Poor Performance Research Articles

Optimising outcomes for frail patients with oesophagogastric (OG) cancers: The impact of dose reduction and comprehensive geriatric assessment.

303 Background: Delivery of appropriate management of elderly patients with OG malignancies in the palliative setting remains challenging and unpredictable. Incidence of OG cancers increases markedly with age, and there are growing numbers of elderly, frail and medically complex patients referred to oncology services for treatment. An adaptive approach to their management is required, tailored to their complex medical needs. The GO2 study sought to optimise chemotherapy delivery in this cohort and demonstrated that upfront dose reductions do not reduce progression-free survival in OG cancers. We analysed the treatment and outcome of elderly patients undergoing first-line palliative chemotherapy at our centre, with or without comprehensive geriatric assessment (CGA). Methods: We retrospectively analysed the records of patients over the age of 75 treated at our centre between May 2011 and March 2023. Progression-free survival (PFS) was calculated from the date of treatment initiation to date of radiological progression, or 19 th March 2024 if patients had not progressed. Overall survival (OS) was calculated from treatment initiation to date of death per the electronic health record, or 19 th March 2024 if patients had not died. Grade 3 (G3) toxicities and dose reductions (DRs) were identified from medical records. Statistical analyses were performed using R v4.3.3. Results: 82 patients were included in the analysis. Overall median PFS was 6.5 months (1-107 months) and median OS was 10 months (1-107 months). Patients who qualified for chemotherapy with immunotherapy had improved PFS (median 16 months, range 2-27 months) and OS (median 16 months, range 10-27 months). G3 toxicities were increased in patients without upfront DR (44% vs. 30%). The most significant predictor for survival in multivariate analysis was performance status (PS), which was associated with worse PFS (hazard ratio 2.66, range 1.35–5.35, p = 0.004), and OS (hazard ratio 6.13, range 2.79–13.44, p < 0.001). Age was not associated with survival. Consistent with the GO2 trial, there was no association between upfront DR and PFS (p = 0.13) or OS (p = 0.72). 38% of patients underwent CGA as part of their workup for chemotherapy. These patients were more likely to have upfront DR (61% vs. 47%). In this cohort, G3 toxicity rates were comparable in patients with PS 0-1 who underwent CGA (39% vs. 35%). In patients with PS ≥ 2, G3 toxicity rates were higher in those who did not undergo CGA (67% vs. 30%). Conclusions: Upfront DR in elderly patients is safe and does not impact survival but does reduce the burden of toxicity. PS, rather than age, is a better predictor of survival and treatment outcome. CGA may help mitigate toxicity burden in patients with poor performance status.

Word vector embedding and self-supplementing network for Generalized Few-shot Semantic Segmentation

Under the condition of sufficient base class samples and a few novel class samples, Generalized Few-shot Semantic Segmentation (GFSS) classifies each pixel in the query image as base class, novel class, or background. A standard GFSS approach involves two training stages: base class learning and novel class updating. However, inter-class interference and information loss which contribute to the poor performance of GFSS, have not been synthetical considered. To address the problem, we propose an Embedded-Self-Supplementing Network (ESSNet), i.e., semantic word embedding and query set self-supplementing information to enhance segmentation accuracy. Specifically, the semantic word embedding module employs distance information between word vectors to assist the model in learning the distance between class prototypes. In order to transform the semantic word vector prototypes from the semantic space to the visual embedding space, we designed a triplet loss function to supervise the word vector embedding module, where the word vector prototype serves as an anchor and positive-negative samples are collected among the general features of the support image. To compensate for the information loss caused by using prototypes to represent classes, we propose a self-supplementing module to mine the information contained in the query image. Specifically, this module first makes a preliminary prediction on the query image, then selects high-confidence area to form pseudo labels, and finally uses pseudo labels to extract query prototypes to supplement the missing information. Extensive experiments on PASCAL-5i and COCO-20i show that ESSNet has superior performance and outperforms state-of-the-art methods in all settings.

