was conducted at Bageshowari Higher Secondary School in Bhaktapur Municipality, Nepal, involving 330 students aged 14-18 years. Participants were selected using a probability simple random sampling method. Data were collected using a self-administered structured questionnaire that covered pubertal changes, sexually transmitted infections, family planning, and abortion. Descriptive statistics and chi-square tests were used for data analysis. The results revealed that 54.8% of adolescents demonstrated adequate ASRH awareness. Age was a significant factor, with older adolescents (≥16 years) showing higher awareness (46.6%) compared to younger adolescents (8.1%). Gender differences also existed, with females demonstrating higher awareness (35.1%) than males (19.6%). Ethnicity influenced awareness, with advantaged Janajatis showing higher awareness (31.1%). Grade-wise analysis indicated that awareness increased with higher grades, peaking at grade twelve (19.4%). Domain-specific analysis revealed the highest awareness for sexually transmitted infections (83.9%) and the lowest for abortion (35.2%). The study concluded that while ASRH awareness was moderate, there are significant gaps, especially concerning abortion. The findings suggest the need for targeted interventions, particularly for younger adolescents and male students, and recommend incorporating ASRH topics into school curricula along with specialized awareness programs focusing on underperforming areas.

Prevalence and lifestyle determinants of depressive symptoms among Chinese children and adolescents

Based on Chinese Students’ Fitness Health Examination, this study sought to investigate the relationships between depressive symptoms and family environment, physical activity, dietary habits, sleep and sedentary behavior among children and adolescents. A cross-sectional study was carried out to estimate the prevalence of depressive symptoms in 32,389 participants (grades 4–12) using the CES-D. Logistic regression was used to evaluate the relationships between lifestyle determinants and depressive symptoms, and a random forest model was used to rank the importance of those determinants. The overall prevalence of depressive symptoms was 39.93%. Students with depressive symptoms had higher grades, lower parental educational levels and unhealthy lifestyles (P < 0.05). The top ten most important determinants of depressive symptoms were grade, egg intake, milk/soy product intake, frequency of muscle strength training, screen time, sleep duration, parental educational level, sugar beverage intake and total physical activity. Socioeconomic status, physical activity, sleep and screen time, and diet habits are determinants of depressive symptoms, and surveillance of lifestyles may be an effective way to detect students with depressive symptoms early.

The clinical relevance of cut-off percentage for high-grade urothelial carcinoma within low-grade urothelial carcinoma: A determining factor?

AimsThe aim of the study was to analyze the cut-off value for the percentage of the high-grade (HG) component that has clinical significance in urothelial carcinoma (UC). Material and MethodsThe study included a total of 362 patients, mixed-grade UC (MGUC) patients were classified as Combine Group (CG) 1 based on the presence of less than 5% HG areas. High-grade papillary UC (HGPUC) patients were grouped based on HG component proportions: CG2 (≥5%–<50% HG), CG3 (≥50%–<100% HG), and pure HGPUC (PHGPUC) for 100% HG components. ResultsThere was a statistically significant difference between low-grade papillary UC (LGPUC) and CG1, CG2, or CG3, as well as LGPUC and PHGPUC, in terms of cancer-specific survival (CSS) (hazard ratio (HR) = 19.85, 95% confidence interval (CI) = 2.30–171.10 P = 0.007, HR = 28.38, 95% CI = 3.50–229.97 P = 0.002, HR = 18.64, 95% CI = 2.26–153.64 P = 0.007, and HR = 35.41, 95% CI = 4.61–271.72 P < 0.001, respectively). There was no statistically significant difference between PHGPUC and CG1, CG2, or CG3 in terms of CSS. ConclusionsThese findings suggest that even the presence of less than 5% HGPUC within LGPUC significantly impacts CSS. Furthermore, the increase in the percentage of HGPUC beyond 5% does not substantially influence the CSS. Based on these findings, disclosing the percentage of the high-grade component may be crucial for future patient management and treatment.

