Inadequate Content Research Articles

Overcoming engagement shortfalls and financial constraints in Small and Medium Enterprises (SMES) social media advertising through cost-effective Instagram strategies in Lagos and New York City

This research explores the challenges faced by Small and Medium Enterprises (SMEs) in leveraging social media advertising, with a focus on engagement shortfalls and financial constraints. The study compares the strategies employed by SMEs in Lagos, Nigeria, and New York City, USA, to overcome these challenges, highlighting the impact of these strategies on business growth and customer loyalty. Through a cross-cultural analysis, this research identifies cost-effective practices that can enhance social media engagement and optimize advertising expenditures for SMEs in diverse economic environments. The findings reveal that while social media platforms offer significant opportunities for SMEs, success is often hindered by limited resources, inadequate content strategies, and the rapidly changing dynamics of social media platforms. This study provides actionable insights for SMEs seeking to maximize their social media presence, offering recommendations for improving engagement and overcoming financial barriers. Keywords: Social Media Advertising, Small and Medium scale Enterprises (SMEs), Engagement Shortfalls, Financial Constraints, Cross-Cultural Study, Lagos, Nigeria and New York City, USA, Cost-Effective Strategies.

Validity of the Musculoskeletal Tumor Society Score for lower extremity in patients with bone sarcoma or giant cell tumour of bone undergoing bone resection and reconstruction surgery in hip and knee

BackgroundThe Musculoskeletal Tumor Society Score (MSTS) is widely used to evaluate functioning following surgery for bone and soft-tissue sarcoma. However, concerns have been raised about its content validity due to the lack of patient involvement during item development. Additionally, literature reports inconsistent results regarding data quality and structural validity. This study aimed to evaluate content, structural and construct validity of the Danish version of the MSTS for lower extremity (MSTS-LE).MethodsThe study included patients from three complete cohorts (n = 87) with bone sarcoma or giant cell tumour of bone who underwent bone resection and reconstruction surgery in hip and knee. Content validity was evaluated by linking MSTS items to frameworks of functioning, core outcome sets and semi-structured interviews. Data quality, internal consistency and factor analysis were used to assess the underlying structure of the MSTS. Construct validity was based on predefined hypotheses of correlation between the MSTS and concurrent measurements.ResultsContent validity analysis revealed concerns regarding the MSTS. The MSTS did not sufficiently cover patient-important functions, the item Emotional acceptance could not be linked to the framework of functioning, the items Pain and Emotional acceptance pertained to domains beyond functioning and items’ response options did not match items. A two-factor solution emerged, with the items Pain and Emotional acceptance loading highly on a second factor distinct from functioning. Internal consistency and construct validity showed values below accepted levels.ConclusionThe Danish MSTS-LE demonstrated inadequate content validity, internal consistency, and construct validity. In addition, our analyses did not support unidimensionality of the MSTS. Consequently, the MSTS-LE is not a simple reflection of the construct of functioning and the interpretation of a sum score is problematic. Clinicians and researcher should exercise caution when relying solely on MSTS scores for assessing lower extremity function. Alternative outcome measurements of functioning should be considered for the evaluation of postoperative function in this patient group.

Assessing informativeness in Spanish-speaking individuals with primary progressive aphasia