Evaluation of visual SLAM algorithms in unstructured planetary-like and agricultural environments

Given the significant advance in visual SLAM (VSLAM), it might be assumed that the location and mapping problem has been solved. Nevertheless, VSLAM algorithms may exhibit poor performance in unstructured environments. This paper addresses the problem of VSLAM in unstructured planetary-like and agricultural environments. A performance study of state-of-the-art algorithms in these environments was conducted to evaluate their robustness. Quantitative and qualitative results of the study are reported, which exposes that the impressive performance of most state-of-the-art VSLAM algorithms is not generally reflected in unstructured planetary-like and agricultural environments. Statistical scene analysis was performed on datasets from well-known structured environments as well as planetary-like and agricultural datasets to identify visual differences between structured and unstructured environments, which cause VSLAM algorithms to fail. In addition, strategies to overcome the VSLAM algorithm limitations in unstructured planetary-like and agricultural environments are suggested to guide future research on VSLAM in these environments.

Feature-level Fusion vs. Score-level Fusion for Image Retrieval Based on Pre-trained Deep Neural Networks

Today’s complex multimedia content made retrieving images similar to the user’s query from the database a challenging task. The performance of a Content-Based Image Retrieval System (CBIR) system highly depends on the image representation in a form of low-level features and similarity measurement. The traditional visual descriptors that do not provide good prior domain knowledge could lead to poor performance retrieval results. On the other hand, Deep Convolutional Neural Networks (DCNNs) have recently achieved a remarkable success as methods for image classification in various domains. Recently, pre-trained deep convolution neural networks on thousands of classes have the ability to extract very accurate and representative features which, in addition to classification, can also be successfully used in image retrieval systems. ResNet152, GoogLeNet and InceptionV3 are some of the effective and successful examples of pre-trained DCNNs recently applied in a computer vision tasks such as object recognition, clustering, and classification. In this paper, two approaches for a CBIR system, namely early fusion and late fusion, have been presented and compared. The early fusion utilizes concatenation of the features extracted by each possible pair of DCNNs, that is ResNet152-GoogLeNet, ResNet152-InceptionV3, and GoogLeNet-InceptionV3, and the late fusion apply CombSum method with Z-Score standardization to combine the score results provided by each DCNN of the aforementioned pairs. In the experiments on a popular WANG dataset it has been shown that late fusion approach slightly outperforms early fusion approach. The best performance of our experiments in terms of Average Precision (AP) for the top 20 results reaches 96.82%.

On-Line Measurement of Tracking Poses of Heliostats in Concentrated Solar Power Plants.

The tracking pose of heliostats directly affects the stability and working efficiency of concentrated solar power (CSP) plants. Due to occlusion, over-exposure, and uneven illumination caused by mirror reflection, traditional image processing algorithms showed poor performances on the detection and segmentation of heliostats, which impede vision-based 3D measurement of tracking poses of heliostats. To tackle this issue, object detection using deep learning neural networks are exploited. An improved neural network based on YOLO-v5 framework has been designed to solve the on-line detection problem of heliostats. The model achieves a recognition accuracy of 99.7% for the test set, outperforming traditional methods significantly. Based on segmented results, the corner points of each heliostat are found out using Hough Transform and line intersection methods. The 3D poses of each heliostat are then solved out based on the image coordinates of specific feature points and the camera model. Experimental and field test results demonstrate the feasibility of this hybrid approach, which provides a low-cost solution for the monitoring and measurement of tracking poses of the heliostats in CSP.