FEATURES OF DEVELOPMENT OF LOGICAL THINKING IN ELEMENTARY MATHEMATICS CLASSES

The elementary school mathematics course is an organic part of the school mathematics course. The most basic and age-appropriate elementary concepts of mathematics taught in grades V-XI are given. In higher grades, these concepts are taught in an expanded, deepened and enriched manner. Therefore, the content of primary grade mathematics determines the content of higher-grade mathematics.

The Role of Bladder-Washing Cytology as an Adjunctive Method to Cystoscopy During Follow-Up for Low-Grade TaT1 Non-Muscle-Invasive Bladder Cancer.

The role of urine cytology during follow-up for low-grade (LG) non-muscle-invasive bladder cancer (NMIBC) is not well established, although cytology has low sensitivity in detecting LG recurrences. Our study aims to evaluate the impact of urine cytology as a complementary method to cystoscopy during follow-up for LG NMIBC. Patients diagnosed with primary LG TaT1 bladder cancer (BC) between 2010 and 2020 were included. Patients were stratified according to the EAU NMIBC scoring model. Urine cytology was performed during follow-up cystoscopy. The outcomes of the study were BC recurrence and upgrading to high-grade (HG). Cytology utility was established by assessing whether its result led to management change. We included 337 patients with LG TaT1 BC. EAU risk group distribution was low in 262 (77.7%), intermediate in 57 (16.9%), and high-risk in 18 (5.3%) cases. With a median follow-up of 5 years, 166 (49.3%) patients experienced recurrence. Cystoscopy was positive in 154 (92.8%) and suspicious in 12 (7.2%) cases. Urine cytology was positive in 33 (19.9%) cases but only changed management in 3 (0.89%), all with suspicious cystoscopy. Positive cytology at first recurrence was associated with higher risk of upgrading during follow-up (HR 2.781, p = 0.006) and lower upgrading-free survival (p = 0.001). The role of urine cytology to detect first recurrences during follow-up for primary LG TaT1 NMIBC might be limited to patients with non-conclusive lesions in the cystoscopy. A positive cytology at first recurrence is associated with a higher risk of upgrading to HG BC during follow-up.

Education is necessary but not sufficient for addressing disparities in concussion knowledge, attitudes, and perceptions

ABSTRACT Introduction Concussion leads to immediate cognitive, physiological, psychological, and emotional consequences that, if left untreated, may persist resulting in longer-term effects. Concussion education programs provide students with the knowledge necessary for them to make an informed decision to seek care should an injury occur. Methods In this observational cohort study, youth participating in public middle or high school athletics in a suburban county in Pennsylvania were asked to complete a survey to assess their concussion knowledge, attitudes, and perceptions before and after concussion education. Results All students increased scores from pre- to posteducation (mean difference, 0.08 to 0.67). Students from noncontact sports, higher grades, and higher Child Opportunity Index (COI) schools tended to have higher scores both before and after concussion education compared to students from contact sports, lower grades, or lower COI schools. Discussion Disparities were identified before and after the educational intervention between sport participation, grade level, and schools with different COI. Although concussion education was successful, with students showing improvement in all questions related to concussion knowledge, attitudes, and perceptions, this study identifies a need for the development of more equitable educational support systems. Understanding these differences may provide opportunities for targeted educational strategies, which might result in improved outcomes for younger athletes, those participating in contact sports, and those from lower COI schools.

The molecular history of IDH-mutant astrocytomas without adjuvant treatment.