ABSTRACT Background Primary progressive aphasia (PPA) is a neurodegenerative disorder associated with atrophy of the frontotemporal region. It is primarily characterized by language impairments that become accentuated over time, often leading to isolation and social exclusion. There are three main subtypes, the semantic (svPPA), non-fluent (nfvPPA), and logopenic (lvPPA) variants, each presenting distinct language deficits, as captured by standard assessment batteries. However, such assessments often fail to adequately identify functional communication (dis)abilities in everyday life, which is crucial for effective diagnosis and treatment. One understudied aspect of communication is informativeness, the conveyance of an appropriate amount of information in an efficient fashion. Aim This study aimed to identify the unique features of each variant of PPA that distinguish it from healthy controls, and the dissimilarity across PPA groups, in terms of the effectiveness and efficiency with which Spanish-speaking individuals with PPA conveyed information. Methods and procedures Thirty-two Spanish-speaking patients with one of the three variants of PPA and 11 healthy individuals were audio-recorded performing a picture description task. The resulting recordings were transcribed, and the contents labelled according to whether they constituted relevant or off-topic content, each type of content being further divided into subcategories. In total, 51 parameters related to the (1) overall amount of speech and number of correct information units, (2) amount of relevant content, (3) completeness of the content, and (4) off-topic information were considered. Nonparametric analyses were conducted to assess the divergence from heathy controls of each PPA group, and the dissimilarity across PPA groups. Outcomes and results Results revealed disruptions in informativeness in all PPA variants compared to controls, with lvPPA characterized by inadequate content and a high concentration of off-topic elements, nfvPPA by inadequate content but efficient delivery, and svPPA by inadequate content delivered inefficiently. Conclusions This study revealed that all three variants of PPA are characterized by reduced informativeness, although each exhibits unique patterns in communicative efficiency and the presence of off-topic information. By assessing the total amount of relevant speech, efficiency in conveying content, and the presence of off-topic elements, this research enhances our understanding of the distinct communication impairments characterizing lvPPA, nfvPPA, and svPPA, and provides valuable insights that can be applied to developing tailored remedial strategies.

Commit-Level Software Change Intent Classification Using a Pre-Trained Transformer-Based Code Model

Software evolution is driven by changes made during software development and maintenance. While source control systems effectively manage these changes at the commit level, the intent behind them are often inadequately documented, making understanding their rationale challenging. Existing commit intent classification approaches, largely reliant on commit messages, only partially capture the underlying intent, predominantly due to the messages’ inadequate content and neglect of the semantic nuances in code changes. This paper presents a novel method for extracting semantic features from commits based on modifications in the source code, where each commit is represented by one or more fine-grained conjoint code changes, e.g., file-level or hunk-level changes. To address the unstructured nature of code, the method leverages a pre-trained transformer-based code model, further trained through task-adaptive pre-training and fine-tuning on the downstream task of intent classification. This fine-tuned task-adapted pre-trained code model is then utilized to embed fine-grained conjoint changes in a commit, which are aggregated into a unified commit-level vector representation. The proposed method was evaluated using two BERT-based code models, i.e., CodeBERT and GraphCodeBERT, and various aggregation techniques on data from open-source Java software projects. The results show that the proposed method can be used to effectively extract commit embeddings as features for commit intent classification and outperform current state-of-the-art methods of code commit representation for intent categorization in terms of software maintenance activities undertaken by commits.

TEMPORARY REMOVAL: Mortalité maternelle par hémorragie obstétricale en France 2016–2018

Between 2016 and 2018, 20 maternal deaths were related to obstetric haemorrhage, excluding haemorrhage in the first trimester of pregnancy, representing a mortality ratio of 0.87 per 100,000 live births (95% CI 0.5 -1.3). Obstetric haemorrhage is the cause of 7.4% of all maternal deaths up to 1 year, 10% of maternal deaths within 42 days, and 21% of deaths directly related to pregnancy (direct causes). Between 2001 and 2018, maternal mortality from obstetric haemorrhage has been considerably reduced, from 2.2 deaths per 100,000 live births in 2001-2003 to 0.87 in the period presented here. Nevertheless, obstetric haemorrhage is still one of the main direct causes of maternal death, and remains the cause with the highest proportion of deaths considered probably (53%) or possibly (42%) preventable according to the CNEMM's collegial assessment (see chapter 3). The preventable factors reported are related to inadequate content of care in 94% of cases and/or organisation of care in 44% of cases. In this triennium, maternal death due to haemorrhage occurred mainly in the context of caesarean delivery (65% of cases, i.e. 13/20), and mostly in the context of emergency care (12/13). The main causes of obstetric haemorrhage were uterine rupture (6/20) in unscarred uterus or in association with placenta accreta, and surgical injury during the caesarean delivery (5/20). Every maternity hospital, whatever its resources and/or technical facilities, must be able to plan any obstetric haemorrhage situation that threatens the mother's vital prognosis. Intraperitoneal occult haemorrhage following caesarean section and uterine rupture require immediate surgery with the help of skilled surgeon resources with early and appropriate administration of blood products.

