Level Of Participation Research Articles

중등학교 기악 교육의 내용과 방법, 평가에 관한 실태 분석

This study aims to analyze the current state, perceptions, and demands related to instrumental education in secondary school music classes, which has been receiving increasing emphasis in recent years, in order to identify issues and discuss possible solutions. To achieve this, various literature on the content, methods, and assessment of instrumental education was reviewed. Based on this review, a survey tool was developed to examine the actual state and demands of instrumental education, and a survey was conducted among secondary school music teachers across the nation. Statistical analysis was performed on the responses from 63 participants. The analysis revealed that secondary school music teachers strongly recognized the necessity of instrumental education. As a result, it was found that the majority of class time in music lessons is devoted to instrumental education. Most teachers also perceived a high level of student participation in instrumental lessons and held a very positive view of instrumental education. However, instrumental education was mainly limited to solo instrument instruction, focusing on posture, techniques, and basic performance skills, while instrumental ensemble activities were not well implemented, despite teachers’ high awareness of their importance. The predominant teaching method involved teachers directly demonstrating through performance and using modeling as an instructional approach. However, teachers felt that their own performance skills were inadequate. In terms of assessment, it was found that the evaluation of artistic and creative expression was not being adequately conducted.

Transformational Leadership and Team Synergy in Improving Communication and Collaboration in Educational Settings

This study explores the impact of transformational leadership on team synergy, communication, and collaboration in educational environments. The purpose of the research is to examine how transformational leadership enhances team dynamics by fostering trust, communication, and participatory decision-making among teachers and staff. Utilizing a qualitative phenomenological methodology, in-depth interviews were conducted with school leaders, teachers, and administrative staff, complemented by participatory observation and document analysis. The results reveal that transformational leadership significantly improves collaboration by encouraging open communication and empowering team members to take initiative. Teachers reported feeling more motivated to innovate in their teaching methods and engage in interdisciplinary collaboration. However, challenges such as staff resistance and limited resources hindered the full adoption of collaborative practices in some schools. The study also highlights varying levels of team participation, which indicates that the effectiveness of transformational leadership depends on the leader's ability to engage all team members. The major conclusion of the study is that transformational leadership positively influences team synergy through enhanced trust and collaborative problem-solving. The findings provide important practical insights for educational leaders, suggesting that transformational leadership fosters a more inclusive and innovative school environment. This research contributes to the field by emphasizing the need for flexible leadership approaches that adapt to team dynamics and the critical importance of institutional support and resources to fully realize the benefits of transformational leadership in educational settings.

Public Participation in Rapid Response Services for the Sustainability of Jakarta Smart City

Public participation plays an important role in the development of rapid response services to support the sustainability of Jakarta Smart City. This study aims to explore and analyse the level of public participation in utilising and developing these services, and their impact on urban sustainability. The research method used is a qualitative case study through in-depth interviews and document analysis. The results of the study indicate that the level of public participation in rapid response services in Jakarta Smart City varies greatly. Factors such as accessibility, trust, and awareness are the main determinants of the level of public participation. Citizens who actively participate tend to feel greater benefits from these services, while those who are inactive tend to experience gaps in services. Public participation also has a positive effect on service efficiency and the quality of life of city residents. However, this study also found several obstacles that hinder public participation. Low awareness of the importance of the role of individuals in developing smart cities, limited accessibility, and low digital literacy are the main challenges. To increase sustainable public participation, efforts are needed that involve education, training, and strengthening of information technology infrastructure. In conclusion, public participation has a crucial role in the sustainability of Jakarta Smart City through rapid response services. Effective management of public participation can improve service efficiency, strengthen community engagement, and support sustainable urban development. Therefore, continuous efforts are needed to improve and manage public participation for long-term success. With education, training, and improved technological infrastructure, broader and more equitable participation can be realised, supporting the growth of inclusive and sustainable smart cities in the future.

