Middle Level Research Articles

In vitro evaluation of filling material removal and apical debris extrusion after retreatment using Reciproc blue, Hyflex EDM and ProTaper retreatment files

ObjectivesTo evaluate the amount of remaining filing material and apical debris extrusion after retreatment using Reciproc Blue, Hyflex EDM and ProTaper Retreatment Files.Materials and methodsThirty-six extracted permanent mandibular first molars with moderately curved mesial roots were selected. Mesiobuccal canals were prepared using the ProTaper Next system up to size X2 and filled using gutta-percha and Adseal sealer via cold lateral compaction. Teeth were randomly divided into three equal groups (n = 12): Group 1: Reciproc Blue (RB)(VDW, Germany), Group 2: Hyflex EDM (HEDM)(Coltene/Whaledent, Switzerland), Group 3: ProTaper Universal Retreatment file system + ProTaper Next file system (PTUR + PTN)( Dentsply Maillefer, Switzerland). Eppendorf tubes were used to collect the apically extruded debris. Cone-beam computed tomographic scans were taken prior to and after retreatment and the volume of remaining filling material was assessed at the coronal, middle and apical levels. Statistical analysis was performed using the Kruskal–Wallis test, Friedman's test and Wilcoxon Sign Rank test. Significance level was set at p value 0.05.ResultsThere were no statistically significant differences among the three groups in the reduction of the volume of the filling material or in the amount of apically extruded debris.ConclusionAll the tested filing systems showed similar efficacy in removing the filling material, however, none of them could achieve its complete removal. Apical extrusion of debris occurred with all the systems used with no significant difference between the three groups.

Middle-power behaviours: Australia’s status-quoist/Lockean and Indonesia’s reformist/Kantian approaches to crises of legitimacy in the Indo-Pacific

ABSTRACT This article maps the behaviours of two middle powers, Australia and Indonesia, as a response to the emergence and evolution of the Indo-Pacific concept. The background for this analysis is the emergence and development of the ‘Indo-Pacific’ concept as a response to crises of legitimacy enveloping the region and how countries in the region, including middle powers, respond to it. Using a minimalist definition which I have developed of a middle power as a country with a middle level of power capabilities and a penchant for cooperation, this article develops a framework based on two dimensions of outcome (ranging from status-quoist to reformist outlooks) and process (ranging from Lockean to Kantian strategies) to facilitate a more open-ended approach towards looking at middle-power behaviours beyond the common categorisation of traditional/emerging, and Western/non-Western. Using Australia’s 2017 Foreign Policy White Paper and 2023 National Defence: Defence Strategic Review, and Indonesia’s 2015 Defence White Paper and 2019 ASEAN Outlook on the Indo-Pacific, this article concludes that while Australia is exhibiting a status-quoist/Lockean approach, Indonesia is demonstrating a reformist/Kantian approach towards the Indo-Pacific. The outcome-process dimension framework developed in this article is useful as a tool to map other middle power behaviours in various contexts.

Job satisfaction in Europe: a gender analysis

PurposeThe main aim of this study was to examine gender differences in job satisfaction in Europe.Design/methodology/approachFor the empirical analysis, data from the Sixth European Working Conditions Survey were used. Oaxaca–Blinder decomposition with a principal component analysis (PCA) aggregated variable, after unconditional quantile regressions in a multiple imputation background, was implemented.FindingsWomen report higher job satisfaction than men do. Women were significantly more satisfied than men for the middle levels of the job satisfaction distribution.Originality/valueThis study expands the evidence on the determinants of job satisfaction in the European labour market by applying a recent form of decomposition that invests in unconditional quantile regression (UQR). To the best of this study knowledge, this is the first time that the Oaxaca–Blinder decomposition with a PCA aggregated variable after unconditional quantile regression has been employed to study gender-based differences in job satisfaction.