Examining Trends and Effectiveness of Academic Institutions’ Website Content

This research aimed to examine the trends in and effectiveness of website content on the websites of selected Ethiopian academic institutions. The data was gathered through content analysis and questionnaire and analysed through descriptive statistics (mean), One-Way ANOVA, and narration. The results confirmed that academic and research content were the strongest content categories compared to the other issues covered on the selected websites; and that program and office related content were the weakest (μ = 0.125). According to the data, Addis Ababa, Hawassa, Bahir Dar and Harmaya universities respectively had better content management trends than the other universities. The data also demonstrated that there were significant statistical differences among the website content offered by different universities. Poor navigation systems, inadequate content, empty menus and sub-menus, inconsistent branding, spelling and grammatical errors, as well as untargeted content were some of the observed limitations of the selected website content. Moreover, the data confirmed that the majority of universities updated their websites infrequently. Thus, the study recommends that universities manage their websites well in order to enhance their visibility and reputation.

YouTube as an information source for bleeding gums: A quantitative and qualitative analysis.

Gum bleeding is a common dental problem, and numerous patients seek health-related information on this topic online. The YouTube website is a popular resource for people searching for medical information. To our knowledge, no recent study has evaluated content related to bleeding gums on YouTube™. Therefore, this study aimed to conduct a quantitative and qualitative analysis of YouTube videos related to bleeding gums. A search was performed on YouTube using the keyword "bleeding gums" from Google Trends. Of the first 200 results, 107 videos met the inclusion criteria. The descriptive statistics for the videos included the time since upload, the video length, and the number of likes, views, comments, subscribers, and viewing rates. The global quality score (GQS), usefulness score, and DISCERN were used to evaluate the video quality. Statistical analysis was performed using the Kruskal-Wallis test, Mann-Whitney test, and Spearman correlation analysis. The majority (n = 69, 64.48%) of the videos observed were uploaded by hospitals/clinics and dentists/specialists. The highest coverage was for symptoms (95.33%). Only 14.02% of the videos were classified as "good". The average video length of the videos rated as "good" was significantly longer than the other groups (p <0.05), and the average viewing rate of the videos rated as "poor" (63,943.68%) was substantially higher than the other groups (p <0.05). YouTube videos on bleeding gums were of moderate quality, but their content was incomplete and unreliable. Incorrect and inadequate content can significantly influence patients' attitudes and medical decisions. Effort needs to be expended by dental professionals, organizations, and the YouTube platform to ensure that YouTube can serve as a reliable source of information on bleeding gums.

Interactive word walls for 3D learning: Visually representing the NGSS in elementary science methods courses

AbstractEven though the Next Generation Science Standards (NGSS) were released over a decade ago, science is still infrequently taught in early childhood and elementary classrooms. A lack of teacher confidence due to inadequate content knowledge may be a contributing factor, making access to high‐quality elementary science methods courses even more imperative. This article highlights preservice elementary teachers’ use of an interactive word wall, an instructional strategy that explicitly documented their experiences with disciplinary core ideas, scientific and engineering practices, and crosscutting concepts. Students enrolled in four undergraduate elementary science methods sections participated in the creation, implementation, and evaluation of their classroom's interactive word wall. Through written assignments, classroom discussions, and photographic documentation, students helped to identify seven benefits of using this strategy while collaboratively building their interactive word walls. This article describes the process of setting up the word walls, the students’ choices during the construction of the walls, and their reflections on the benefits and challenges associated with using an interactive word wall at the university level. This article provides teacher educators with a strategy to strengthen students’ understanding of the NGSS framework and encourages preservice teachers to reflect upon how to use this strategy in their future classrooms.

Improving nursing education curriculum as a tool for strengthening the nurse-client relationships in maternal and child healthcare: Insights from a human-centered design study in rural Tanzania.