Hypermutation and malignant transformation are potential complications arising from temozolomide treatment of IDH-mutant gliomas. However, the natural history of IDH-mutant low-grade gliomas without temozolomide treatment is actually under-studied. We retrieved retrospectively from our hospitals paired tumors from 19 patients with IDH-mutant, 1p19q non-codeleted Grade 2 astrocytomas where no interim adjuvant treatment with either temozolomide or radiotherapy was given between primary resections and first recurrences. Tissues from multiple recurrences were available from two patients and radiotherapy but not temozolomide was given before the last specimens were resected. We studied the natural molecular history of these low-grade IDH-mutant astrocytomas without pressure of temozolomide with DNA methylation profiling and copy number variation (CNV) analyses, targeted DNA sequencing, TERTp sequencing, FISH for ALT and selected biomarkers. Recurrences were mostly higher grades (15/19 patients) and characterized by new CNVs not present in the primary tumors (17/19 cases). Few novel mutations were identified in recurrences. Tumors from 17/19 (89.5%) patients showed either CDKN2A homozygous deletion, MYC or PDGFRA focal and non-focal gains at recurrences. There was no case of hypermutation. Phylogenetic trees constructed for tumors for the two patients with multiple recurrences suggested a lack of subclone development in their evolution when under no pressure from temozolomide. In summary, our studies demonstrated, in contrast to the phenomenon of temozolomide-induced hypermutation, IDH-mutant, 1p19q non-codeleted Grade 2 astrocytomas which had not been treated by temozolomide, acquired new CNVs at tumor recurrences. These findings improve our understanding of the molecular life history of IDH-mutant astrocytomas.

Emergency Medicine Clerkship Grading Scheme, Grade, and Rank-List Distribution as Reported on Standardized Letters of Evaluation

Background: The Standardized Letter of Evaluation (SLOE) is a crucial component of the emergency medicine (EM) application process. Given the critical role of the SLOE, we attempted to better understand the grading scales used, as well as the distribution of grades and rank-list positions.Objectives: Our primary objective in this study was to determine the distribution of grading formats, grades given, and rank-list positions across EM clerkships using the SLOE. Methods: We performed a cross-sectional study of the grading formats, grades given, and ranking distributions as reported on the SLOE during the 2022–23 application cycle. We obtained data on SLOEs from EM residency programs accredited by the Accreditation Council for Graduate Medical Education by reviewing all applicants who applied to either of two EM residency programs in geographically different regions. Trained abstractors recorded the following data: number of students rotating in the prior year; grading format used; and grade and rank distribution among students. Results: We included 264 programs in our final analysis, after 13 programs met exclusion criteria. The majority of programs (72.2%) use an Honors/High Pass/Pass/Fail grading scheme. We determined the mean percent of each grade: Honors/A 27.6%; High Pass/B 31.1%; Pass/C 40.8%; Low Pass/D 0.2%; and Fail/F 0.3%. Finally, we determined the mean percent for each rank-list position: top 10% was 17.6%; top third 36.5%; mid third 34.1%; and low third 11.8%. Conclusion: We determined the grading schemes and grade and rank-list distributions for EM programs during the 2022–2023 academic year. Most programs used a Honors/High Pass/Pass/Fail grading scheme, with the majority of students receiving Honors or High Pass, while 0.3% failed their rotation. Both grades and rank list demonstrated evidence of a skewed distribution toward higher grades and rank-list position.

HOXA9 and CD163 potentiate pancreatic ductal adenocarcinoma progression

BackgroundThe role of HOXA9 requires investigations in pancreatic ductal adenocarcinoma (PDAC) as HOXA9 inhibitors are being developed. HOXA9 might attract CD163 expressed tumor associated macrophages (TAM) and could affect PDAC prognosis. This work aims to study the expression and relevance of HOXA9 and CD163 in PDAC progression.Materials and methodsSelected 98 PDAC and 98 adjacent non tumor tissues as a control group were immunostained with HOXA9 and CD163 antibodies.ResultsPDAC displayed highly significant higher HOXA9 staining intensity, percent and H score values than control group. HOXA9 staining of PDAC cases showed significant associations with poor prognostic indicators including larger tumor size, higher grade and advanced stage. PDAC showed highly significant differences regarding CD163 macrophage-specific staining intensity, percent and H score values than control group. CD163 showed significant higher expressions with larger tumor size, higher histological grade and advanced stage group. HOXA9 staining in PDAC showed highly significant direct correlations with CD163 positive macrophages. Follow up of PDAC cases revealed that high median H score of HOXA9 and CD163 were significantly associated with worse overall survival. CD163 was an independent prognostic marker of worse survival.ConclusionsIn conclusion, HOXA9 could potentiate PDAC progression by stimulating CD163 expressed TAM attraction in tumors. HOXA9 and CD163 could participate in PDAC therapy. HOXA9 and CD163 could be predictors of worse prognosis and shorter survival in PDAC.