Carrier Dynamics in Quantum Dot Light‐Emitting Diodes: The Conversion between Electrons, Excitons, and Photons

AbstractElectrically driven self‐emissive quantum dot light‐emitting diodes (QLEDs) offer the advantages of high contrast, high color saturation and simple solution processability, making them the ultimate target for commercialization of QD‐based displays. Challenges remain, such as the lack of a comprehensive understanding of device mechanisms, the poor performance of blue Cd‐based and Cd‐free devices, and the immature of color patterning processes, which are far from the requirements of practical applications. The study of carrier dynamics is a crucial part of understanding the physical mechanisms of devices and improving their performance. Therefore, this review summarizes and discusses the related researches on the conversion process between electrons, excitons and photons in QLEDs. First, an overview of the electron‐photon conversion process is given to elucidate the underlying principles of QLEDs. Then, the two sub‐processes involved, the exciton formation process and the photon formation process, are discussed. Next, the most commonly used characterization tools for the study of carrier dynamics are presented. Finally, the opportunities and challenges associated with QLED research on carrier dynamics are summarized and outlined.

Tough strippable hydrogel films based on acrylic acid/acrylamide/zirconyl chloride for surface radioactive decontamination at low temperatures

Strippable films are extensively utilised for the decontamination of radioactive surfaces because of their cost-effectiveness, ease of operation, and minimal liquid waste. However, traditional strippable detergents are formulated for use at normal ambient temperatures and typically lose their efficacy at low temperatures because of poor performance or excessively long film-forming time. In this study, we have developed an anti-freezing and sprayable AMZW detergent based on acrylic acid (AA), acrylamide (AM), zirconyl chloride octahydrate (ZrOCl2·8H2O), and water (H2O), which possesses a freezing point of approximately −34 ℃ due to the solvation interaction between Zr4+ and H2O. Even at temperatures as low as −25 ℃, the AMZW detergent can be easily sprayed using a conventional apparatus and rapidly cured into a strippable hydrogel film under irradiation by 365 nm UV LED light (LED@365 nm), household LED panel light, or sunlight. The coordination bond formed between Zr4+ and the carboxyl group of the polymer chain imparts excellent mechanical properties to the hydrogel while the carboxyl group can complex with uranyl nitrate hexahydrate (UO2(NO3)2·6H2O)—a radioactive simulant. As a result, the strippable hydrogel film demonstrates high tensile strength (6.1 ∼ 19.3 MPa), excellent flexibility (elongation of 90 ∼ 855 %), moderate peel strength (0.05 ∼ 3 N/cm, room temperature (RT)), and high decontamination efficiency (>91.6 % on stainless steel and glass; >81.3 % on concrete) over a wide range of temperatures (−25 ∼ 25 ℃). This work presents a novel approach for producing anti-freezing, fast-forming, flexible, and high-strength strippable hydrogel films for surface radioactive decontamination at low temperatures.

Identifying the Key Factors of Intermodal Travel Using Interpretative Ensemble Learning

Intermodal travel is considered an effective method for achieving sustainable urban transportation. Understanding the factors influencing intermodal travel is crucial. Due to the relatively small proportion of intermodal trips within cities, datasets are significantly imbalanced, leading to poor performance of traditional logit models. In this paper, we develop a novel interpretable ensemble learning (IEL) model to identify key factors through voting by five types of machine learning models. We test our model on two datasets with different numbers of features. The results show that travel duration, travel distance, vehicle ownership, and distance to the nearest metro station are the key factors influencing intermodal travel, cumulatively contributing nearly 70% in the JDS2021 dataset with 14 features and nearly 80% in the SHS2019 dataset with 8 features. Furthermore, we analyze the interpretability of our model and compare it with the logit model. Our model enriches the methodology for modeling intermodal travel behavior.

Adult Sports Participation and Physical Activity: How About Curling?