There are growing evidence of poor nurse-client relationships in maternal and child health (MCH). The nursing curriculum forms an important entry point for strengthening such relationships, consequently improving client satisfaction with nurses' competencies, confidence in the formal healthcare system, healthcare-seeking practices, continuity with care, and MCH outcomes. MCH nurses and clients were invited to design an intervention package (prototype) to improve nurse-client relationships using a human-centered design (HCD) approach. A multi-step HCD approach was employed to first examine the contributors of poor nurse-client relationships using nine focus group discussions with nurses and clients and 12 key informant interviews with MCH administrators. Then, three meetings were held with 10 nurses, 10 clients, and 10 administrators to co-develop an intervention package to address the identified contributors. The solutions were validated by collecting qualitative information through six focus groups with nurses and MCH clients who were not involved in the initial HCD stages. Finally, refinement and adaptation meetings were held with 15 nurses, 15 clients, and 10 administrators. The data were managed with NVivo 12 software and analyzed thematically. Nursing curriculum challenges contributing to poor nurse-client relationships in MCH care included inadequate content on nurse-client relationships specifically topics of customer care, communication skills, and patient-centered care; an inadequate practice on communication skills within nursing schools; and the absence of specific trainers on interpersonal relationships. Consequently, improving the nursing curriculum was one of the interventions proposed during the co-design and rated by participants as highly acceptable during validation and refinement meetings. Suggested improvements to the curriculum included increasing hours and credits on communication skills and patient-centered care, including customer care courses in the curriculum and creating a friendly learning environment for clinical practice on strengthening interpersonal relationships. Improving the nursing curriculum was considered by nurses and clients as one of the acceptable interventions to strengthen nurse-client relations in MCH care in rural Tanzania. Nursing education policy and curriculum developers need to ensure the curriculum facilitates the development of much-needed interpersonal skills among nursing graduates for them to have positive therapeutic interactions with their clients.

Examining young adults daily perspectives on usage of anxiety apps: A user study.

The growing number of mental health smartphone applications has led to increased interest in how these tools might support users in different models of care. However, research on the use of these interventions in real-world settings has been scarce. It is important to understand how apps are used in a deployment setting, especially among populations where such tools might add value to current models of care. The objective of this study is to explore the daily use of commercially-available mobile apps for anxiety that integrate CBT, with a focus on understanding reasons for and barriers for app use and engagement. This study recruited 17 young adults (age M = 24.17 years) while on a waiting list to receive therapy in a Student Counselling Service. Participants were asked to select up to two of a list of three selected apps (Wysa, Woebot, and Sanvello) and instructed to use the apps for two weeks. Apps were selected because they used techniques from cognitive behavioral therapy, and offer diverse functionality for anxiety management. Qualitative and quantitative data were gathered through daily questionnaires to capture participants' experiences with the mobile apps. In addition, eleven semi-structured interviews were conducted at the end of the study. We used descriptive statistics to analyze participants' interaction with different app features and used a general inductive approach to analyze the collected qualitative data. The results highlight that users form opinions about the apps during the first days of app use. A number of barriers to sustained use are identified including cost-related issues, inadequate content to support long-term use, and a lack of customization options for different app functions. The app features used differ among participants with self-monitoring and treatment elements being the most used features.

Swedish dental students’ clinical notes and reflections as part of a case-based examination – challenges for undergraduate education

Clinical records are the basis for clinical reasoning, diagnostics, treatment planning, and management as well as for management of the patient and the outcome of the treatment, and therefore an important aspect of health professionals’ work. Several articles emphasize the importance of adequate and correct content in these records. Previous research shows that even health professionals need to improve the content and structure of their clinical records, for them to give the information needed for various needs. The focus of this article are the clinical records of undergraduate dental students. The aim of the study was to explore patterns of adequate and inadequate content in clinical notes of undergraduate dental students in their final year of education. Secondly, whether these results could provide insights for development of health professions education. Data comprised of 33 cased-based examinations collected during January 2020 at the University Dental Clinic, Department of Dental Medicine, Karolinska Institutet, in Huddinge Sweden. Also, data included teachers’ assessment of these examinations. The texts were analyzed with thematic analysis. Analytical results showed three themes. The first theme, (i) Professional content knowledge, concerned information in patient history, status, diagnostics and treatment plan, and an information ambiguity. The theme also included the students' use of professional terminology and the choice of articles to support reflections. The second theme (ii) incomplete method of investigation involved the actual patient interview, but also students’ various misunderstandings of the template. The third theme was (iii) Academic formalities. This theme concerned students' understanding of the purpose of referencing and its function, but also a non-use of references, the use of irrelevant references, errors in the given citation style, and an incorrect structure of the text according to the template. In conclusion, results showed the need for continuous training in clinical note-taking and reflections during dental students' professional education. In this training, teachers’ assessment is important for students' development of professional literacy and professional judgment. Also, a continuous reminder of science and proven experience as the basis for the profession which is also made visible through academic formalities.