Implementation Strategy for Improving Policy Quality at SMP Negeri 1 Sumenep

This research aims to describe the strategies for implementing quality improvement policies, obstacles to implementing quality improvement policies, and solutions to overcome obstacles to implementing quality improvement policies at SMP Negeri 1 Sumenep. This type of research is descriptive using a descriptive qualitative approach. This research was carried out at SMP Negeri 1 Sumenep, from 19 February 2021 to 16 April 2021. The research subjects were the principal, deputy principal and teachers. Data collection was carried out by observation, interviews and documentation. Data were analyzed using the Miles and Hubberman interactive analysis model, namely data collection, data reduction, data presentation, and drawing conclusions. Meanwhile, the validity of the data was tested by triangulation of techniques and sources. The research results show the following. The strategy for implementing quality improvement policies at SMP Negeri 1 Sumenep has been running in accordance with the objectives of its establishment. This can be seen from several indicators, including standards and policy objectives that have been achieved, supporting resources, communication between school principals and teachers, employees and students running smoothly, interorganizational and inauguration activities running well, the characteristics of implementing agents support, as well as conducive social, economic and political conditions and support strategies for implementing quality improvement policies. Obstacles that arise in the implementation of quality improvement policies are: students' low understanding of the importance of education, the number of teaching staff is inadequate, learning infrastructure is inadequate, and the economic situation of students' parents is at a lower middle economic level. Solutions to overcome obstacles in implementing quality improvement policies are: providing an approach so that students want to continue their education to the next level, looking for substitute teachers according to subjects, providing infrastructure through BOS funds, providing the Smart Indonesia Program (PIP) for students who cannot afford it.

Adolescents’ ethnic hate speech exposure and ethnic bullying perpetration: The moderating role of tolerance towards diversity and gender

Information and Communication Technologies have become powerful tools for adolescents, but they have enabled a huge number of online risks, such as being exposed to Online Hate Speech (OHS). High exposure to hateful content has been linked to despicable offline actions, including hate crimes. However, there is a lack of studies considering the associations with certain specific forms, such as the perpetration of bullying. The purpose of this study was to fill this gap in the literature by analysing the associations between exposure to OHS targeting ethnic minorities and ethnic bullying perpetration, and considering the potential moderating role of tolerance towards diversity and of gender. Participants were 960 high school students (53.6% females; Mage = 15 years, SD = 0.59). Data were collected in January/February 2020, before the first lockdown due to the Covid-19 pandemic. Findings suggest that being exposed to ethnic OHS is significantly, but weakly, associated with traditional ethnic bullying perpetration. Moreover, this association is moderated by tolerance towards diversity and by gender. In particular, for male adolescents, at low and middle levels of tolerance, higher ethnic OHS exposure is not associated with a higher tendency to perpetrate bullying toward peers with a different ethnicity. For females, instead, tolerance is not a moderator in the relationship between ethnic OHS exposure and ethnic bullying perpetration. Results are discussed in terms of their practical implications.

Human Development Index Forecasting with Moving Average, Simple Exponential Smoothing and Naïve Method

The purpose of this research is to forecast the Human Development Index (HDI) using the moving average (MA) method, the simple exponential smoothing method and the naïve method. The region forecasted for its HDI is North Lombok Regency, for which it has the lowest HDI in West Nusa Tenggara, Indonesia. The data used for this research is the HDI from 2010 to 2022. The selection of these methods is due to the limited amount of data and the popularity of MA, SES, and Naïve method in the world of forecasting until this day. The results of this research is the MA method which consists of MA MA3, SMA MA5, WMA MA3, WMA MA5, EMA MA3, EMA MA5, and SES tested value α=0.1 and α=0.9 and Naïve method have a high degree of accuracy that can be seen in the Mean Absolute Percentage Error (MAPE) value which is below 10%. However, the chosen method is the best method with the smallest MAPE which is Naïve method with MAPE 1.32% where MAPE is below 10% indicating that the model used is Highly accurate and the result of North Lombok Regency HDI in 2023 is 65.7 which means that the HDI in North Lombok Regency has not changed. HDI in North Lombok Regency stay on middle level

