Initial Difficulties Research Articles

Feasibility of Emergency Department-Initiated HIV Pre-Exposure Prophylaxis

Introduction: Pre-exposure prophylaxis (PrEP) for HIV—using antiretroviral medication in non-infected individuals to prevent HIV—has immense potential to slow the spread of the virus. However, uptake has been insufficient, and stark racial disparities exist in both HIV acquisition and PrEP usage, making PrEP access a health equity issue. A promising venue to engage high-risk populations in PrEP care is the emergency department (ED); however, existing ED PrEP initiatives have been costly or have had limited success. We hypothesize that two strategies could overcome these barriers: prescribing PrEP during an ED visit and providing patients with an initial supply of PrEP medication in the ED. Here, we describe the results of a qualitative study exploring multidisciplinary emergency clinicians and HIV clinicians’ needs and views about the feasibility of such an initiative. Methods: We conducted 22 semi-structured interviews with multidisciplinary clinicians from an urban, safety-net medical center in the ED and the on-site HIV clinic that provides PrEP services.We performed thematic analysis to summarize challenges and potential solutions described by participants. Results: Participants’ responses fell into three thematic categories: operational challenges; patient-level considerations; and potential impacts. Operational challenges highlighted the difficulty of PrEP initiation in a busy ED and clinician support needs. Patient-level considerations included the complex psychosocial needs of ED patients who could benefit from PrEP. Finally, participants anticipated that an ED-based PrEP initiation program could positively impact both individual patients and public health. Conclusion: Interviews with emergency department and HIV clinic staff revealed important considerations and potential solutions for ED-initiated PrEP workflows. Clinicians in both specialties were enthusiastic about such an initiative, which could facilitate its success. This study lays the groundwork for the future design of an efficient and innovative workflow to leverage the ED as an essential entry point into HIV prevention services.

Chronic inflammatory demyelinating polyneuropathy: current state of the problem (analysis of a clinical case)

Chronic inflammatory demyelinating polyneuropathy is an acquired autoimmune disease of the peripheral nervous system, heterogeneous in course and clinical manifestations, which is curable. The variety of forms of the disease and its course cause difficulties in timely diagnosis and initiation of pathogenetic therapy. This article presents a clinical observation of a patient with a wide range of concomitant pathologies, the presence of which significantly complicated the diagnosis and led to delayed prescription of immunosuppressive therapy.

Analisis Kesulitan Membaca Permulaan Siswa Sekolah Dasar

Early reading difficulties in elementary school students are an important problem in the educational process. The aim of this research is to determine the factors that influence initial reading difficulties, as well as the types of difficulties students face in initial reading based on several related studies. Various factors such as the environment, psychology, and internal maturity of students can be the main causes of reading difficulties. Types of difficulties include a lack of understanding of letters, difficulty pronouncing words, and limitations in reading sentences or paragraphs. This research uses qualitative methods through literature study. The data analysis technique used in this research is content analysis. The results illustrate the various difficulties experienced by students, including difficulties in recognizing letters, difficulties in pronouncing, and difficulties in reading words, syllables, sentences, as well as aspects of incorrect pronunciation. solving initial reading difficulties includes the important role of teachers in providing learning that suits students' needs, parental support in providing motivation, as well as creating a social environment that supports the process of learning to read. By overcoming initial reading difficulties, it is hoped that elementary school students can develop their reading skills effectively to support better academic development

Utilization of Art in Nursing Education to Enhance Student Spiritual Growth and Holistic Nursing Practice.

Purpose: The purpose of this study was to investigate student nurses' perceptions of how creative art activities might support spiritual self-exploration, foster understanding of holistic care and promote spiritual growth in relation to Mercy and Jesuit values emphasized in their nursing program. Design: A qualitative design was used with data collected through surveys and students' reflections. Methods: Students enrolled in an introductory nursing course with a service-learning component participated in the study. Students were initially asked to create drawings depicting Mercy/Jesuit charisms, spirituality, and holistic nursing then complete written reflections. At the term's end, students created group art projects connecting service learning, holistic nursing care, and spiritual growth. Students responded to survey questions regarding spirituality, Mercy/Jesuit charisms, nursing practice, and their art experiences. Findings: Surveys were completed by 122 of the 137 students who participated in the art projects. After initial difficulty with artistic expression, most students reported the projects provided an opportunity for introspection related to personal spirituality, nursing, and the impact of service-learning experiences on future nursing practice. Conclusion: Arts-based learning can help students explore and express spirituality related to nursing and support their understanding and integration of values essential to the delivery of holistic nursing care.