BOOSTING STUDENT ENGAGEMENT IN UNIVERSITY PHYSICAL ACTIVITIES: AN EXPLORATORY STUDY

Physical activity is a critical component of a healthy lifestyle, significantly contributing to the prevention and management of chronic diseases, mental health support, and overall well-being. Despite its benefits, recent lifestyle changes in post-communist Romania have led to an alarming increase in overweight and obesity rates, especially among urban youth. This research focuses on the University of Bucharest (UniBuc) to explore the reasons behind students' low participation in university-organized physical activities. By employing a structured questionnaire distributed electronically, this study aims to collect comprehensive data on student demographics, participation levels, motivations, barriers, and suggestions for improvement. The quantitative analysis component of the study aims to identify participation trends and barriers, while qualitative insights will provide nuanced perspectives on students' experiences. The findings will inform targeted strategies to promote physical activity among students, contributing to their immediate and long-term health. Overall, this exploratory study seeks to lay the groundwork for future research on enhancing physical activity participation in academic settings, ultimately supporting the holistic development of young adults.

Green infrastructure as understood by stakeholders in small and medium-sized towns in Poland

Motives: In urban governance processes involving local communities, green infrastructure (GI) is an important proxy for the local quality of life. In this paper, the authors focus on GI in small and medium-sized Polish towns, which attracts much less research interest than that in large cities. The study covered 97 towns, and it included desk research and a questionnaire survey of local authorities and NGOs.Aim: The aim of the study was to determine whether residents are involved in the management of urban GI, whether local authorities and communities have identified the need to develop new GI, and whether they are taking appropriate measures to maintain and preserve the existing GI resources. Another objective was to examine the priority of existing GI resources in governance policies.Results: The levels of citizen participation and GI management in small and medium-sized towns were ranked. The general observation is that green spaces are not an effective participation tool in small towns. The situation has gradually improved in medium-sized cities and towns within metropolitan regions, but this does not seem to be a determining factor.

Relationship between smoking, excessive androgen and negative emotions in women with polycystic ovary syndrome (PCOS)

BackgroundLifestyle intervention is the first-line treatment for PCOS. Numerous studies have investigated the effect of various lifestyle factors, including dietary habit, smoking, and alcohol consumption on PCOS women. These studies have found that such factors may be associated with physiological parameters such as androgen, and emotional states like anxiety or depression. Smoking, a harmful lifestyle habit widely recognized to contribute to various diseases, has also been found to be related to PCOS. Current research has not adequately compared the effects of smoking with other lifestyle habits on PCOS, and there is little mention of its relationship with the emotional states of patients with PCOS. To further elucidate the association between smoking and other lifestyle factors with clinical symptoms in patients with PCOS, we conducted a cross-sectional evaluation using data from Peking University Third Hospital, with a special focus on analyzing smoking habits and comparing it with a variety of lifestyle factors.MethodsThis cross-sectional study included 601 PCOS women and 184 healthy controls who underwent physical examinations, hormone profiles and psychological measures. We assessed the association between smoking and the clinical symptoms in PCOS women.ResultsWe found a significant correlation between smoking and the degree of depression in PCOS women among the three emotional states: anxiety, depression, and stress. Smoking was also significantly associated with testosterone level in PCOS participants, suggesting that PCOS women who smoke exhibited more severe depressive symptoms and higher testosterone level. In addition, compared to the control group, PCOS women had notably higher testosterone (T) and luteinizing hormone (LH) levels. Smoke and alcohol were statistically significantly more common in women with PCOS than the Control.ConclusionWomen with PCOS who smoke were found to have elevated testosterone levels and more severe depression. These findings suggest that clinicians should monitor smoking women with PCOS for symptoms of depression and assess their hyperandrogenic status.

Retelling of Stories with Common Phrasal Expressions by High-Proficiency Learners: Implications for Learning and High-Stakes Testing

The goal of this research was to investigate how well L2 English speakers of different proficiency levels were able to perform on a test of auditory memory like that used in the Wechsler Memory Scale (WMS). In this test, participants must retell heard stories. While the validity of elicited imitation tests is well established in second-language acquisition research, the effectiveness of using retelling as a neuropsychological measurement when a language other than the test taker’s L1 is used is unclear. Further, due to their importance in memory function, this study also analyzed the role of common phrasal expressions in how well participants retold stories in three groups of different proficiency. The results indicated that the increase in scores in the retelling of stories aligned with the proficiency level of the non-native participants. Higher-proficiency NNSs were also able to use more of the commonly used spoken phrases in their retelling. Further, there was no difference in this measure between the higher-proficiency Second-Language English and First-Language English participants. While the effectiveness of this test method as a neuropsychological tool when a language other than the test taker’s L1 is used is unclear, these results indicate significant progress by the higher-proficiency participants. Nevertheless, given that this test is often used in this context with immigrants and minority language patients, doubts remain about its suitability for less proficient individuals.