Effects of myopia on health-related quality of life in adolescents: a population-based cross-sectional causal empirical survey

ObjectiveMyopia is a prevalent disease affecting adolescent vision and harms various health outcomes. However, the evidence about the effects of myopia on adolescents’ overall health status is limited. Using health-related...

Enhancing legal writing skills: The impact of formative feedback in a hybrid intelligence learning environment

AbstractRecent developments in artificial intelligence (AI) have significantly influenced educational technologies, reshaping the teaching and learning landscape. However, the notion of fully automating the teaching process remains contentious. This paper explores the concept of hybrid intelligence (HI), which emphasizes the synergistic collaboration between AI and humans to optimize learning outcomes. Despite the potential of AI‐enhanced learning systems, their application in a human‐AI collaboration system often fails to meet anticipated standards, and there needs to be more empirical evidence showcasing their effectiveness. To address this gap, this study investigates whether formative feedback in an HI learning environment helps law students learn from their errors and write more structured and persuasive legal texts. We conducted a field experiment in a law course to analyse the impact of formative feedback on the exam results of 43 law students, as well as on the writer (students), the writing product and the writing process. In the control group, students received feedback conforming to the legal common practice, where they solved legal problems and subsequently received general feedback from a lecturer based on a sample solution. Students in the treatment group were provided with formative feedback that specifically targeted their individual errors, thereby stimulating internal cognitive processes within the students. Our investigation revealed that participants who were provided with formative feedback rooted in their errors within structured and persuasive legal writing outperformed the control group in producing qualitative, better legal text during an exam. Furthermore, the analysed qualitative student statements also suggest that formative feedback promotes students' self‐efficacy and self‐regulated learning. Our findings indicate that integrating formative feedback rooted in individual errors enhances students' legal writing skills. This underscores the hybrid nature of AI, empowering students to identify their errors and improve in a more self‐regulated manner. Practitioner notesWhat is already known about this topic Collaboration between humans and AI in educational settings advances learning mutually, fostering a unified developmental process. Collaborative education models advocate leveraging human and AI strengths for adaptive learning. Despite abundant theoretical research, empirical studies in HI remain limited. This gap underscores the need for more evidence‐based approaches in integrating AI into educational settings. What this paper adds Field experiment investigating the impact of formative feedback in a hybrid intelligence learning environment based on the theory of learning from errors. Comparison of a traditional legal learning environment (lecturer teaching using sample solutions) versus formative feedback in a hybrid intelligence learning environment. Implementing formative machine learning‐based feedback supports law students in producing more structured and persuasive legal texts, leading to enhanced exam performance and higher grades. Implications for practice and/or policy Our research contributes significantly to computer‐based education by presenting empirical evidence of how formative writing feedback impacts students' legal knowledge and skills in educational settings. This underscores the importance of incorporating empirical data into the development of AI‐based educational tools to ensure their effectiveness. By focusing on individual errors corrected by formative feedback, we contribute to the learning from errors literature stream. This perspective offers valuable insights into how such feedback can support students' writing and learning processes, filling a gap in empirical evidence. Our findings demonstrate the potential impact of ML‐based learning systems, particularly in large‐scale learning environments like legal mass lectures. Formative writing feedback emerges as a scalable and beneficial addition to traditional learning environments, triggering internal learning processes, fostering self‐regulated learning and increasing self‐efficacy among students. By demonstrating the effectiveness of formative feedback within the framework of HI, particularly in legal education, our research underscores the potential of combining human understanding with AI‐supported feedback to enhance learning outcomes.