Despite its well-documented physical and psychosocial benefits, sport remains the least engaged form of physical activity (PA) among adults. Many adults may lack the skills needed to play or continue to play sports and aging adults are more likely to avoid participation for fear of poor performance or injury. A sport that shows great promise for adults seeking new sports participation outlets is curling. Curling is a team sport comprised of four interchangeable positions working collectively to deliver granite stones across a sheet of ice in an effort to outscore the opponent team. While it seems reasonable that walking on ice, “throwing” a 44 lb granite stone across a sheet of ice, and periodically sweeping while walking on ice over a two-hour period would generate at least a moderate amount of physical activity, research to date is quite limited. Therefore, the purpose of this study was to objectively measure the amount and intensity of PA achieved by average recreational curling participants during a typical curling match. Methods Members of a curling club in NC were asked to wear Actigraph Accelerometers (model GT3X) while they participated in their regularly scheduled curling match. All participants had at least one year of curling experience. Curling matches lasted between 90 and 120 minutes. Participants were asked to indicate their age, gender, and curling position during the match (lead, second, vice, skip) which were matched with accelerometer data. Results Overall, 110 participants (37 female, 73 male, avg. age 50 yrs) spent most of their curling time in light or moderate-intensity activity (18.1% Sedentary; 49.5% light; 32.4% moderate; .03% vigorous). In terms of minutes, the average participant spent 35.9 minutes engaged in Moderate-to-Vigorous PA (MVPA) per curling experience. This represents 23.9% of the weekly 150min of MVPA suggested by the CDC. The second position had the highest percentage of moderate activity level and a small percentage of vigorous activity. No other position reached a vigorous level. The skip position had the highest amount of sedentary activity as well as light activity. Females had a higher level of moderate activity in comparison to males. However, males reached a small amount of vigorous activity. The age group of 18 - 36 had the highest amount of moderate activity and the lowest amount of sedentary activity. This age group reached an average of 41.0 minutes of MVPA per curling experience. The age group of > 58 had the highest amount of sedentary activity and the lowest amount of moderate activity. Conclusions Curling may be a good sports participation option for adults looking for alternatives to meet recommended weekly amounts of MVPA. Participants should consider playing in one of the first three positions to maximize the amount and intensity of PA achieved while playing. Furthermore, since curling also requires balance, coordination, muscular strength, multitasking, strategic reasoning, and can cater to most physical challenges without compromising the integrity of the game, it may be an ideal sport to promote for adults of all ages and sport abilities. Implications for Practice and Policy Findings should be used to inform strategies for promoting curling as an opportunity for team sport involvement that has the added value of contributing to daily physical activity. However, , access and opportunities to play, especially for underserved populations, are limited. Given that most curling clubs in America are private and require a membership to play. Partnership arrangements between existing clubs and public parks and recreation departments could increase both access and opportunities to play.

Using patient-reported performance status to guide management of advanced cancer: A quality improvement initiative.

379 Background: Performance status is a key prognostic factor among patients with advanced cancer and can inform the need for supportive care services. However, assessment and documentation of performance status is inconsistently integrated into standard oncology care. Patient-reported performance status (PRPS) is a surrogate for clinician-assessed performance status and has the potential to address this challenge. We piloted a decision support tool in our electronic health record (EHR) that uses PRPS to prompt clinician assessment of performance status and suggest referrals to supportive care services. Methods: We identified patients with advanced cancer using a pre-built and validated registry driven by ICD codes in our EHR (EPIC). For patients with advanced cancer seen at one of our clinics, a multiple-choice question with options derived from the Eastern Cooperative Oncology Group (ECOG) scale in patient-friendly language was added to the pre-visit questionnaire sent electronically prior to oncology visits. For patients with a poor PRPS (2 or greater), a clinical decision support tool alerted providers of the patient’s self-reported performance status, encouraged input of the clinician’s ECOG assessment, and suggested referral orders to supportive care services such as palliative care, nutrition, and social work. We are currently evaluating how our PRPS-driven decision support tool impacts the rate of clinician-assessed ECOG documentation, referral rates, and clinical outcomes. Results: Between 3/13/24 and 5/13/24, of 336 patients identified by the advanced cancer registry, 70% (235) of patients completed the PRPS questionnaire. Among patients with an available PRPS score, 18% (42) of patients reported a poor performance status (2 or greater) at least once, triggering the decision support tool. Providers entered ECOG assessments for 93% (39) of patients and sent referrals to supportive care services for 10% (4) of the patients. Three patients died during this time period, and all three of them reported a poor performance status of 3 or 4. Oncologists at the clinic reported no significant disruption to routine workflow. Conclusions: Preliminary results suggest feasibility of a PRPS-driven decision support tool to flag patients with advanced cancer and declining function and improve discrete documentation of clinician-assessed performance status. Notably, the rate of referrals to supportive care services remains low. Next steps include obtaining longitudinal data from this pilot, assessing the impact of the pilot on goals of care documentation, and validating the concordance of PRPS and ECOG and their effect on clinical outcomes. Ultimately, we aim to use the resulting data and harness our dashboard of patients with advanced cancer and poor performance status to develop innovative, automated, and targeted quality improvement interventions.