Increase in serum TTR levels observed with acoramidis treatment in patients with transthyretin amyloid cardiomyopathy (ATTR-CM): insights from ATTRibute-CM and its open-label extension

Abstract Background/Introduction Patients with ATTR-CM can have lower circulating TTR levels, which is associated with worsening of cardiac function and increased risk of cardiovascular mortality.[1] Acoramidis has been shown to reduce cardiovascular mortality and hospitalization, while increasing circulating TTR levels, in the ATTRibute-CM phase 3 study.[2] Purpose I. Evaluate serum TTR levels in participants (pts) receiving acoramidis vs those who received tafamidis in the placebo group in ATTRibute-CM at Month 30. II. Evaluate serum TTR levels in pts who transitioned from placebo+tafamidis to acoramidis in the open-label long term extension (OLE) study. Methods ATTRibute-CM study: Eligible pts with ATTR-CM were randomized in a 2:1 ratio to receive acoramidis or placebo for 30 months. Pts in both groups had the option of initiating open-label, commercially available tafamidis after 12 months in the study. Upon completion of Month 30, pts were invited to participate in the OLE study. In OLE, pts who had previously received acoramidis continued acoramidis, and those who had previously received placebo+tafamidis were switched to acoramidis-only treatment. All pts in the OLE study received acoramidis only. Change in serum TTR levels in ATTRibute-CM and OLE at data cutoff (Oct 9, 2023) are summarised using descriptive statistics. Results In the phase 3 study, efficacy analyses were performed in 611 pts, of which 61 of 409 (14.9%) and 46 of 202 (22.8%) received tafamidis in acoramidis and placebo groups, respectively. The median time until tafamidis initiation was 17.8 and 16.1 months, respectively; median exposure duration was 11.6 and 10.5 months, for acoramidis and placebo groups, respectively.[3] Change from baseline (CFB) in serum TTR levels remained unchanged at Month 30 in the placebo-only group (mean [SD] = –0.4 [4.92] mg/dL). Characteristics of pts analysed are described in Fig. 1. A total of 380/611 pts (62.2%) entered the OLE study (229 pts continued acoramidis only, and 23 switched from placebo+tafamidis to acoramidis). At the time of data cutoff, 214 pts who had received acoramidis only completed Month 6 in OLE versus 18 who switched from placebo+tafamidis to acoramidis. At Month 30 in ATTRibute-CM, CFB in serum TTR levels were higher for patients who received acoramidis only than those receiving placebo+tafamidis (Fig 2A). Serum TTR levels increased further in pts who switched from placebo+tafamidis to acoramidis in OLE (Fig. 2B). The OLE study is ongoing, and this analysis includes pts who completed the Month 6 visit at time of data-cut. Conclusion(s) CFB in serum TTR levels were higher in pts receiving acoramidis only than those receiving placebo+tafamidis at Month 30 in the double-blind study. A further significant increase in serum TTR levels was observed in those who received placebo+tafamidis and switched to acoramidis in OLE.