유아교사의 놀이민감성과 전문성이 교사-유아 상호작용에 미치는 영향

Objectives This study aims to analyze the influences of teachers' play sensitivity, professionalism of early child-hood teachers on the interactions between teachers and children by reviewing general trends about them, and finding out their relations. Methods This survey research was conducted on early childhood teachers in Gyeongnam, and data was collected from December 10, 2022 to December 31, 2022, and 321 questionnaires were collected. Statistical analysis was conducted using SPSS 27.0 program, and descriptive statistical analysis, t-test, one-way ANOVA, Pearson's cor-relation analysis, and hierarchical regression analysis were used. Results Play sensitivity and professionalism, interactions between teachers and children of early childhood teach-ers were generally higher than the middle levels and they had statistically significant differences depending on general characteristics including age, education, institutional type, career and age of children in the classes in charge. All play sensitivity, professionalism, and teacher-child interactions had significantly positive correlations. The factors that significantly influenced teacher-child interactions were the play support and play observation for play sensitivity, and the communication ability, professional improvement ability, and childcare protection ability for professionalism. Conclusions In order to make higher quality interactions between teachers and children, it is necessary to prepare systematic education and programs to develop early childhood teachers’ play sensitivity, professionalism.

Lean Management and Organizational Performance in Selected Manufacturing Firms in Akwa Ibom State

The study centered on Lean management and Organizational performance in selected manufacturing firms in Akwa Ibom State. Two research questions as well as two hypotheses were formulated for the study. The researcher adopted survey research design. The population covers 59 top management level, middle management level and lower management level staff in selected manufacturing firms in Akwa Ibom state. Census Techniques was used to collect data for the entire population. Using Ordinal Logistic Regression Tool Analysis, the two hypotheses were tested at 0.05 level of significance and the results of the analysis showed that Lean Management dimension (Value stream mapping is 3.246, PV = 0.002., and waste elimination is 3.024, PV = 0.003,) has a significance relationship on Organizational Performance in manufacturing firms in Akwa Ibom State. From the study conducted, it was concluded that value stream mapping, waste elimination, are relational dimensions that can influence organizational performance in selected manufacturing firms in Akwa Ibom State. It was recommended that, management of the studied organization should strengthen their policies that will support manufacturing and operations by identifying the value from the customer's perspective, map out the value stream, which is the end-to-end flow of activities required to deliver the product or service analyze the value stream to identify and eliminate waste, such as overproduction, waiting time, unnecessary motion, defects, and excess inventory. It is also recommended that the manufacturing firms should incorporate waste eliminating in its operations process such as value stream mapping, total product maintenance and continues improvement in order to increase overall cost efficiency.

Moisture sources and isotopic composition of the 2020 extraordinary and persistent Meiyu rainfall in the Yangtze River valley modulated by large-scale circulations

Meiyu rainfall is an important climate phenomenon in East Asia, but its interannual variability has amplified in recent decades. To gain a better understanding of the underlying atmospheric processes of torrential Meiyu rainfall, we investigated the moisture sources and isotopic composition of the 2020 extraordinary and persistent Meiyu rainfall in the Yangtze River valley from June 19 to July 10 using an isotopic regional spectral model. During the Meiyu period, significant amounts of Indian Ocean moisture were transported to Yangtze River valley by Indian monsoonal southwesterlies, especially in the middle levels between 850 hPa and 600 hPa. Whereas moderate amounts of East Asian continent moisture were distributed principally within the boundary layer below 850 hPa. Besides, tiny amounts of South China Sea moisture were transported by the western Pacific subtropical high to the middle and lower reaches of Yangtze River valley within the boundary layer below 900 hPa. With respect to isotopic characteristics, the lowest δ2H and the highest d-excess values of the Indian Ocean moisture were attributable to more rainout and below-cloud evaporation during long-distance transport. In contrast, the isotopic signals of the East Asian continent moisture and the South China Sea moisture were relatively preserved. The 2020 Meiyu rainfall exhibited significant intraseasonal variability and was classified into heavy and light Meiyu periods based on rainfall amount. Heavy Meiyu rainfall with northward migration were characterized by enhanced Indian Ocean moisture with lower δ2H and higher d-excess, resulting from the westward expansion of the western Pacific subtropical high and the deepened East Asian mid-latitude trough.