The Impact of Cool and Warm Color Tones in Classrooms on the Perceived Emotions of Elementary School Students in Northwest China

Although it has been shown that color can influence mental health and behavior, few studies have discussed the effects of cool and warm colors in classrooms on the perceived emotions of elementary school students. In this study, we investigated the emotional changes of elementary school students in Yinchuan City, Northwest China in classrooms with cool and warm color tones. By using the Positive and Negative Affect Scale for Children (PANAS-C), the emotions of 123 third- to sixth-grade students in classrooms with cool and warm color tones were measured. We found the following conclusions: (1) Overall, the emotional responses of the subjects in both the cool- and warm-colored classrooms showed a tendency for positive emotions to be higher than negative emotions. (2) There was no significant difference between the effects of cool and warm colors on the overall emotion of elementary school students, but there were significant differences in specific emotions; Compared to warm colors, cool colors had a more significant effect on increasing feelings of calm (β = −0.365, p = 0.041). Compared to cool colors, warm colors were more likely to cause participants to feel mad (β = 0.186, p = 0.099). (3) The effects of cool and warm colors on students’ emotions differed significantly by gender and grade level. Cool and warm color tones had a significantly greater positive impact on females. In contrast, cool and warm colors had a more pronounced effect on males’ negative emotions. In addition, we found that grade level was significantly negatively correlated with overall emotion (β = −0.696, p &lt; 0.001), with lower grades perceiving emotion more positively than higher grades. These findings provide important insights into the spatial design of elementary school classrooms and provide valuable comparative data for studies in different regional and cultural contexts, further enriching the empirical support of color psychology theory.

PD-L1 protein expression in breast cancer

AimsThe immune checkpoint marker, Programmed cell death-ligand 1 (PD-L1), is expressed by both cancer epithelial cells and tumour-infiltrating immune cells (TICs) thus constituting a potential target for immunotherapy. This is...

Introductory Physics Students Who Typically Worked Alone or in Groups: Insights from Gender-Based Analysis Before and During COVID-19

Collaboration with peers both inside and outside the classroom can be an invaluable tool for helping students learn physics. We investigated the impact of peer collaboration on learning physics by examining the characteristics of women and men who typically worked alone versus those who typically collaborated with peers in their algebra-based introductory physics course when they took the course before and during the COVID-19 pandemic when the classes were on Zoom. Our findings indicate that, on average, students who worked with peers had higher grades and reported greater peer influence on their physics self-efficacy during the pandemic compared to those who worked alone. We also observed that, for both women and men, a larger percentage of students typically worked in groups before the pandemic, while a greater percentage typically worked alone during the pandemic. We discuss these results in relation to students’ prior academic preparation, physics grades, self-efficacy and their perception of the effectiveness of peer collaboration on their physics self-efficacy.

THE MOLECULAR HISTORY OF IDH-MUTANT ASTROCYTOMAS WITHOUT ADJUVANT TREATMENT

Abstract AIMS Hypermutation and malignant transformation are potential complications arising from temozolomide treatment of IDH-mutant gliomas. However, the natural history of IDH-mutant low-grade gliomas without temozolomide treatment is relatively un-studied. We set out to study the molecular history of paired IDH-mutant astrocytomas without adjuvant treatment in the interim. METHOD We retrieved retrospectively from our hospitals paired tumors from 19 patients with IDH-mutant, 1p19q noncodeleted Grade 2 astrocytomas where no interim adjuvant treatment with either temozolomide or radiotherapy was given between primary and first recurrences. Two patients had multiple resected recurrences and radiotherapy but not temozolomide was given before the last specimens were resected. We studied the natural molecular history of these low-grade IDH-mutant astrocytomas without pressure of temozolomide with methylation profiling and copy number variation (CNV) analyses, target DNA sequencing, TERTp sequencing, FISH for ALT and selected biomarkers. RESULTS Recurrences were mostly higher grades (15/19 patients) and characterized by new CNVs not present in the primary tumors (17/19 cases). Few novel mutations were identified in recurrences. Tumors from 17/19 (89.5%) patients showed either CDKN2A homozygous deletion, MYC or PDGFRA amplification at recurrences. There was no case of hypermutation. Phylogenetic trees constructed for tumors for the two patients with multiple recurrences showed a conserved evolution pattern. CONCLUSION In summary, our studies demonstrated in contrast to the phenomenon of temozolomide-induced hypermutation, IDH-mutant, 1p19q non-codeleted Grade 2 astrocytomas which were not treated by temozolomide instead acquired new CNVs at tumor recurrences. These findings improve our understanding of the molecular life history of IDH-mutant astrocytomas.