Knowledge and Preventive Practice of Urinary Tract Infection among Bangladeshi Female Ready-made Garments Worker

Ready-made garments (RMG) are Bangladesh’s largest export earner sector, with 800,000 workers, including two-thirds of females. Female RMG workers suffer from various illnesses, including urinary tract infections (UTI), but data is scars related it in Bangladesh. Therefore, the study aimed to evaluate the knowledge and preventive practice of UTI among female RMG workers. Method: This cross-section survey was conducted to evaluate the knowledge and preventive practice of UTI among female RMG workers. Using convenient sampling technique, we collected 351 data between February to April 2021 from two RMG. Data were analysed by using Statistical Package Social Science (SPSS) software version 23. Descriptive statistics was conducted using frequencies and proportions. Chi-square test was used to determine the association between dependent and independent variables. Linear regression and Pearson co-relation was used to determine the association between knowledge and practice. Results: Of 351 participants, 22% had good knowledge and 33% were in good practice. The study found a statistically significant correlation between knowledge level of UTI and participants’ age, education, residence, family size, parents’ education and occupation (p<0.05). Similarly, participants’ education, marital status, residence, family size, parents’ education and occupation were significantly correlated with practice level of female RMG workers towards UTI (p<0.05). Furthermore, participants who received health-related training had good knowledge and practice of UTI. Conclusion: Female RMG workers’ sociodemographic variables were significantly correlated with their knowledge and practice of UTI. Training on health-related issues was significantly associated with good knowledge and practice of UTI. It’s urgent to keep female RMG workers aware of health-related issues and easily accessible health care. EWMCJ Vol. 12, No. 1&2, January-July 2024: 50-59

Women in Legal Governance: A Comparative Analysis of Female Participation and Advancement in the Legal Profession in Japan and India

The social advancement of women in the legal field is a critical indicator of societal modernisation. Despite the progress made globally in the pursuit of gender equality, there are still substantial disparities, particularly in Asian countries such as India and Japan. In this article, the participation and advancement of female legal professionals in these two nations are analysed, with a particular emphasis on the persistent gender disparity and the influence of cultural and institutional barriers on their professional development. The study employs a comparative analysis using data from the White Paper on Lawyers published by the Japan Federation of Bar Associations, alongside statistical data from Indian state bar councils. Findings indicate a significant disparity in the level of female counsel participation between Japan and India. The proportion of female lawyers in India was less than 11% of the total legal professionals in 2010, a figure that increased marginally to 15% by 2020. The study reveals that in order to address the gender disparity in the legal profession, it is imperative that both Japan and India take proactive measures. This study contributes to the limited corpus of comparative research on female legal professionals in Asian countries. The study provides a nuanced comprehension of the socio-legal dynamics that influence women’s advancement in the legal profession by contrasting the legal landscapes of Japan and India. It urges a joint endeavour to achieve gender equality, underscoring the importance of data-driven policies in the development of an inclusive legal environment.

A study of staff pre‐evacuation behaviors in a Malaysian hotel

AbstractSimulating fire and evacuation scenarios is crucial for engineers to assess building safety during fire incidents. Accurate simulations require data on occupants' behaviors, particularly during the pre‐evacuation phase as these decisions significantly impact evacuation duration. Gathering comprehensive data from diverse regions while considering cultural and regional variations is necessary to understand how occupants' behavior is influenced. Thus, this study focuses on examining the behavior of Malaysian hotel staff during unannounced fire drill to gain insights into factors affecting their behavior during pre‐evacuation stage, such as fire experience, fire alarm, drill participation, fire training, and awareness. The study categorizes the actions performed by the hotel staff into sequences and analyses them based on influencing factors. The findings indicate that instead of immediately evacuating in response to emergency notification, the hotel staff engage in various actions. Most staff members initially investigate or ignore the emergency, resulting in longer pre‐evacuation times. Moreover, the results suggest that previous drill participation and high awareness levels contribute to shorter pre‐evacuation times. Conversely, previous fire experience, fire training, and fire alarm familiarity have no effect on pre‐evacuation time.

Which diversity factors influence the attribution of competences and co-operation in nursing teams?