Exploration of medical students’ approach to progress test preparation

Introduction: Medical students are expected to develop competencies in applying clinical knowledge. Progress testing is an assessment for learning and is intended to assist in knowledge acquisition and to promote ongoing recall. This study explored student preparation for progress tests (PTs), relationships between approach and performance, and patterns that could assist with targeting learning support. Methods: A cross-sectional survey exploring study approach and learning context, comprising multi-choice and open-ended responses, was administered to students during their clinical years (n = 297). Quantitative data was analysed using descriptive statistics and comparative analysis, and qualitative data was categorised. Results: One hundred twenty-nine students responded (43.4%), with most demonstrating a stable PT performance over time. Twenty-two students had dynamic changes in their aggregate grades. Poor early PT performance was associated with developing an improvement strategy (χ2 6.954, p = 0.008). Students never falling below satisfactory were less likely to have a strategy (χ2 10.084, p = 0.001). All poorly performing students were using practice question banks, but this was not true for students who scored satisfactorily. The need for pastoral care was associated with poorer performance (χ2 4.701, p = 0.030). Conclusions: Student approaches to PT preparation are diverse, however there are correlations between preparation factors and performance outcomes. Students with poor early performance demonstrated improved results over time that may be attributed to targeted support and preparation strategies. Widespread use of practice questions may not be sufficient to impact results without additional strategies. External impacts to performance were common, and barriers to accessing pastoral care were evident. The feedback dashboard was underutilised, suggesting a need to improve feedback literacy and ensure this is fit for purpose.

Drug Addiction Clinical Study Among Patients Admitted to the Alqana Center for Social Rehabilitation

Background: Drug addiction is a worldwide issue; 5.6% of the world's population aged 15 to 64 took drugs at least once in 2016. For the majority of medicines, younger individuals use them more than older people do. Drug abuse seems to be on the increase in several ASEAN (Association of Southeast Asian Nations) countries, particularly among young men aged 15 to 30. Illicit drug abuse account for around 14% of the overall health burden among young males. Younger individuals are also more prone to die from drug abuse issues. Aims of study is to assess the severity of problems related to drug addiction. in Baghdad city and to study epidemiological features of drug addiction among Patients Admitted to the Alqana Center for Social Rehabilitation. Patients and methods: An analytical cross-sectional study of 300 individuals diagnosed as a drug addiction patient according to the criteria established by the "Diagnostic and Statistical Manual of Mental Disorders", Fifth Edition, text revision, often called the DSM-V-TR or DSM-5-TR. From the medical department at Alqana Center for Social Rehabilitation in Baghdad. The research was carried out from 25/December/2023 to 30/June/2024. Results: the demographic characteristics of the study sample. In with a mean and a standard deviation (SD) of age of 29.33±18.68. Individuals aged 20-29 year had the highest proportion to addiction, with a rate of 42.7%. Conversely, 89.3% of the participants were male. The majority,86.7%, live in urban regions. The majority of patients had 51.7% unmarried, with only 36.0% being married and 12.3% was divorced. The main rate among drug addiction patients was 38.7% primary education ,33.0% secondary education, and 16.0% was illiterate patient, while lowest patient 12.3% at collage. According to the statistics in the table,76.3% of the participants were free business. 95.0% cigarette smoker. presented the result of psychological symptoms as show 93.0% of study addictive patient have mood swings, and in the same table the behavioral and social symptoms showed as 97.0% of study patient had poor performance and/or attendance at work or school. Also, physical symptoms of addiction showed as 74.7% of patient suffering from disrupted sleep patterns, including insomnia Regarding to the withdrawal symptoms of drug addiction presented in Table (3), results showed as 95.7% fatigue, 85.3% muscle pain or aches, 81.0% irritability and agitation, 76.0% trembling and tremors, 69.3% hunger, 50.7% anxiety, 36.7% sweating, 30.7% insomnia, 25.3% loss of appetite, 22.7% depression, 20.7% confusion, 22.3% nausea, 9.3% seizures, 8.0% dilated pupils, 3.3% vomiting, and 2.3% paranoia. Conclusion: the majority of addicted patient was male. the main symptoms were Poor performance and/or attendance at work or school and mood swing. The highly complication was fatigue. Regarding the way of addiction, the tablets is vast majority and enjoyment is the most common cause of addiction. Recommendations: It's possible that other important differences between the factors seen in this study would become clearer if multicenter study, the sample size was larger and the duration of the addiction study had been longer.