Design and assessment of a virtual reality learning environment for firefighters

The use of virtual reality (VR) in firefighter training is promising because it provides cost-effective, safe environments that arouse similar behavioral responses to real-life scenarios. However, the pedagogical potential of VR and its impact on learning outcomes compared to traditional methods is currently an under-explored area. This research investigates how well VR can support learning compared to traditional methods in the context of training firefighters in combating vegetation fires. A VR learning environment was developed, informed by a “design for learning” framework providing a pedagogical underpinning. A between-subjects experiment was conducted with 40 participants to measure the knowledge transfer of the VR learning environment against the official textbook. In addition, VR's theorized learning benefits of intrinsic motivation, situational interest, and self-efficacy were compared with textbook-based learning. Lastly, the design quality of the learning environment was assessed based on its learning and user experience. We employed a primarily quantitative approach to data collection and analysis, using a combination of knowledge test results and questionnaires, with supporting qualitative data from semi-structured interviews and observation notes to answer our hypotheses. The results found a significant difference between the knowledge transfer of both conditions, with textbook-based learning more effectively transferring factual and conceptual knowledge than VR. No significant difference was found in reported self-efficacy between the two conditions but was found in reported levels of intrinsic motivation and situational interest, which were higher in the VR condition. The design was found to have facilitated a good user and learning experience, assessed via questionnaire responses. During interviews, VR participants reported high levels of satisfaction with the experience, praising the hands-on learning approach and interactivity, while reporting frustration with the lack of knowledge reinforcement and initial difficulties with the controls. A key finding was that presence was found to be negatively associated with knowledge transfer, which we theorize to be caused by the novelty of the realistic VR environment distracting participants from the more familiar lesson content. This research contributes to the body of work related to knowledge transfer within VR in this domain while highlighting key pedagogical and design considerations that can be used to inform future design implementations.

Analysis of competition and interference mechanisms of multiple hydraulic fractures in deep-sea hydrate reservoirs in the South China Sea

Improving the fundamental theory of hydraulic fracturing in deep-sea hydrate reservoirs is of great significance in enhancing the efficiency of gas hydrate mining. In this paper, a multi-cluster fracturing model for a horizontal well was established with a three-dimensional extended finite element method and the measured geo-mechanical data from hydrate reservoirs in the South China Sea. The performance, fracture initiation, and expansion mechanisms of multi-hydraulic fractures are investigated under different fracturing sequences, hydrate saturation and cluster deployment patterns. Some interesting results have been discovered: In the case of three-cluster, the fractures produced by sequential fracturing are notably more affected by pre-existing fractures. Furthermore, the effect of fracture interference between simultaneous and sequential fracturing is reflected in the middle fracture is compressed by the fractures on its left and right sides. The increase in hydrate saturation enhances the cementing ability of the sediments and results in an increased difficulty of fracture initiation for the five-cluster simultaneous fracturing. It also results in a decrease in the geo-stress field, where the interaction between fractures plays a dominant role in the process of fracture expansion, leading to non-uniform expansion.

Common Childhood Sleep Problems and Disorders.

Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents. A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled. Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized. Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.

The Aha! experience is associated with a drop in the perceived difficulty of the problem.

The study investigated the correlation between the intensity of the Aha! experience and participants' subjective difficulty ratings of problems before and after finding their solutions. We assumed that the Aha! experience arises from a shift in processing fluency triggered by changing from an initially incoherent problem representation to a coherent one, which ultimately leads to the retrieval of a solution with unexpected ease and speed. First, we hypothesized that higher Aha! experience ratings would indicate more sudden solutions, manifesting in a reduced correlation between the initial difficulty ratings and solution times. Second, we hypothesized that higher Aha! experience ratings would correspond to a greater shift in the subjective difficulty ratings between the initial and retrospective assessments. To test our hypotheses, we developed a novel set of rebus puzzles. A total of 160 participants solved rebuses and provided initial (within 5 s of problem presentation) and retrospective difficulty ratings (following the generation or presentation of a correct solution). They also rated their Aha! experience (after solution generation or presentation), confidence in solutions, and the likability of each rebus. Our findings revealed that the initial ratings of the problem's subjective difficulty were positively correlated with the solution time and that this correlation decreased in the case of a stronger Aha! experience. Aha! experience ratings were positively correlated with the differences between initial and retrospective difficulty ratings, confidence, solution accuracy, and rebus likability. We interpreted our results to be in line with the processing fluency and metacognitive prediction error accounts.