Home-based sexual Education for Children with Intellectual and Developmental Disability (IDD)

This study was qualitative and used an exploratory research design. The sample of the study included 15 parents of children with IDD recruited using a purposive sampling technique. The tool for data collection was a self-developed semi-structured interview. The findings of the study revealed parents perceive that sexual education helps in appropriate interaction with the opposite gender and development of a sense of right. Parents also face some common changes such as attraction for the opposite gender, prominent physical changes, psychological changes, and emotional changes. The study revealed some basic problems included communication barriers, lack of knowledge and skills to talk about sexual education, inadequate content on sexual education, family values as taboos to discuss sexual matters, health-related problems, problems in managing anger and frustration, and not aware of the strategic measure. This study emphasizes the need for future interventions to overcome challenges.

Economic and Management Sciences as the Ground Rule for Grades 10 to 12 Accounting Learners in South Africa

The purpose of this study was to explore economic and management sciences (EMS) as ground rule for Grades 10 to 12 accounting learners in South Africa. The objective of introducing EMS in schools was to equip learners with basic real-life skills in accounting, economics, and business. This requires educators who are highly skilled and well vested with the content of EMS to impart knowledge to learners. However, research has shown continuous challenges in accounting, as it is regarded as a difficult subject due to a high failure rate. Data were obtained through semi-structured interviews from six EMS educators who were purposively sampled. The results revealed that EMS educators are qualified for either one or two EMS disciplines, resulting in EMS being taught by unqualified educators with inadequate content knowledge (CK) due to the scarcity of qualified educators. The study revealed a continuous neglection of accounting content, as EMS educators focus more on economics and business studies. The study also revealed that the time allocated to teach EMS is insufficient and that accounting should not be merged with other subjects as it requires more time. We recommend that the way in which EMS educators are trained should be reviewed. In addition, we suggest that a special program should be designed to fully equip EMS educators in all three areas to ensure the availability of qualified EMS educators. We further recommend that the Department of Education should review time allocation for EMS.

Early language outcomes in Argentinean toddlers: Associations with home literacy, screen exposure and joint media engagement.

This study aimed to analyse the contribution of mothers' home literacy beliefs and practices and the quantity and quality of screen media exposure on Argentinean toddler's language. In addition, we considered parent-child joint engagement, as well as adult scaffolding behaviours during the use of electronic devices. A total of 465 mothers of 18-36 months old children completed an online survey including: the MacArthur Bates CDI, home literacy, screen exposure, joint engagement and scaffolding questionnaires. We observed positive effects of literacy beliefs, PC times and verbal scaffolding on language outcomes. TV exposure contributed negatively to vocabulary and, along with educational content, to sentence use. Shared reading and screen media experiences can be an opportunity for language stimulation, provided there is dialogue and joint engagement. Passive screen exposure and inadequate content may be detrimental for toddlers' language outcomes, probably by displacement of socially significant interactions.

Quality of Pre-operative Assessment for Mid Urethral Slings in Women Who Present With Mesh Complications

ObjectiveTo study quality of pre- and post-operative evaluation in women undergoing mid-urethral synthetic sling surgery who subsequently have complications. Materials and methodsStudy inclusion was chart availability for preoperative clinical history, examination, urodynamics and/or post-operative visit in women with mesh complications 2014-2021 in a tertiary practice. The primary outcome was compliance with quality indicators and guidelines for preoperative and post-operative clinical evaluation and urodynamics. Results122 women had preoperative, 102 urodynamic reports and 108 post-operative charts available for review. Only clinical history and examination showed moderate compliance (71% nature, 57% severity, 87% exam) with quality indicators, all other quality indicators were low. including documentation of counselling of mesh risks (11%) and risks of incontinence surgery (17%) . Compliance with guidelines (optimal care) was also low (bladder diary 61%, all others ≤41%). Post-operative evaluation did not comprehensively screen for complication e.g., flow rate/post-void residual performed in 9%. A significant proportion had an early adverse symptom (55%) or intervention e.g. trimming of exposure (40%) ConclusionCompliance with quality indicators and guidelines was generally low for pre-operative evaluation and urodynamic testing. There was inadequate content and length of post-operative evaluation despite a significant proportion presenting with adverse symptoms at first postoperative follow-up. Future research could target these areas for development of tools to improve compliance and education of health providers.