Impacto de la motivación laboral en el desempeño del personal administrativo en home office: un caso de estudio en una empresa comercializadora de plásticos.

In 2020, the world faced a severe health crisis derived from SARS CoV-2, so different social sectors found it necessary to modify and acquire new habits aimed at preserving hygiene and health. Specifically in the workplace, organizations faced situations that forced them to make decisions that significantly changed their usual work style. As a result of this situation, companies implemented different strategies in favor of staff health, one of the most used was the Home Office (working at home), which caused various problems among employees, such as increased stress, lack of communication, poor time management, poor performance, etc. In relation to the above, this research was carried out using a quantitative approach, with the application of a survey to the administrative staff of a company dedicated to the marketing of plastic items, with the purpose of knowing the working conditions of the collaborator. At home, and consequently, propose motivational strategies focused on promoting their performance and well-being at work. The results obtained reflect that the staff did not have spaces suitable for working at home, as well as difficulty communicating and interacting with colleagues, as well as the lack of time organization to carry out their work activities. Finally, recommendations are designed such as the periodic scheduling of effective meetings, discussions; actions that favorably impact the performance of collaborators.

Surface Lattice Engineering Enables Efficient Inverted Perovskite Solar Cells

AbstractState‐of‐the‐art inverted perovskite solar cells (PSCs) have exhibited considerable promise for commercialization due to their prospective stability. However, the intricate crystallization of halide perovskite, especially for multi‐component perovskites, not only distorts the surface lattice from its ideal form but also introduces numerous unsaturated dangling bonds to form surface defects, which can easily lead to reduced stability and poor performance. Herein, a surface lattice engineering is developed by coupling surface unsaturated ions and regulating ion bonding lengths/angles to achieve efficient and stable inverted PSCs. The renovated surface lattice not only eliminates shallow/deep level defects on the surface of perovskite, but also enhances photo/thermal stability of the materials. Moreover, the surface lattice engineering contributes to uniform potential surface, and improves energy‐level alignment at the interfaces of the perovskite and C60 carrier transport layer, enhancing charge carrier extraction and transportation. Finally, the champion PSC delivers an impressive efficiency of 25.82% (certified 25.5%). Moreover, these PSCs exhibit excellent operational stability, retaining 94% initial efficiency after more than ≈1 000h maximum power point test.