First-year engineering students’ affective behavior about mathematics in relation to their performance

The present study examines the first-year engineering students’ attitudes towards mathematics, their beliefs and self-efficacy about mathematics, as part of their affective performance, in relation to their mathematical academic performance before and after attending an introductory mathematics course. It aims to contribute on the ongoing discussion about the teaching of mathematics at the level of higher education in engineering programs. First-year engineering students completed a questionnaire and a test after their entrance at the university. Their mathematical performance was examined by using their results at the midterm and the final mathematical mark during AMAT111 course offered at the first semester of their studies. Results indicated that aspects of the affective domain were related with students’ performance, while the predominant role belonged to their previous mathematical knowledge and skills (as learning outcome of the high school education), which undoubtedly need further enhancement. The belief about a formalistic perspective of mathematics and the lack of understanding of the implementation of the mathematical concepts on engineering problem solving situations were obstacles for them on recognizing the importance of attending mathematics courses as part of their engineering studies. Discussion concentrates on the following up steps, which have to be done at the level of higher education in order to face the initial difficulties, which have been identified.

Shadow Theatre as a Performative Art for the Development of Uninhibited Corporal Expression and Group Cohesion in Sixth-Grade Students of Primary Education

Shadow theatre is an educational resource based on the use of silhouettes and the body as a means of communication. It allows the incorporation of music and sound effects that help students discover movement possibilities in the stage space. It also encourages collaborative work through the creation of groups. Therefore, the aim of this research is the incorporation of shadow theatre as a performance art for the promotion of uninhibited corporal expression and group cohesion. An action-research methodology is used to define a didactic proposal that incorporates shadow theatre in the field of music education at primary school. The learning situation is carried out in two public schools in the province of Malaga, with a sample of 213 students. The results indicate that shadow theatre effectively improved pupils’ body expression and group cohesion. Some students had initial difficulties, but thanks to the anonymity provided by this resource, fear of ridicule was reduced. It is proposed to compare this resource with theatre in order to define whether the method of incorporating the shadow is really effective.

THE ALPHABET AND SYLLABLE METHOD AS A TEACHER STRATEGY IN IMPROVING BEGINNING READING IN PHASE A CLASS I STUDENTS AT SEKOLAH DASAR NEGERI KALIPUCANG KULON BATANG

<em>A teacher is someone who plays an important role in education and tries various ways to overcome the difficulties experienced by students. One of the learning difficulties experienced by students, especially phase A, is difficulty in initial reading. If initial reading difficulties can be overcome well, it will be easy for students to take the next stage of reading. This research aims to describe the alphabet method as a teacher's strategy in improving initial reading skills in phase A class I students at the Kalipucang Kulon State Elementary School, to outline the teacher's strategy in improving initial reading skills using the syllabic method for phase A class I students in elementary school. Kalipucang Kulon State, and to explain the factors that influence initial reading difficulties in phase A class I students at Kalipucang Kulon State Elementary School. The type of this research is field research, namely research carried out directly to obtain data with a qualitative approach namely the approach used to gather information from reasonable conditions. Meanwhile, the data sources used are primary data sources and secondary data sources. Meanwhile, the data collection techniques used were observation, interviews and documentation. The data analysis techniques used are data condensation, data display, and conclusion drawing. The results of this research show that: (1) The alphabet method as a teacher's strategy in improving initial reading skills in phase A class I students at Kalipucang Kulon Batang State Elementary School, is considered quite successful in improving initial reading skills, there are changes in the students. (2) The teacher's strategy in improving initial reading skills using the syllabic method for phase A class I students at the Kalipucang Kulon Batang State Elementary School has not yet been achieved optimally, but little by little there has been an improvement in the students' reading skills. (3) The factors that influence initial reading difficulties in phase A class I students at Kalipucang Kulon Batang State Elementary School are caused by four factors, namely </em> <em>physiological factors, intellectual factors, environmental factors and psychological factors.</em>

Validation of a Machine Learning–Based Nuclear Forensics Methodology for the Discrimination of a Chemically Separated Plutonium Sample from Low-Enriched Uranium

When the foundation of a method is simulated data, it is paramount that the method is validated with data from physical samples when possible. This study presents the results of validating a recently developed nuclear forensics methodology with a new low-burnup plutonium sample, chemically separated from low-enriched uranium irradiated in thermal neutron flux. The nuclear forensics methodology uses machine learning models to discriminate the reactor type of origin, fuel burnup, and time since irradiation (TSI) of chemically separated plutonium samples. The machine learning models use intra-elemental isotope ratios of cesium, samarium, europium, and plutonium as features; the isotopic ratio data for training the models were generated through fuel burnup simulations of various nuclear reactor types. The methodology predicted the reactor type and fuel burnup of the plutonium sample successfully. Initial difficulties to predict the TSI were resolved with the inclusion of a new intra-elemental isotope ratio of cerium.