Failure Investigation &amp;amp; Analyses of AISI D3 Dies Used in Tableting Machines for Pharmaceutical Application

AISI D3 material finds wide use as Dies in Tableting Machines for Pharmaceutical applications owing to its good strength, toughness and moderate corrosion resistance combined with cost effectiveness. However, 10-15% of AISI D3 Dies used in rotary Tableting Machines were found to fail within 4-6 months of service resulting in frequent disruption of regular production and loss in overall productivity besides having potential long-term risks such as metal contamination in the output product. Visual examination of the failed Die showed 180o crack across the top Die face with rust marks, but no such crack was found on the bottom face. Also, the crack on the top Die face had a jagged morphology and those cracks on the Outer Diameter (OD) surface oriented in the axial direction were found to be straight and sharp. Macro-examination of Die sectioned diametrically and perpendicular to the crack on the Die face revealed jagged axial cracks on the Internal Diameter (ID) surface. Cluster pitting marks centered around mid-height of the Die were observed on the ID surface and the cut open sections of the Die along the crack revealed extensive corrosion. While microstructural examination of samples taken on the ID surface showed presence of banded carbides oriented axially in tempered martensite matrix, the same examination carried out on samples taken on Die face revealed fine needle like carbides in tempered martensite matrix. Fractography analysis conducted in the cluster pitting zone on the ID surface clearly showed presence of micro-cracks having multiple points of origin with clear indications of propagation into the cross section of the Die. Scanning Electron Microscopy (SEM) carried out in the aforementioned zone near ID surface also showed the presence of multiple micro-cracks. The SEM-EDX analysis in the referred zone at specific locations in the vicinity of microcracks confirmed inadequate Chromium oxide content leading to lack of corrosion resistance in the material. Based on the investigation &amp; analyses and the detailed study of the Tableting Process in rotary Tableting Machines that revealed the nature of applied load to be cyclic, a comprehensive failure mechanism was arrived at, and it was inferred that the predominant mode of AISI D3 Die failure was Corrosion Fatigue. Finally, recommendation has been proposed to prevent such failures during service.

School curricullum and enviromental sustainability

Despite far-reaching environmental concerns, school curriculum in Kenya lacks adequate environmental sustainability address, yet global indicators show deterioration of the environment in developing countries is obviously leading to loss of biodiversity, rise in carbon levels, climate change (UNESCO. 2016) and overall poor-quality life. Research conducted on values education and environmental sustainability determined effective approaches to promote environment sustainability among school going children in Kenya. Inadequate environmental values education was hypothesized to lead to low awareness and action towards sustainability. To determine the extent to which Kenya’s education curriculum addresses environmental sustainability values for ESD, the findings form a basis for proposing innovation in EESD in school curricular. Mixed research design involved content analysis of the curricula and textbooks, descriptive surveys and expert interviews. Multistage sampling was applied among students and teachers from 8 former provinces of Kenya for administration of questionnaires to determine environmental content in educational materials, values and skills taught. Expert officials from KICD, MOEST, and UNEP were selected using purposive sampling for interviewing on required content, policy and adequacy. Findings indicated that EESD is not explicitly taught, does not adequately reflect in curricular objectives or textbooks, teaching on environment is mainly knowledge based and lacks experiential learning activities, heads of department (50%) have no training on environmental issues, students (51.8%) have not learnt enough of environmental issues, teachers (56%) are not motivated to teach about environment, and over 62% of teachers report the curriculum is insufficient to develop environmental values. MoE and NEEMA confirmed that values and policy on environmental sustainability are insufficiently taught, teachers are inadequately trained and initiatives on curriculum for environmental sustainability are inconclusive. Teaching and learning for EESD in Kenya is based on inadequate content, values and methodology. In conclusion appropriate EESD content, values and methodologies should be integrated in unfolding curriculum reviews for school.&#x0D; Key Words:&#x0D; School Curricular&#x0D; Environmental Education&#x0D; Environmental Education for Sustainable Development&#x0D; Environmental Sustainabilit