Abstract Background Diversity within nursing teams increases due to staff shortages in Germany, nurse migration and the current academization of the profession. Quality of patient care is associated with intraprofessional teamwork. Little is known about how nurse’s own diversity factors and those of team members impact nurse’s perception and behavior in team situations. Methods A quasi-experimental, cross-sectional study with a factorial online survey with fictional case studies (vignettes) was conducted in two German hospital operators in 2023. Nurses of legal age working in hospitals or nursing homes were eligible to participate. Associations of diversity factors, i.e., gender, age, migration background, and qualification, on the participant and vignette level on perceived competences and willingness to cooperate were preliminary analyzed via multi-level fixed effects models in SPSS. Results N = 684 nurses participated (76% female; mean age: 44.2 years; 88% born in Germany; 75% completed vocational training). Competency of team members in patient’s personal hygiene was rated higher by respondents born in Germany (.36), when fictional colleagues were of middle age (.06) compared to higher age and were from Germany (.22) or France (.08) compared to China. Competency in inserting infusions was rated higher by respondents born in Germany (.56), when fictional colleagues were from Germany (.29) or France (.20) compared to China and when one worked together for months compared to days (-.39). Willingness to swap shifts was affected by the fictional length of collaboration (-.08). All significance levels were p<.02. Conclusions How nurses perceive their colleagues’ competences is mainly influenced by their own and the other’s migration background, while willingness to cooperate is only affected by length of collaboration. Improving the onboarding process of new nurses in teams, and providing the time and space for professional exchange might improve mutual trust and teamwork. Key messages • Diversity in German nursing teams increases due to nurse migration and plurality of qualifications. • Facilitating professional exchange about individual competences might improve team work in nurses.

Outcomes and effects of sacubitril/valsartan according to NT-proBNP level in patients with heart failure: a patient-level pooled analysis of the PARADIGM-HF and PARAGON-HF trials

Abstract Background NT-proBNP levels are associated with disease severity and outcomes in patients with HF across the spectrum of LVEF. Recently, it has been suggested that the effectiveness of certain treatments may vary by NT-proBNP level with greater benefit from omecamtiv mecarbil, and smaller benefit from vericiguat, in patients with higher NT-proBNP levels. We examined the benefit of sacubitril/valsartan on outcomes across the range of NT-proBNP levels in patients with HFrEF/HFmrEF/HFpEF. Purpose To evaluate clinical outcomes, and the efficacy of sacubitril/valsartan, according to NT-proBNP levels, in patients with HFrEF/HFmrEF/HFpEF, using the pooled dataset of participants in the PARADIGM-HF and PARAGON-HF trials. Methods The PARADIGM-HF (n=8399) and PARAGON-HF (n=4822) trials enrolled patients with HF, functional limitation, and elevated NT-proBNP levels. Patients with LVEF ≤40% were randomized to sacubitril/valsartan 200 mg twice daily or enalapril 10mg twice daily in PARADIGM-HF, and those with LVEF ≥45% to sacubitril/valsartan 200 mg twice daily or valsartan 160mg twice daily in PARAGON-HF. Patients were categorized by quintiles of NT-proBNP level and using NT-proBNP as a continuous variable, analysed using restricted cubic splines. The primary outcome in the present study was the composite of cardiovascular death or HF hospitalization. Results Among the 13195 patients in the pooled PARADIGM-HF and PARAGON-HF dataset, 13142 (99.6%) patients with baseline NT-proBNP were analysed. Patients with higher NT-proBNP levels were more often male, had lower body mass index and LVEF, worse New York Heart Association functional class, worse kidney function, and more atrial fibrillation, while age was similar across NT-proBNP levels. The rate of the primary outcome (per 100 person-years) increased with NT-proBNP level: quintile 1, 5.9 (95%CI 5.3-6.5); quintile 2, 7.5 (95%CI 6.9-8.2); quintile 3, 9.0 (95%CI 8.2-9.7); quintile 4, 12.0 (95%CI 11.1-12.9); and quintile 5, 20.8 (95%CI 19.6-22.2) (Figure 1). Similar trends were observed for other outcomes. The benefit of sacubitril/valsartan was consistent across NT-proBNP levels: the hazard ratio for the primary outcome in NT-proBNP quintile 1 was 0.79 (95%CI 0.65-0.96); quintile 2, 0.87 (95%CI 0.72-1.04); quintile 3, 0.79 (95%CI 0.66-0.93); quintile 4, 0.85 (95%CI 0.73-0.99); and quintile 5, 0.86 (95%CI 0.76-0.97), P-interaction=0.86. The consistent benefit of sacubitril/valsartan was also seen when NT-proBNP was analysed as a continuous variable (Figure 2). The absolute benefit was greatest in quintile 5 of NT-proBNP; the number needed to treat for quintile 5 was 16 versus 37 for the quintile 1 for the primary endpoint. Conclusions Patients with higher NT-proBNP had worse outcomes, but the benefits of sacubitril valsartan were consistent across the range of NT-proBNP levels of participants in PARADIGM-HF and PARAGON-HF.Kaplan-Meier curvesEffect of sac/val across NT-proBNP range