RISK FACTORS FOR SUBSTANCE USE AMONG MALE SECONDARY SCHOOL STUDENTS IN ADEN GOVERNORATE, YEMEN

Substance use among secondary school students is a growing concern with significant implications for public health. This study aimed to identify the risk factors associated with substance use in a community of secondary school students in Aden Governorate, Yemen. A cross-sectional study was conducted among secondary school students in Aden governorate, using a structured questionnaire to collect data on potential risk factors for substance use. The questionnaire included measures of Peer Pressure, Academic Performance (GPA), Parental Monitoring, as well as self-esteem towards drug use. The Self-esteem among secondary students was measured using Rosenberg's Self-Esteem Scale. Descriptive and inferential statistical analyses were performed to identify significant risk factors. A total of 280 male students from 10 secondary schools (both section) of Aden governorate participated in the study, with a mean age of 17.37± 1.42 years. Risk factors associated with substance use included peer pressure (OR=2.34, 95% CI: 1.56-3.42), poor academic performance (OR=1.87, 95% CI: 1.23-2.81), lack of parental supervision (OR=1.62, 95% CI: 1.09-2.37), and low self-esteem (OR=1.45, 95% CI: 1.01-2.11). The findings highlight the complex interplay of social, familial, and individual factors in contributing to substance use among secondary school students. These results can inform targeted interventions and preventive strategies to address the identified risk factors in the community. This study identified several key risk factors for substance use among secondary school students in the community. Understanding and addressing these risk factors is vital for the development of effective preventive interventions and support systems to mitigate the impact of substance use on the health and well-being of young individuals.

Whose democratization matters? Understanding the effects of regime change on normative changes in ASEAN

AbstractThis article aims to elucidate the varying effects of democratization in ASEAN members on the normative changes in the core principles of the “ASEAN Way.” Utilizing a regional-centric approach that emphasizes ASEAN members’ agency, the article posits that two critical variables shape the changing trajectory of ASEAN norms: ASEAN members' democratic performances and their regional status. While an ASEAN member’s democratic performance influences its willingness to advocate for normative changes, its regional status is also crucial in determining its capability to implement changes by navigating the divergent interests among ASEAN members. Only the ASEAN member with a high-quality democratic performance at home and recognized regional leadership can effectively bring about normative changes to ASEAN norms. Otherwise, either the domestic democratic deficit or a lack of leadership status will hinder the ASEAN members’ efforts to promote normative changes. Using the process-tracing method, the article empirically focuses on the Philippines, Thailand, and Indonesia for comparative case studies. The findings reveal that the Philippines’ poor democratic performance since the democratic restoration in 1986 has hindered its motivation to push for normative changes in ASEAN, rendering the Philippines a reluctant promoter. Although Thailand has made notable achievements in democratic consolidation since the downfall of junta rule in 1992, its lack of regional leadership has greatly limited its capability to reconcile the divergent interests among ASEAN members, resulting in the failure of its “flexible engagement” initiative. Conversely, Indonesia, with a high-quality democratic performance at home and bolstered by its regional leadership status, successfully brought significant changes to ASEAN norms by facilitating the ASEAN Charter signed in 2007.

Silent Struggles: Exploring the Effects of Anxiety and Depression on Higher Level Students

The purpose of the current study was to explore the effects of anxiety and depression on higher level students. The research was descriptive in nature, and to achieve the objectives of the study, a sample of three thousand four hundred and eighty higher level students was selected using stratified sampling technique. The data analysis statistics included both descriptive and inferential analysis. The findings reveal that anxiety and depression have a significant effect on university students, leading to poor academic performance. Moreover, males face higher levels of anxiety and depression as compared to females. This study recommends that teachers and parents should try to identify or understand if their child is going through any sort of mental discord. Teachers should act as role models for students to promote the importance of a content and calm mind and explain to them the importance of mental health.

Influence of Students’ Participation in Young Farmers’ Club on Performance in Agriculture in Secondary Schools in Suba Sub-County, Kenya