Pengaruh Ketidakpastian Lingkungan dan Sistem Informasi Akuntansi Manajemen terhadap Kinerja Manajerial

The purpose of this study is to investigate and offer empirical data on the relationship between management accounting information systems and environmental uncertainty in relation to managerial performance. In this study, questionnaires were filled out as part of the survey method of data collecting. 50 middle and low level managers from banks and non-bank financial firms in Metro City and East Lampung made up the study's population. Purposive sampling was utilized during sampling. Structural Equation Model (SEM) with the Partial Least Square (PLS) application program version 4.0.m is the analysis method employed. The study's findings demonstrate that (1) there is no relationship between environmental uncertainty and managerial performance, contradicting the hypothesis. (2) The qualities of information integration significantly improve managerial effectiveness. Meanwhile, managerial performance is unaffected by the information qualities of broad scope, timeliness, and aggregation.

Morphological structure of the right ventricular outflow tract (RVOT) muscle including anatomical variations - clinical implications for electrocardiological procedures using autopsy material

Abstract Background/Introduction The therapeutic effect of the electrocardiological procedure results not only from the correct supply of rhythm or conduction disturbances, but also from the avoidance of complications. The optimisation of the procedure is furthermore related to the efficient reaching of the target site and avoiding blockage of the used equipment by myocardial bridges or trabeculations. Purpose The purpose of our study was to evaluate in detail the right ventricular outflow tract (RVOT) muscle and to determine the types and extent of variation in this area. Methods We analysed 220 hearts (82 female, 37.2%) obtained during forensic medicine section from adult donors without structural heart disease. Collected hearts were fixed in 10% formaldehyde solution. The RVOT was opened by dissecting the muscle along its right periphery. The researchers assessed the presence and position of myocardial bridges, myocardial recesses and trabeculations. In addition, wall thickness and the presence of epicardial fat were assessed at 3 levels along the long axis of the RVOT at 4 points at each level. Linear dimensions were recorded using a precision electronic calliper by 2 different investigators. Statistical analyses were performed using STATISTICA 13.1. Results The presence of myocardial trabeculations covering the entire RVOT free wall was found in 72 hearts (35.5%), with 12 (5.90%) having a completely smooth wall. In the remaining 119 (58.6%), myocardial trabeculations covering the free wall partially were found. In the transition of the free wall to the posterior wall, trabeculations were found on the right and left periphery in 44 (21.6%) and 72 (35.6%) cases, respectively. At the same time, trabeculations were found in the middle part of the posterior wall in only 2 cases (1%). The RVOT recesses were found in 190 cases (92.2%), their number ranging from 1 and 6, with 3 being the most frequently found (26.7%). They were most frequently described on the left and right periphery (in 62.4%, 59.9% of hearts, respectively). Muscle bridges, running through the RVOT lumen, were localised within the left periphery in 109 cases (40.1%). RVOT muscle thickness ranged from 10.5 mm [5.24 mm] (median [IQR]) on the posterior wall, in the middle level, to 4.00 mm [1.36 mm] (mean [SD]), proximally, on the left periphery of the RVOT. The occurrence of epicardial adipose tissue ranged from 196 (96.1%) on the right periphery, in the middle part of the RVOT, to 102 [54.5%] proximally, on the anterior periphery. Conclusions The presence of myocardial bridges and RVOT recesses, while varying in their location and size, are factors that make full access difficult. The small thickness of the RVOT free wall in different regions suggests to consider wall perforation as a probable complication of the procedure, and the concomitant epicardial adipose tissue may be a factor explaining the subacute course of complications, including cardiac tamponade.