Atrial fibrillation virtual ward - a hospital is not always the best place to be

Abstract Background Atrial fibrillation (AF) continues to represent a global health challenge. Our ability to prolong our lives has inevitably led to an increase in the incidence of AF, with subsequent increase in AF-related hospitalisations. With at least 92% of the global population having access to a digital telecommunication medium, virtual wards could be the way forward for managing acute AF patients. Purpose We implemented a virtual ward for hospital patients presenting with fast AF or atrial flutter (AFL), aiming to provide remote hospital-level care. Methods Patients presenting acutely with AF/AFL to the hospital were onboarded to the virtual ward and managed remotely at home, after being given access to a single-lead ECG device, a blood pressure monitor and pulse oximeter with instructions to record daily ECGs, blood pressure, oxygen saturations and to complete an online AF symptom questionnaire via a smartphone app. Data were uploaded to a digital platform for daily review by the clinical team. Admissions were either "step-up", where patients were onboarded to the virtual ward instead of hospitalisation, or "step-down" where early hospital discharge was facilitated through virtual ward support. Outcomes included hospitalisations avoided, bed-days saved and destination therapy plans (defined as electrical cardioversion, catheter ablation, or AV nodal ablation). Patients' satisfaction was assessed using the NHS Friends and Family test (FFT) and free-text narrative feedback. Results There were 118 virtual admissions between Jan 2022 – Jan 2023. Sixty-six (55%) of them avoided initial hospital admission as patients were directly enrolled to the virtual ward from outpatient settings. A further 61 re-admissions were appropriately prevented during virtual surveillance. Hence, avoiding a total of 127 unplanned hospitalisations, saving a median of 444 days (assuming a median hospital stay of 3.5 days per AF admission). The mean age on onboarding to the virtual ward was 66 ± 10 years. Mean HR at the time of onboarding and offboarding was 124 ± 22 and 84 ± 24 bpm respectively (P<0.0001; 95% CI= -47 to -34). A rhythm control strategy was pursued in 75% (n=88, P<0.0001), and 65% (n=75, P<0.0001) were referred for destination therapy. The FFT questionnaire yielded 100% positive responses among participants. Positive feedback themes focused on avoiding hospital stay and active participation in care plans, whilst the main negative comments addressed initial difficulty with technology and expressed the need for more instant communication. There were 5 unplanned discharges from the virtual ward requiring hospitalisation. Conclusion Our preliminary outcomes demonstrate a promising foundation for a reproducible model of healthcare delivery that provides an alternative to the traditional in-patient care for patients with AF. Thus, reducing the huge associated economic burden on healthcare without compromising on patients’ care or safety.AF virtual ward referral criteriaThe new Clinical Pathway

Initial Reading Difficulties in Second-Grade Elementary School Students

Beginning reading is an ability that students must master in elementary school. In the implementation process, students who still have difficulty in beginning reading are sometimes found. These difficulties become an obstacle in the student's learning process because success in mastering reading skills at the initial reading stage will impact the development of subsequent reading skills. This research aims to analyze the types of initial reading difficulties in students, the factors that influence initial reading difficulties in students, and the efforts made by teachers to overcome initial reading difficulties in second-grade elementary school students. This research uses descriptive qualitative methods. Data collection techniques are done through interviews, observation, tests, and documentation. The study results showed that three second-grade students had difficulty reading initially. In research, it is known that the types of initial reading difficulties in students are: (a) not fluent in reading, (b) many errors in reading, (c) difficulty distinguishing similar letters, (d) inability to understand symbols sounds. Factors that influence students' initial reading difficulties are physiological, intellectual, environmental, and psychological factors. Efforts made by teachers to overcome students' initial reading difficulties are: (a) giving assignments to students, (b) providing additional hours after school, (c) preparing reading learning media such as alphabet letter posters, letter cards, and books that support students' initial reading ability, (d) teaching using the alphabet method.