Intercultural communicative competence in foreign language learning

The importance of teaching both language and culture inseparably are widely acknowledged by both instructors and students. As a result, new concepts such as intercultural communicative competence have emerged. This means that this new skill has to be promoted and fostered so that students can develop it and interact with other people effectively in a more culturally diverse setting. This paper aims to analyse the role of this new competence in foreign language learning, which is characteristic of 21st-century citizens. The study, therefore, conducts a literature review. In this process, teachers, and to a lesser extent coursebook, play a paramount role. Even though all the agents involved in the teaching-learning process value its importance, there are some factors such as a lack of appropriate training on the part of teachers, inadequate content and materials contained mainly in coursebooks, and effective ways of assessment, which prevent the development of this new 21st-century skill. Keywords: Awareness; culture; development; intercultural communicative competence; interculturality

Macronutrients and fatty acids of enteral diets: A comparison between labels and analytical findings

The present study evaluated the parameters of the nutritional quality of fatty acids and macronutrients in ten industrial enteral formulas. The results obtained were compared with those reported on the food labels. Two samples presented lower total protein contents compared to the values reported by the manufacturers. Four samples presented relatively higher carbohydrate contents – between 128 and 177 %, compared to the values reported on the labels. Four other samples exhibited relatively lower total lipid contents – between 65 and 68 %, as opposed to the values reported on the label. The caloric density values obtained were within the established tolerance limits. The contents of saturated fatty acids (SFA) in six formulas exceeded the values indicated on the labels; furthermore, the contents of monounsaturated fatty acids (MUFA) found in four formulas were lower than the values reported on the labels, while seven samples recorded lower contents of polyunsaturated fatty acids (PUFA) compared to the labels reported values. Only 30 % of the formulas presented all the parameters of macronutrients as reported on the labels. The discrepancy between the values obtained in the experiments and the values reported on the labels points to the need for stringent supervision of the actual composition of enteral formulas administered to individuals with specific nutritional needs who may have their clinical outcomes compromised by the intake of inadequate contents of fatty acids and macronutrients that differ from the contents prescribed in the Intensive Care Unit (ICU), in the outpatient clinic, or at home.

Four of five frequently used orthopedic PROMs possess inadequate content validity: a COSMIN evaluation of the mHHS, HAGOS, IKDC-SKF, KOOS and KNEES-ACL.

Content validity is the most important property of PROMs. The COSMIN initiative has published guidelines for evaluating the content validity of PROMs, but they have only sparsely been applied to relevant PROMs for musculoskeletal conditions. The aim of this study was to use the COSMIN Risk of Bias checklist to evaluate the content validity of five PROMs, that are highly relevant in musculoskeletal research and used by the arthroscopic surgery community: the modified Harris' Hip Score (mHHS), the Copenhagen Hip and Groin Outcome Score (HAGOS), the International Knee Documentation Committee Subjective Knee evaluation Form (IKDC-SKF), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Knee Numeric-Entity Evaluation Score ACL (KNEES-ACL). The development articles for the five PROMs were identified through searches in PubMed and SCOPUS. A literature search was performed to identify additional studies assessing content validity of the PROMs. Additional information, necessary for the assessments, was obtained from the PROM developers after direct request. To evaluate the quality of the development studies and rate the content validity, the COSMIN Risk of Bias checklist was applied to all studies. All five development studies were identified. Three subsequent content validity studies were identified, all evaluating KOOS and one also IKDC. One content validity study was of inadequate quality and excluded from further analysis. The development of mHHS, IKDC-SKF, and KOOS was rated inadequate and possess insufficient content validity for their target populations. Due to the irrelevance of multiple items, KOOS was in particular inappropriate to evaluate patients with an ACL injury. The development of HAGOS was also rated inadequate, although the insufficiency aspects can be regarded as minor. KNEES-ACL possessed sufficient content validity. Out of five PROMs, only KNEES-ACL possessed sufficient content validity. Particularly, KOOS should not be used as an outcome for patients with an ACL injury. There is an urgent need for condition-specific PROMs for musculoskeletal conditions, developed with adequate methods. III.