Evaluation and Prediction of Environmental Capacities of Heavy Metals in the Surface Sediments of Lakes in Huoqiu County

To clarify the environmental capacity of heavy metals in sediments of Chengxi Lake and Chengdong Lake in Huoqiu County, 30 sediment samples were collected from Chengxi Lake and Chengdong Lake, respectively. The environmental capacity characteristics and spatial distribution of heavy metals in sediments of Chengxi Lake and Chengdong Lake were studied using the comprehensive environmental capacity index, the static and dynamic environmental capacity was estimated, and the change trend of nearly one hundred years was predicted. The results showed that the average contents of As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn in the sediments of Chengxi Lake and Chengdong Lake did not exceed the national soil risk screening values. The average values of the single environmental capacity index of heavy metals in the sediments of Chengxi Lake and Chengdong Lake were in the following orders:Ni(0.81)<Zn(0.83)<Cu(0.88)<Cr(0.91)<As(0.95)<Cd(0.98)=Pb(0.98)<Hg(1.00) and Ni(0.89)<Zn(0.91)<Cu(0.96)<Cr(0.98)=As(0.98)<Hg(1.01)=Pb(1.01)<Cd(1.17), respectively. Except for Hg, Pb, and Cd in the sediments of Chengdong Lake, the other elements were basically in the medium capacity. The mean of PI of Chengdong Lake was significantly higher than that of Chengxi Lake, and Chengxi Lake and Chengdong Lake were in the middle capacity level as a whole. The static total capacity of heavy metal elements in the sediments of Chengxi Lake was smaller than that of Chengdong Lake sediments, and the static total capacity was in the same order as the existing capacity, with the order of Zn>Cr>Pb>Cu>Ni>As>Hg>Cd. Within 5 to 20 years, the static and dynamic annual capacity changed faster than that of other years, and the dynamic annual capacity of each year was greater than the static annual capacity.

Cone beam computed tomography evaluation of c-shaped canal morphology in mandibular premolar teeth.

The aim of this study was to evaluate the prevalence and the morphology of c-shaped root canal(s) in mandibular premolars using cone beam computed tomography (CBCT) images. CBCT images of 1095 mandibular premolars were examined at coronal, middle, and apical levels of the root canals. The type, the level, and the position (buccal or lingual) of the c-shaped anatomy were recorded. Absolute counts and percentages of different groups and subgroups of C-shape morphologies were calculated. The Chi-square test was used to compare the prevalence of C-shaped morphology between mandibular first and second premolars. The Z-test for proportions in independent groups was used to analyze the differences in mandibular C-shaped premolar proportions between location (left and right side) and tooth (first or second premolars) (p=0.05). C-shaped root canal morphology was present in 44 teeth. The percentage of c-shaped morphologies was 6.9% and 1.6% in mandibular first and second premolars, respectively. Comparison of the first and the second premolars showed that C1 type (p=0.008) and C4b type (p=0.013) configurations are more common in the first premolars at the coronal level. In contrast, the C2 type configuration showed significantly higher prevalence in the second premolars (p=0.009). Additionally, the C4c type configuration was significantly frequent on the right premolars at the coronal level (p=0.038). C-shape canal morphology is a rare but complex anatomic feature in mandibular premolars. Therefore, clinicians should be aware of this complex root canal anatomy for the success of endodontic treatment in mandibular premolar teeth.