A cross-sectional survey on sleep disturbances with special reference to sleep quality among COVID-19-recovered patients attending outpatient department of a medical college hospital in Eastern India

Background: The prevalence of sleep problems is approximately 40% among the general and health-care populations. Post-covid-19 sleep disturbances may persist for a long time and are often precursors of psychiatric disorders and expeditors of many systemic diseases. Studies on sleep quality in COVID-19 patients are considerable but in post-COVID-recovered subjects are scanty. There is no study on sleep quality of such patients in Eastern India. Aims and Objectives: We hypothesize that both sleep disturbances and sleep quality may be affected in subjects in their post-COVID state. Therefore, we planned to study the prevalence of sleep disturbances, sleep quality, severity of insomnia, and the relationship of different parameters with respect to sleep quality. Materials and Methods: Two hundred and fifty COVID-19-recovered patients were administered a pre-structured questionnaire including Pittsburgh sleep quality index and insomnia severity index containing various sleep parameters. Results: Majority of the study participants had sleep disturbances in the form of change in sleep pattern (59.6%), poor sleep quality (77.6%), reduced sleep duration (29.6%), daytime sleepiness (20%), difficulty in sleep initiation (29.6%), and subthreshold insomnia (53.6%). Poor sleep quality was strongly associated with reinfection, change in sleep pattern after infection, sleep pattern alteration during pandemic, and those who felt tired during daytime. Conclusion: This study concludes that a significant number of COVID-19-recovered subjects experienced sleep disturbances including poor sleep quality.

72 Lesion Location and Differing Symptom Presentation in Two Arachnoid Cyst Cases

Objective:Arachnoid cysts are fluid-filled sacs thought to be a developmental abnormality which form as a result of splitting or duplication of the arachnoid membrane. In most cases, arachnoid cysts are congenital and asymptomatic throughout an individual’s life. Rarely, arachnoid cysts develop because of head injury, intraventricular hemorrhage of prematurity, presence of a tumor, infection or surgery on the brain. Intracranial cysts are typically incidental brain imaging findings and most commonly located in the middle fossa, the suprasellar region, and the posterior fossa. In cases where the cyst enlarges significantly individuals may experience symptoms of increased intracranial pressure, mass effects, seizures, nausea and vomiting, focal neurological deficits, or hydrocephalus. This presentation compares the differing symptom presentation of two individuals with medically confirmed arachnoid cysts -- one in the middle cranial fossa region (Patient A) and the other in the posterior cranial fossa region (Patient B).Participants and Methods:The 2 patients were referred to a private practice neuropsychological clinic for neuropsychological assessment. Patient A was a 39-year-old, right-handed, married Syrian male with 12 years if education, unemployed at the time of testing. Changes in cognition, behavior and personality were reported for Patient A approximately two years after a known cerebrovascular accident. Patient B was a 48-year-old, left-handed married Caucasian male with 16 years of education, on disability due to his medical condition. Patient B reported severe memory impairment, speech and language deficits, variable attention, executive dysfunction, impaired gait with falls, emotional dysregulation, and sleep difficulties. He was diagnosed with bipolar disorder and alcohol use disorder in remission for 9 years.Results:Neuropsychological testing results for Patient A were not valid, due to initiation difficulties, paranoia about the testing and consequent limited engagement in the process. Predominant symptoms were consistent with negative symptoms of schizophrenia, (i.e., avolition, abulia, and diminished emotional expression); no positive symptoms were observed or reported. His speech was limited -he lacked spontaneous speech and only responded to direct questions. His informant completed a measure assessing pre/post changes in frontal systems and there were significant increases in apathy and executive dysfunction reported. Neuropsychological results collected from Patient B revealed mild to severe impairment of aspects of executive functioning, memory, processing speed, visual attention, expressive language, and manual dexterity bilaterally and manual motor strength - more consistent with subcortical neurological disease. Self-report and informant data revealed significant difficulties with functional abilities, pre/post changes in frontal systems (apathy, disinhibition, and executive dysfunction), sleep efficiency and daytime fatigue, and psychological distress (anxiety and depressive symptoms).Conclusions:The presenting case analysis illustrates the importance of neuropsychology in identifying and tracking the nature of symptoms associated with neuroimaging confirmed arachnoid cysts. This case analysis is unique as it highlights the complexities of differing symptom phenotypes of the same condition due to location of the cyst. Surgical intervention usually through draining the cyst directly or implantation of a shunt is typically recommended for symptomatic patients and that course of treatment was suggested to both patients. Treatment recommendations geared to target psychosocial and functional difficulties should also be considered.