The Effect of the COVID-19 Pandemic on the Working Conditions and Efficiency of Radiographers at Ahvaz Jundishapur University of Medical Sciences' Radiology and CT Scan Imaging Centers

Background: Radiographers are highly skilled imaging technology users who work directly with COVID-19 cases. Objectives: This study aims to assess the impact of COVID-19 on the working conditions and efficiency of radiographers and their level of satisfaction with personal protective equipment (PPE), cleaning supplies, and facilities during the COVID-19 epidemic. Methods: A prospective observational study was conducted among radiographers registered in the radiology and CT scan imaging centers of Ahvaz Jundishapur University of Medical Sciences and some private centers between June and October 2022. A questionnaire with 28 multiple-choice questions was used to collect information. The questionnaire consisted of two sections; the first part contained demographic information. In the second part, participants answered questions about changes in working conditions, such as changes in stress level, work efficiency, the need for more rest, imaging time, use of equipment, and personal protective equipment at work, based on their experiences and observations during the COVID-19 pandemic. The data analysis was performed using Statistical Product Service Solutions (SPSS) software, version 26.0, with statistical significance assumed at a P-value < 0.05. Results: One hundred and fifty radiographers completed the questionnaire. The mean age and mean work experience of participants were 33.2 ± 8.3 years and 9 ± 7.2 years, respectively. The results showed that most participants of both sexes agreed that they needed more rest (P-value < 0.05); their work efficiency had not decreased significantly during the COVID-19 epidemic. The stress level of participants had significantly increased compared to before the epidemic. There were significant differences between government-owned hospitals and private radiology centers regarding the presence of a COVID-19-related protocol, the compulsory use of masks, the existence of decontamination instructions, the type of air decontamination, the contact with imaging equipment manufacturers, the timing of decontamination, and the type of decontamination applied to the imaging equipment (P-value < 0.05). Conclusions: This study demonstrated that the reduction in work efficiency among radiographers was not significant compared to before the COVID-19 pandemic. According to the study's results, radiographers' working conditions underwent numerous adjustments over the course of the COVID-19 epidemic.

Engaging practitioners in developing a guide for citizen participation in community health promotion

Abstract Background Community health promotion aims to improve the living conditions in municipalities, cities, or regions to support health maintenance or promotion. Participation is a fundamental element in health promotion, as it enables community members to engage in decision-making, program development, and tailored health initiatives. This project focused on crafting a practical guide for citizen participation in community health promotion, involving experts and future users. Methods We conducted a literature review to identify existing guidelines and materials pertinent to community health promotion, with a focus on practical guidance for municipal practitioners. To delve deeper into the topic, we conducted interviews with 6 experts in the field of participation and community health promotion as well as with 6 practitioners working in “healthy municipalities” in Lower Austria. The guide was developed collaboratively, with two workshops being held to gather input on the draft concept of the guide and to prioritize topics. Moreover, experts and practitioners were involved to provide feedback on the drafted guidance document. Results Discrepancies emerged between theoretical concepts and real-life implementation of community participation. While the literature delineates up to 12 participation levels, practitioners identified three: contributing ideas, advising and co-deciding, and actively participating in planning and implementation. Informing the target group was conceptualized as a preliminary stage and basic requirement for citizen participation. Above all, practitioners sought low-key suggestions and short descriptions of methods that they could use directly in their everyday context. Conclusions Involving practitioners and potential users enhanced the accessibility and utility of the guide. Their input ensured that the guide remained practical, relevant and informative without excessive academic or theoretical abstraction. Key messages • Involving health promotion practitioners helped shaping the practical guide in a way to be most useful for the intended audience. • Experts and practitioners have different views regarding the theoretical distinctions of levels of participation in community health promotion.