Variations in Summer Surface Air Temperature Over the Eastern Tibetan Plateau: Connection With Barents‐Kara Spring Sea Ice and Summer Arctic Oscillation

AbstractVariations in surface air temperature on the eastern Tibetan Plateau (TP‐SAT) during boreal summer, related to Barents‐Kara spring sea ice and summer Arctic Oscillation (AO), are investigated using observations and ERA‐5 reanalysis data during 1979–2018. Results show that the primary mode of summer eastern TP‐SAT (SAT_EOF1) is characterized by the consistent warming pattern with larger values over the northeastern TP, which is linked with the anticyclonic circulation located in the northeastern flank of the TP. This anticyclone enhances westward water vapor transport, warm temperature advection, and causes descending over the eastern TP, Descending further results in deceased middle level cloud cover and increased solar radiation, accordingly, favoring the eastern TP warming. Further statistical analysis reveals a robust connection between Barents‐Kara spring sea ice, summer AO and SAT_EOF1. Moreover, anticyclonic anomaly located in the northeastern region of the TP acts as an important driver of this consistent warming pattern over the eastern TP, which is modulated by two individual Rossby wave trains from the northwestern Russia and northwestern Atlantic. The spring sea ice in Barents‐Kara could cause decreased precipitation and reduced soil moisture in northwestern Russia during following summer, which further induces the Eurasian‐like teleconnection and affects the anticyclonic anomaly situated in the northeastern flank of the TP, thereby favoring eastern TP warming. In addition, from northwestern Atlantic to northeastern region of the TP, the Rossby wave train is mainly affected by summer AO, with positive AO causing anticyclonic anomaly over northeast of the TP, thus contributing to the TP warming.

Middle Level Mathematics Teachers’ Problems on Linear Relationships in a Semi-Structured Problem Posing Situation

This study examines in-service mathematics teachers’ problems on linear relationships that they posed in a semi-structured problem posing situation with a group and their ideas about the factors affecting the quality of the posed problems. Eight groups of 24 teachers participated in the study. Teachers' problems, written group work, and class discussion all served as sources of data for this study. The data was mainly analyzed through qualitative methods. The results demonstrate that seven groups’ problems were invalid because the problems did not meet the given conditions in the problem posing task. Their problems mostly lacked key mathematical concepts related to linear graphs, such as linearity, slopes, and y-intercepts. In class discussion, teachers dealt with the following factors that affect the quality of posed problems: misunderstanding of the problem posing situation, making inappropriate mathematical decisions, and using improper mathematical language. This study revealed that more content-focused practices are necessary to support teachers’ problem posing skills.

Association between the peripheral neutrophil-to-lymphocyte ratio and metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes frequently co-occur, imposing a tremendous medical burden. A convenient and effective MASLD indicator will be beneficial to the early diagnosis of disease. In the clinical laboratory, the neutrophil-to-lymphocyte ratio (NLR) is a readily accessible hematological marker. This study designed to determine the relation between the NLR and MASLD in type 2 diabetes patients. Data from 1,151 type 2 diabetes inpatients without infections, malignancy or hematological diseases who were recruited from 2016 through 2022 were analyzed in the retrospective study. The patients were stratified into NLR tertiles (total population: high NLR level > 2.18; middle NLR level: 1.58-2.18; low NLR level < 1.58), with additional subgroup stratification by sex (men: high NLR level > 2.21; middle NLR level: 1.60-2.21; and low NLR level < 1.60; women: high NLR level > 2.12; middle NLR level: 1.53-2.12; and low NLR level < 1.53). After adjusting for confounders (age, sex, weight, Glu, ALT and TG) associated with MASLD, the odds ratio (OR) and the corresponding 95% confidence interval (CI) of the NLR were obtained by using a binary logistic regression analysis to verify the correlation between the NLR and MASLD. Compared to non-MASLD patients, MASLD patients had higher weight, blood glucose, insulin and C-peptide, worse liver function (higher ALT and GGT), lower HDL (all p < 0.05), and lower NLR (p < 0.001). The prevalence of MASLD was 43.75% (high NLR level), 55.21% (middle NLR level) and 52.22% (low NLR level) (p < 0.05). Compared to those of the high NLR level, the adjusted ORs and 95% CIs of the middle and low NLR levels were 1.624 (95% CI: 1.141-2.311) and 1.456 (95% CI: 1.025-2.068), for all subjects, while they were 1.640 (95% CI: 1.000-2.689) and 1.685 (95% CI: 1.026-2.766), for men. A low NLR is associated with a greater risk of MASLD.