How does apathy impact exploration-exploitation decision-making in older patients with neurocognitive disorders?

Apathy is a pervasive clinical syndrome in neurocognitive disorders, characterized by a quantitative reduction in goal-directed behaviors. The brain structures involved in the physiopathology of apathy have also been connected to the brain structures involved in probabilistic reward learning in the exploration-exploitation dilemma. This dilemma in question involves the challenge of selecting between a familiar option with a more predictable outcome, and another option whose outcome is uncertain and may yield potentially greater rewards compared to the known option. The aim of this study was to combine experimental procedures and computational modeling to examine whether, in older adults with mild neurocognitive disorders, apathy affects performance in the exploration-exploitation dilemma. Through using a four-armed bandit reinforcement-learning task, we showed that apathetic older adults explored more and performed worse than non-apathetic subjects. Moreover, the mental flexibility assessed by the Trail-making test-B was negatively associated with the percentage of exploration. These results suggest that apathy is characterized by an increased explorative behavior and inefficient decision-making, possibly due to weak mental flexibility to switch toward the exploitation of the more rewarding options. Apathetic participants also took longer to make a choice and failed more often to respond in the allotted time, which could reflect the difficulties in action initiation and selection. In conclusion, the present results suggest that apathy in participants with neurocognitive disorders is associated with specific disturbances in the exploration-exploitation trade-off and sheds light on the disturbances in reward processing in patients with apathy.

Parental Adherence to Cranial Remolding Orthotic Treatment of Infants with Positional Cranial Deformities: A Qualitative Content Analysis.

This qualitative study was designed to investigate parental adherence to cranial remolding orthotic (CRO) treatment of infants with positional cranial deformities. A qualitative content analysis was employed in this study. Researchers sought to find parental behavior while using a CRO for their infant with cranial deformity. Through in-depth and in-person interviews, researchers collected data from 22 participants using semi-structured questions regarding adherence to CRO treatment. Data were examined for patterns until saturation occurred, yielding categories that focused on the parents' main barriers and facilitators. Two general themes of "potential barriers to CRO treatment adherence" and "potential facilitators to CRO treatment adherence" were extracted from 12 subthemes of parental burden, transportation, availability of CRO services in hometown, financial responsibility, maternal/paternal attachment attitudes, CRO-related problems, others feedback, adjustment to the treatment, motivation and self-confidence, aesthetic satisfaction, communication with orthotist, and wife's empathy/spousal support. Getting time off work, transportation to the orthotics' clinic, the lack of medical insurance coverage for CRO, reduced physical contact between parents and their child, and getting negative feedback from others were the most reported challenges. However, overcoming the initial difficulties and adjustment to the treatment with CRO, the high motivation of parents during therapy, an orthosis with good fitting and minor complications, a strong relationship between the parents and orthotist, and the father's companionship were revealed to facilitate the treatment process and increase adherence of treatment with CRO.

Developing Teaching Material “Jurus Kilat! 6 Minggu Mahir Membaca Tanpa Eja” To Solve Initial Reading Difficulties in Primary School

Developing Teaching Material “Jurus Kilat! 6 Minggu Mahir Membaca Tanpa Eja” To Solve Initial Reading Difficulties in Primary School

Structural optical design of multi-group, high zoom ratio optical systems

In this paper, we propose a method for the structural optical design of multi-group, high zoom ratio optical systems based on matrix optics and Particle Swarm Optimization (PSO) algorithm. This method effectively addresses the problems of initial structural calculation difficulties, large volume, and unsmooth zoom curves with large inflection points in high zoom ratio optical systems. To design the zoom optical system, the matrix equations of the multi-group zoom system are derived using geometric optics; and a mathematical model is built to solve the initial structural parameters of the zoom system based on the matrix. Then, a new fitness function is introduced as an indicator to iteratively optimize the initial structural parameters of the system in multi-dimensional space, considering factors such as maximum zoom ratio, total optical length, and full field of view angle. Finally, this method is validated in two complex optical system designs including a 20x four-group and a 35x five-group zoom optical system, showing strong retrieval capabilities. Independent of traditional trial-and-error investigations for solutions, our method facilitates the automatic intelligent design of complex optical systems.