Canagliflozin reduces oral loop diuretic intensification in patients with type 2 diabetes: a participant level pooled analysis of CREDENCE and CANVAS

Abstract Background Patients with type 2 diabetes often have coexistent heart failure or chronic kidney disease (CKD) that require treatment with loop diuretics; however, the prognostic implications of oral loop diuretic intensification are not well characterized. The sodium glucose cotransporter-2 inhibitor canagliflozin reduces the risk of hospitalization for heart failure or cardiovascular death and CKD progression among patients with type 2 diabetes at high cardiovascular risk or with concomitant CKD. Purpose To assess the prognostic implications of oral loop diuretic intensification and the treatment effects of canagliflozin versus placebo on loop diuretic use in high-risk patients with type 2 diabetes. Methods This was a post-hoc participant-level pooled analysis of the CANVAS Program and CREDENCE trial which enrolled patients with type 2 diabetes at high cardiovascular risk or with CKD. Oral loop diuretic intensification was defined as a composite of new loop diuretic initiation (among patients not receiving loop diuretics at baseline) or loop diuretic dose increase (among patients receiving loop diuretics at baseline). We assessed the association between the requirement for loop diuretic intensification and the incidence of subsequent all-cause death. The effect of canagliflozin versus placebo on the composite of loop diuretic intensification as well as its components were evaluated. We further examined the effect of canagliflozin on an expanded post hoc composite of cardiovascular death, hospitalization for heart failure or loop diuretic intensification. Results 2,263 (15.6%) of 14,543 patients were treated with loop diuretics at baseline. Over a median follow-up of 2.2 years, 1,264 patients (9.4%) required oral loop diuretic intensification, of which 981 (77.6%) patients required initiation of oral loop diuretics and 283 (22.4%) required oral loop diuretic dose increase. Patients requiring oral loop diuretic intensification experienced rates of subsequent mortality that were 3.5-fold higher (5.9[5.4-6.5] per 100 patient-years) than those not requiring oral loop diuretic intensification (1.7[1.6-1.9] per 100 patient-years). Treatment with canagliflozin reduced the need for oral loop diuretic intensification by 41% (HR 0.59; 95%CI: 0.53-0.66) including both new diuretic initiation (HR 0.65; 95%CI: 0.57-0.74) and diuretic dose increase (HR 0.42; 95%CI: 0.33-0.54); Figure 1. Treatment with canagliflozin similarly reduced an expanded composite of worsening heart failure inclusive of cardiovascular death, heart failure hospitalization or diuretic intensification (HR 0.64; 95%CI: 0.58-0.70). Conclusion Among high-risk patients with T2D, new oral loop diuretic intensification was frequent and associated with an increased risk of subsequent mortality. Treatment with canagliflozin significantly reduced the need for loop diuretic intensification.

School-level competition for US high school extracurricular resources

ABSTRACT In the United States, families know that extracurricular activities serve as a qualitative distinction in postsecondary admissions and merit-based aid awards, leading to competition in their participation and leadership positions. Despite the extensive literature supporting extracurricular activities, there is an incomplete picture of how school characteristics influence high school students’ participation and holding of leadership positions within extracurricular activities. Using the US Education Longitudinal Study of 2002, our study explores how the school characteristics of socioeconomic status, test scores, class size, school urbanicity, and school control shape twelfth-grade participation and holding leadership positions in ten school-sponsored extracurricular areas. From our results, we offer recommendations on how schools can create equitable participation levels and discuss the ever-expanding role of extracurricular activities in defining merit.