Changes in the Place of Death of Patients With Cancer After the Introduction of Insurance-Covered, Home-Based Hospice Care in Korea

Although hospice care has been covered by health insurance for the purpose of improving the quality of life of patients with terminal cancer as well as their caregivers, few studies have evaluated the outcomes of the policy to cover home-based hospice care services. To investigate the changes in the place of death of patients with cancer after the introduction of insurance-covered, home-based hospice care services in Korea. This cohort study used data from February 1, 2018, to December 31, 2021, from the Causes of Death Statistics database, released annually by Statistics Korea, which contains information on all deaths in the country. Individuals who died of cancer, a representative hospice-eligible disease, were assigned to the case group, and those who died of dementia, a non-hospice-eligible disease, were assigned to the control group. A total of 218 522 individuals constituted the study population. Because the Korean Health Insurance Service had begun covering home-based hospice care services on September 1, 2020, and the last follow-up date was December 31, 2021, the follow-up periods for before and after intervention were 31 months and 16 months, respectively (preintervention period: February 1, 2018, to August 31, 2020; postintervention period: September 1, 2020 to December 31, 2021). The place of death was categorized as a binary variable according to whether it was the person's own home or not. Comparative interrupted time-series models with segmented regression were applied to analyze the time trend and its change in outcomes. Of the 218 522 deaths eligible for the analysis (mean [SD] age at death, 78.6 [8.8] years; 130 435 men [59.7%]), 207 459 were due to cancer, and 11 063 were due to dementia. Immediately after the introduction of home-based hospice care, the rate of home deaths was 24.5% higher for patients with cancer than for those with dementia (estimate, 1.245 [95% CI, 1.030-1.504]; P = .02). The difference in the level change between cancer deaths and dementia deaths, on intervention, was more pronounced for those living in rural areas (estimate, 1.320 [95% CI, 1.118-1.558]; P = .001). In addition, a higher educational level was associated with a larger difference in the immediate effect size due to home-based hospice care (low educational level: estimate, 1.205 [95% CI, 1.025-1.416]; P = .02; middle educational level: estimate, 1.307 [95% CI, 0.987-1.730], P = .06; high educational level: estimate, 1.716 [95% CI, 0.932-3.159]; P = .08). In this cohort study exploring the changes in the place of death for patients with cancer after the insurance mandates for home-based hospice care in Korea, the probability of patients with cancer dying in their own homes increased after the intervention. This finding suggests the need to broaden the extent of home-based hospice care to honor the autonomy of individuals with terminal illness and improve their quality of death.

Microplastic distribution and ecological risk in water and sediments of marine ranching area in Haizhou Bay

The widespread existence of microplastics (MPs) in marine environment and organisms is always an undeniable fact, and more attention should be paid to its ecological risk. In this study, four areas (natural area (NA), comprehensive effective area (CEA), artificial area reef (AR), and aquaculture area (AA)) in the marine ranching area of Haizhou Bay (Lianyungang City, Jiangsu Province) were selected as a case study to quantitatively analyze the distribution and potential ecological risks of MPs in the surface water and sediment. The mean abundance of MPs in the surface water and sediment was 5.05 ± 1.05 n/m3 and 0.47 ± 0.18 n/g, respectively. MPs were mostly < 5 mm (>98%), fibrous (water: 74%; sediment: 64%), blue (water: 41%; sediment: 47%), and polyethylene terephthalate (PET) (water: 42%; sediment: 52%). CEA had the highest MP abundance (P < 0.05) and MPs in CEA significantly correlated with other areas (P < 0.05). Under the effect of currents or tides, we judge that MPs in AA and AR will accumulate in CEA from the surface water and sediment, and their transfer process will be blocked in sediments of AR. According to the hazard score (H score) and pollution loading index (PLI), the MPs in this region have middle and upper levels of ecological risk. We believe that the ecological risks of MPs should be closely monitored, and some assessment indicators should be added to help control and mitigate MP pollution.