A Study of Fibroid Vascularization and Vascular Indices With Three-Dimensional Power Doppler and Superb Microvascular Imaging and the Correlation With Heavy Menstrual Bleeding.

Objective The objective of the study was to evaluate fibroid vascularization and vascular indices with three-dimensional (3D) power Doppler and superb microvascular imaging (SMI) and its correlation with heavy menstrual bleeding (HMB). Material and methods A total of 75 women with intramural uterine fibroid: 50 with HMB (Group A) and 25 without HMB (Group B)were recruited for the study. All participants were subjected to transabdominal and transvaginal color Doppler ultrasound. A 3D Power Doppler was used to measure Doppler Indices and flow rate in uterine arteries and the dominant vessel of fibroid. SMI was also used to determine vascularity in the dominant fibroid and to grade the vascularity. Results A significant association was observed between Doppler indices in the dominant feeding vessel of fibroid and HMB. Flow rates, namely peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly higher. Contrarily, resistance measured as Resistive Index (RI) and Pulsatility Index (PI) was lower in Group A than in Group B. The mean PSV of the dominant feeding vessel in group A was 26.42 ± 4.57and in group B was 14.56 ± 3.17, with p-value < 0.0001. For EDV, the median value (25th-75th percentile) in women with HMB was 6.76 (6.152-8.74) vs 3.99 (3.2-5.95)in womenwithout HMB (p < 0.0001). A significant association was observed between uterine artery Doppler indices (specifically, PSVand EDV) and HMB. However, no significant association was found between RI and PI of the uterine artery and HMB. In the study of the vascular pattern on SMI, the percentage of women exhibiting both central and peripheral vascularity in Group A and Group B were 72% and 4%, respectively (p< 0.0001). Women in Group A showed a significantly higher proportion of grade 2 and grade 3 vascularity (76% and 20%, respectively), whereas only 4% showed grade 1 vascularity. Conversely, in Group B, all the women showed grade 1 vascularity (p <0.001). Conclusion Doppler indices in the dominant feeding vessel of fibroid show a positive correlation with HMB. In the study of the vascular pattern on SMI, a significant proportion of women with HMB exhibited both peripheral and central vascularity and a higher grade. Most women with symptomatic fibroids are of childbearing age and fertility preservation is at times their prime concern. Fibroid vascularization assessed with 3D power Doppler ultrasound and the new advanced SMU tool may prove to be useful in the prediction of response to various non-surgical management options of uterine leiomyoma and thus aid in counseling and appropriate patient selection.

The characteristics of high-risk HPV-negative cervical cancer: a systematic review and meta-analysis.

In order to comprehensive understanding of the characteristics of high-risk HPV-negative cervical cancer and aiming to provide certain evidence in the diagnosis and treatment of this kind of disease, the clinical and pathological characteristics of high-risk HPV-negative (hr-HPV-negative) cervical cancer was evaluated through systematic review and meta-analysis. We employed a systematic search strategy incorporating both MeSH terms and free words across multiple databases including PubMed, Embase, Cochrane Library, Web of Science, CNKI and Wanfang. The strategy was specifically designed to identify articles investigating risk factors or clinical characteristics of hr-HPV-negative cervical cancer. Our database search spanned from their inception until October 2023. The literature selection and data collection processes were guided by predetermined inclusion and exclusion criteria. Each included research was independently evaluated by two reviewers using the Newcastle-Ottawa Scale (NOS) and a meta-analysis was conducted utilizing RevMan5.4. In total, nine studies published between 2013 and 2020 were included. The risk of lymph node metastasis was notably higher in hr-HPV-negative cervical cancer patients compared to hr-HPV-positive counterparts [RR=1.99, 95%CI (1.46-2.72), P<0.0001]. It was found that clinical staging of Ib2 or higher grade was significantly increased in hr-HPV-negative cervical cancer patients, as reported by seven studies [RR=1.42, 95%CI (1.15-1.77), P=0.0001]. Non-squamous carcinoma incidence, reported in seven studies, was significantly higher in hr-HPV-negative patients [RR=2.56, 95%CI (1.63-4.01), P=0.001]. Adenocarcinoma incidence was also significantly higher in hr-HPV-negative cervical cancer patients [RR=2.36, 95%CI (1.44-3.89), P=0.005]. Cervical cancer patients not infected by hr-HPV exhibited increased rates of lymph node metastasis, adenocarcinoma, and non-squamous carcinoma. And they were often diagnosed at more advanced stages. These variables suggest that hr-HPV-negative cervical cancer patients presented with a more severe health status at the time of their initial cancer diagnosis.