Community Engagement in the Management of Urban Green Spaces: Prospects from a Case Study in an Emerging Economy

Urban green spaces (UGSs) play a vital role in enhancing the quality of life in cities, particularly in rapidly urbanizing regions such as the Metropolitan Region of São Paulo (MRSP). However, significant challenges related to equitable management and access persist, often exacerbated by socio-environmental inequalities. While much of the existing literature on UGS management focuses on developed economies, there is a gap in our understanding of how community engagement influences UGS outcomes in emerging economies, which face unique socio-economic and infrastructural constraints. This study addresses this gap by investigating the impact of community engagement on UGS management in the MRSP, specifically examining how increased participation correlates with improved UGS access and reduced socio-environmental inequality. Utilizing survey data from 33 municipal environmental departments across the MRSP, this research applied correlation tests, generalized linear models, and a non-parametric analysis of variance to evaluate the relationships between community engagement, UGS coverage, and inequality. The findings reveal a moderate positive correlation between community engagement and UGS coverage, alongside a negative correlation with socio-environmental inequality. Increased levels of community participation were associated with greater access to UGSs and a reduction in disparities across socio-economic groups. These results underscore the potential of fostering community involvement in UGS management to promote urban equity and environmental sustainability in emerging economies, particularly through institutional support and transparent information sharing. Future research should focus on longitudinal studies to better understand the long-term effects of sustained community engagement and incorporate qualitative data from community members to provide a more comprehensive analysis of participatory processes. Additionally, expanding the scope of analysis to include informal and private green spaces will offer a more holistic understanding of urban greening dynamics.

Community-Based Tourism Implementation as Mediator on the Relationship between Community Participation and Socio-Economic Sustainability of Tourism

This study explored the mediating effect of community-based tourism implementation on the relationship between community participation and the socio-economic sustainability of tourism in Marilog District. This study employed a quantitative method and stratified random sampling to select the 380 respondents. The survey was distributed to two areas in Marilog District: Barangay Baganihan and Barangay Datu Salumay. The data was evaluated to ascertain whether the variables had a statistical relationship. This study used non-experimental quantitative research, the descriptive-correlation approach, and mediation analysis. The weighted mean, Pearson product-moment correlation coefficient, multiple regression analysis, and path analysis were used to analyze the data. The result revealed that the respondents have high levels of community participation, socio-economic sustainability, and community-based tourism implementation. The relationship between community participation and socio-economic sustainability, community participation and community-based tourism implementation, and socio-economic sustainability and community-based tourism implementation were statistically significant. However, the indirect effect of community participation in socio-economic sustainability through community-based tourism implementation is insignificant and statistically supported by this study, indicating no significant mediation. The study findings’ implications are presented.

Intestinal Parasites and Hematological Parameters in Children Living in Ambatoboeny District, Madagascar

Madagascar is one of the poorest countries in the world. The country’s extreme weather conditions, poor sanitation, and weak economy facilitate the spread of parasitic diseases. Infections with intestinal parasites are particularly dangerous for children because they can cause malnutrition and anemia, which, in turn, have a negative effect on children’s cognitive functions and physical development. The aim of the present study was to analyze the prevalence of intestinal parasites and to assess hematological parameters in a group of children living in northern Madagascar. The screening was conducted in May 2024 in the Clinique Medicale Beyzym in Manerinerina, the Ambatoboeny district. It involved a sample of 208 children aged 0–17 years. Single stool samples were collected from all study participants. The samples were fixed in SAF fixative and then transported from Africa to Europe for further diagnostics at the Department of Epidemiology and Tropical Medicine, the Military Institute of Medicine–the National Research Institute in Poland. First, the samples were analyzed by light microscopy methods using three different diagnostic techniques (direct smear, decantation with distilled water, and the Fülleborn method). Next, they were tested by molecular biology methods (real-time PCR). Blood samples for the assessment of hematological parameters were collected at the healthcare center in Madagascar. The prevalence of intestinal parasites in the study sample was 61.5%. Helminths were found in 15.2% of the investigated children, and Giardia intestinalis (20.5%) was found to be the most prevalent parasite in the study population. Most infections were caused by potentially pathogenic stramenopila Blastocystis spp. (32.0%). Mean Hb, HCT, MCV, MCH, and MCHC levels in the study participants were below normal values. However, no correlation was found between the presence of a parasitic infection and low hematological parameters, which are a clinical sign of anemia. High rates of infections with intestinal parasites in children living in northern Madagascar support the necessity to introduce long-term preventive measures, which would limit the spread of parasitic diseases in the Malagasy population. Low hematological parameters in non-infected children may be indicative of persistent malnutrition or infection with other parasites, e.g., malaria or schistosomiasis.