Stakeholder Involvement and Strategy Implementation among County Governments in Kenya: A Case Study of Narok County Government, Kenya

In today’s global environment, management is constantly looking for initiatives in creating and sustaining a stakeholder involvement within the organizations to motivate them in strategy implementation. However, stakeholders have continued to complain about how management of different organizations has compromised strategy implementation. The aim of this study therefore, was to ascertain the effects of stakeholder involvement on strategy implementation in Narok County Government in Kenya. The specific objectives were: to determine the effect of stakeholder procedure compliance the effect of stakeholder communication stakeholders’ involvement and stakeholder support on strategy implementation at Narok County Government. The research employed descriptive research design. The target population comprised 58 top level managers, 46 middle level managers; 30 lower-level managers and 300 community project representatives. The study adopted proportionate stratified random sampling technique to select a sample of 87 respondents from the target population. The research utilized primary data collection methods via the utilization of questionnaires including both open-ended and closed-ended questions. The instruments' validity was established via the assessment of face and content validity, while reliability was evaluated utilizing Cronbach's Alpha. A value of 0.7 or above was deemed adequate for reliability. The analysis of the data included the use of both descriptive and inferential statistical methods, facilitated by the SPSS. The data that was evaluated was provided in tables and figures. The researchers used a multiple regression model in order to investigate the correlation between stakeholder participation and the execution of strategic initiatives. The study's findings indicated a statistically significant positive correlation between the independent factors and the dependent variables under investigation. Hence, it is recommended that the county government actively solicit perspectives and opinions from various stakeholders throughout the process of plan implementation, while also facilitating their active involvement in such implementation. This research provides valuable insights for directors, managers, policy makers, and academics seeking to comprehend the impact of stakeholder participation on the accomplishment of strategic initiatives.

Discipline of Middle and High School Level Children during Evening Study Hours

Education is an effort to prepare the necessary human resources that can be realized, and cannot be separated from human life, because it is absolute both in the life of individuals, families, communities and in the life of the nation and state. Education is a process of humanizing humans from the time they happened until the end of their lives through various knowledge which is conveyed in the form of teaching in stages, where the teaching process becomes the responsibility of parents and society towards approaching oneself to God so as to become a perfect human being. The purpose of this study was to find out: 1. To find out the Discipline attitude of Middle and High School Level Children at Night Study Hours in Walnewen Hamlet, Waspait Village, Fena Leisela District, Buru Regency. 2. To find out how Children Discipline During Night Study Hours in Walnewen Hamlet, Waspait Village, District Fena Leisela, Buru Regency. 3. To find out the driving and inhibiting factors that are experienced in the Discipline of Middle and High School Level Children during Night Study Hours in Walnewen Hamlet. Type of research. This study uses a qualitative descriptive method, namely to reveal the Discipline of Middle and High School Level Children at Night Study Hours in Walnewen Hamlet, Waspait Village, Fena Leisela District, Buru Regency and the approach used in this research is a qualitative approach to find out or describe the reality of the problems researched. The data analysis technique used in this study is to use the steps as stated, namely as data collection is an integral part of data analysis activities. Data collection activities in this study were conducted using interviews and documentation studies. Research Results Based on observational data, interviews and documentation carried out in this study were to collect information related to the Discipline of Middle and High School Level Children in Evening Study Hours. Walnewen Hamlet, Waspait Village, Fena Leisela District, Buru Regency, will discuss the findings of the following researchers.