Instructional delivery mode, response format, and student performance in accounting: evidence from Brazil

ABSTRACT This study investigates how instructional delivery modes (i.e. face-to-face vs. distance education) are associated with multiple measures of student performance. More than 52,000 unique observations were collected from a Brazilian nationwide exam. Descriptive statistics, Welch’s t-tests, correlation analysis, and regression models were employed. The results indicated that, in general, students enrolled in face-to-face education outperformed their distance education counterparts, especially on accounting-specific questions. The results also showed that, although face-to-face education is more effective than distance education, students in both delivery modes presented poor performance. Additionally, the response format is relevant to student performance as higher grades were observed for multiple-choice questions than open-ended ones. Accounting faculty may want to consider the findings of this study when designing their exams in terms of format and content.

Minimally Invasive Direct Coronary Artery Bypass

After experiencing chest pressure while exercising, a 72-year-old patient tested positive in both a stress test and nuclear medicine study, triggering a left heart catheterization that revealed a high grade lesion of the proximal left anterior descending coronary artery. His cardiologist determined the lesion would not be amenable to angioplasty or stenting, so Dr. Marco Zenati performs a minimally invasive coronary artery bypass (MIDCAB).

Molybdenum isotope behavior during subduction zone metamorphism

The molybdenum (Mo) isotope composition (defined as δ98Mo measured per mil relative to NIST-3134) of many modern arc systems and the upper continental crust is heavier than the mantle and most subducting slab lithologies. This observation has led to a model whereby fluids leaving the slab transfer isotopically heavy Mo preferentially to the mantle wedge, leaving the residual slab isotopically lighter. We explore this model via an Mo isotope study of the metasedimentary and mélange lithologies of the Catalina Schist in California. These rocks record subduction zone metamorphism over a wide range of high-pressure/low-to-medium temperature conditions.Mo isotope compositions of the metasedimentary rocks decrease with increasing metamorphic grade, from a δ98Momean of −0.04 ± 0.13 ‰ (1σ, n = 3) for the lawsonite albite facies to −0.38 ± 0.07 ‰ (1σ, n = 5) for the epidote–amphibolite facies. The highest grade [amphibolite facies] samples show a slight uptick in δ98Mo values, with a mean of −0.19± 0.14 ‰ (1σ, n = 4). When coupled with major and trace element variations, the changes in δ98Mo appear to reflect metamorphic effects rather than sedimentary source rock heterogeneity. The positive relationship between δ98Mo and [Mo] and negative relationship with Ce/Mo argue for progressive loss of Mo with isotope fractionation during increasing P-T conditions; the reversal of this trend, seen in the increase in δ98Mo between the epidote amphibolite and amphibolite facies may reflect a subsequent partial re-fertilization by fluids carrying isotopically heavy Mo. δ98Mo values in the mélange across all grades are highly variable, ranging from −1.75 to −0.19, consistent with large scale mobilization of Mo with isotope fractionation. A metasomatized amphibolite block and reaction rind show similar light isotope compositions and signs of Mo depletion and transport. Together these three whole-rock data sets demonstrate pervasive open system behavior and mobility of Mo in the Catalina Schist. LA-ICP-MS Mo measurement of minerals in the differing metasedimentary metamorphic grades indicates that Fe oxides and/or hydroxides, titanite, rutile, and epidote are important reservoirs of Mo but when comparing mineral Mo content and modal abundance to whole-rock Mo concentrations, several samples were found to have “missing Mo”, something that has been observed in other Mo inventory studies. We attribute this to sample heterogeneity between the thin section and whole-rock powder scales.