Agriculture is one of the most important sectors for economic growth in Kenya. Setting up of young farmers’ club (YFC) in secondary schools is one way of attracting young people in agriculture as well as developing their production skills. Inadequate participation in young farmers’ club may lead to poor performance in agriculture and negative attitude towards the subject by secondary school students.The aim of this study was to determine the influence of students’ participation in young farmers’ club on performance in agriculture subject in secondary schools in Suba Sub-County. A cross-sectional survey research design was employed in the study which targeted 628 Form Three agriculture students in public secondary schools in Suba Sub-County. Data was collected from an accessible population of 286 Form Three Young Farmers’ Club members in 37 public secondary schools in Suba Sub-County. Stratified random sampling was used to get the study sample of 126 respondents. Data was collected using semi-structured questionnaires. Experts from the field of Agricultural Education and Extension of Egerton University assessed the instrument to ensure validity. Reliability was estimated through a pilot testing of 30 agriculture students in five secondary schools in neighbouring Nyatike Sub-County. The reliability was estimated using Cronbach alpha co-efficient where a co-efficient of 0.817 was computed and taken as satisfactory. Data was arranged,coded and analyzed using SPSS version 25. The study findings revealed that students’ performance in agriculture subject is significantly enhanced by participation in Young Farmers’ Club. This study recommends that students’ participation in Young Farmers’ Club activities should be encouraged in all secondary schools as a way of augmenting the students’ performance in agriculture subject. This can be done by availing adequate time for YFC’s activities. In addition, students in YFCs should be accorded with the required facilities in order to make their participation worthwhile.

Misconceptions and Errors Among Grade 12 Students When Learning Differentiation Rules: A Case Study

t is an established fact that some grade 12 students learning differentiation in calculus are found struggling with the rule of differentiation and these rules include power rule, quotient rule, chain rule and product rule. Because of these, some students came up with some misconceptions which eventually resulted to the students having multiple errors when learning rules of differentiation. The reason associated with these common errors are not far from their failure to model some prerequisite knowledge in the laws of logarithm into their learning of the laws of differentiation. And this has resulted to the poor performance of some students in mathematics (calculus) since calculus carries about 40% in the overall grade in mathematics as a subject at grade 12 level. On this note, this paper presents an analysis of students’ errors and misconceptions in learning differentiation rule. The study was conducted among grade 12 students preparing for NSC examination in a high school in Limpopo province in South Africa. And the data was initially collected using 35 test scripts of grade 12 on the topic of differentiation and differentiation rule. A qualitative approach was considered, and the data collected was analysed, focusing on product rules, quotient rules and chain rules and the errors committed. The result of the study indicated that some grade 12 students make some errors and misconceptions in differentiation rules. And these were because of poor conceptual understanding, poor mathematics language understanding, and some other error. It was confirmed that the results of this study highlight the common mistakes and errors students make when learning differentiation rules, and these errors are; conceptual, systemic, language, and generalization errors.

The Real-World Outcomes of Relapsed/Refractory Multiple Myeloma Treated with Elotuzumab, Pomalidomide, and Dexamethasone.

Introduction: A combination of elotuzumab, pomalidomide, and dexamethasone (EPd) was approved for the treatment of relapsed/refractory multiple myeloma (RRMM) following the ELOQUENT-3 phase II clinical trial. However, the clinical experience with this therapy is still limited. In this retrospective study, we analyzed the efficacy and safety of EPd in a real-world cohort of RRMM patients. Patients and Methods: The medical records of 22 patients who received EPd for RRMM at Yokohama Municipal Citizen's Hospital (Japan) between January 2020 and July 2021 were reviewed. Results: The median age of our cohort was 73.5 years. The overall response rate was 55%. With a median follow-up of 20.2 months, the median progression-free survival (PFS) was 9.1 months (95% confidence interval [CI], 2.5-23.0 months). The median PFS was shorter in patients with a poor performance status (PS) than in those with favorable PS (2.5 vs. 10.8 months; p < 0.01). Patients with prior daratumumab had significantly shorter PFS than those without prior daratumumab (2.1 vs. 23.0 months; p < 0.01). Additionally, patients with prior pomalidomide had significantly shorter PFS (1.7 vs. 10.3 months; p < 0.01). In the multivariate analysis, poor PS (hazard ratio [HR] = 4.1, 95% CI: 1.1-15.6; p = 0.04) and prior exposure to daratumumab (HR = 3.8, 95% CI: 1.1-13.8; p = 0.04) remained significantly associated with shorter PFS. Conclusions: The results of our study suggest that EPd is an active and well-tolerated regimen in RRMM, even in real-world patients. Furthermore, EPd may be useful, especially in daratumumab-naïve patients.