Research Study Research Articles

Science Learning Game (SLG) Based on Augmented Reality Enhances Science Literacy and Critical Thinking Students Skills

Science literacy is the ability of individuals to understand, evaluate, and apply scientific knowledge in everyday problem-solving, while critical thinking is the ability to analyze, evaluate, and make decisions based on evidence and logic. This research is based on several issues in SDN Sentul2 Kota Blitar in grade 6 post-Covid 19. This research aims to produce a product used as a learning tool in Grade 6, namely Science Learning Game (SLG) Media based on Augmented Reality to Improve Science Literacy and Critical Thinking Skills in Grade 6 Students in Kota Blitar. This research and development (R&D) study uses the ADDIE (analysis, design, development, implementation, and evaluation) model. The instrument used is a questionnaire. The research data analysis results show that the developed media can improve critical thinking skills, as evidenced by comparing the Pre-test results at 72.21% with the Post-test results at 93.57%. This media can also enhance science literacy, as indicated by the increase between the Pre-test results at 74.28% and the Post-test results at 92.14%. The implication is that the science literacy and critical thinking abilities of students in Indonesia still need improvement, which can be achieved by considering the use of instructional media. With positive results in pre-test and post-test scores, this media has the potential to enhance science literacy and critical thinking skills in students.

Effects of Multimodal Exercise With Augmented Reality on Cognition in Community-Dwelling Older Adults

ObjectivesThis study aims to investigate the effects of an exercise intervention using multimodal exercise with augmented reality and multimodal exercise-only on cognitive function in older adults living in a community dwelling. DesignQuasi-experimental research study. Setting and ParticipantsIn this control study, 78 participants were divided into 2 experimental groups (with sessions 3 times a week for 12 weeks) and a control group (CG). MethodsEG1 participated in a multimodal exercise-only intervention program, EG2 participated in a multimodal exercise program with augmented reality exergames, and CG continued its usual activities. Participants were assessed at baseline and postintervention after 12 weeks. ResultsComparison between baseline and postintervention at 12 weeks showed significant improvements in executive functions, verbal fluency, choice reaction time, and dual task in EG1, whereas there were improvements in general cognition, executive functions, verbal fluency, discrimination reaction time, and depression in EG2 (P ≤ .05). The clinical effect sizes of the interventions were large for overall cognition, executive functions, and reaction time on single- and dual-task reaction time in EG1 and for overall cognition, executive functions, and verbal fluency in EG2. Conclusion and ImplicationsThe intervention programs showed significant improvements in several cognitive domains. The multimodal exercise-only showed improvements in more variables than the multimodal exercise with augmented reality, but the augmented reality group showed greater changes between baseline and postintervention.

Synthesis, in vitro α‐Glucosidase Inhibition, DFT Calculations, and Molecular Docking Studies of Some New Substituted 2,5‐Bis(pyrazolyl)‐1,3,4‐oxadiazoles

AbstractA pivotal feature of present research study is the synthesis of some new 2,5‐bis(pyrazolyl)‐1,3,4‐oxadiazoles as promising α‐glucosidase inhibitors. In this regard, a facile reaction scheme was designed to afford 1,3,4‐oxadiazole ring. In search of the most favourable reaction condition, a model reaction was first carried out between 1,3‐diphenyl‐1H‐pyrazole‐4‐carbohydrazide (3) and 1,3‐diphenyl‐1H‐pyrazole‐4‐carboxylic acid (4 a) using phosphorous oxychloride (POCl3). The results emanated from this model reaction were utilized to prepare other derivatives to highlight the scope of current synthetic approach and the structures of the prepared molecules were characterized from spectroscopic techniques. These derivatives were further investigated for their α‐glucosidase inhibitory potentials. 2,5‐Bis(1,3‐diphenyl‐1H‐pyrazol‐4‐yl)‐1,3,4‐oxadiazole (5 a) and 2‐(3‐(4‐bromophenyl)‐1‐phenyl‐1H‐pyrazol‐4‐yl)‐5‐(1,3‐diphenyl‐1H‐pyrazol‐4‐yl)‐1,3,4‐oxadiazole (5 c) displayed strong in vitro inhibitory activities with IC50 73.1±1.13 μM and IC50 87.3±1.12 μM respectively with least toxicity profiles. Molecular docking and computational studies including geometry optimization of synthesized molecular systems, calculations of their orbital energies, and molecular electrostatic potential (MEP) surface maps further helped to establish structural and electronic properties contributing towards their bioactivity. The electrophilicity index significantly quantifies the biological activity. The experimental and computational data altogether facilitated in understanding the therapeutic attributes of these versatile scaffolds in relation to their α‐glucosidase inhibition.

Proposed Corporate Performance Management Using Knowledge-Based Performance Management System (KBPMS) For Privy

PT. Privy Identitas Digital or Privy Digital Identity (Privy) is a firm established in Jakarta in 2016 that specializes in the provision of Certified Electronic Certificate Organization and Electronic Signature Organization services. Privy offers legally enforceable digital signature services, along with reliable digital identities, facilitating direct connections between businesses and customers. This thesis investigates the deployment of an integrated performance management system emphasising the Knowledge-Based Performance Management System (KBPMS) at PT. Privy Identitas Digital (Privy), a firm that specialises in certified electronic certificates and digital signatures. The exponential expansion of Privy's services has highlighted the need of aligning its business strategy with frontline operations by using integrated planning and monitoring tools. The research study of integrated performance management, which includes financial goals, customer, process, and employee perspectives, is examined in detail. The suggested method uses a robust performance management framework to address enterprise issues including traditional marketing tactics and the absence of Key Performance Indicators (KPIs). KBPMS optimises company performance, meets business objectives, and promotes continuous development. Significant benefits are anticipated to result from the implementation of the KBPMS, including the following: increased talent development by means of targeted training and feedback derived from individual performance evaluations; enhanced employee engagement and motivation through transparent feedback and aligned goals; increased organisational agility and responsiveness to market changes via data-driven performance insights; and optimised resource allocation and cost reduction via the KBPMS. By showcasing the advantages of incorporating digital technology into performance management, it facilitates the adoption of comparable approaches by other organisations, thereby maximising the capabilities of their workforce.

Teaching physical education during the time of pandemic

This research study aimed to identify the modalities used in teaching Physical Education in the district of San Rafael, Bulacan during the time of pandemic. Further, the study investigated the challenges experienced by the Physical Education (PE) teachers and the solutions they made to address these challenges. The end goal of the study was a school action plan for physical education to address the issues in teaching PE during the pandemic. Qualitative research design through thematic analysis was employed and a semi structured virtual interview was conducted to further substantiate the findings of the study. Results revealed that modular learning is the most common modality used by Physical Education teachers in this time of pandemic. Other modalities such as synchronous and asynchronous online learning and physical activity mobile applications were used by the teachers. It was also revealed that their main reason for using the modalities was for the welfare of their students. Further, the lack of resources of students in terms of internet connectivity and gadgets was the common struggle experienced by the Physical Education teachers and the most common solution done by the Physical Education teachers was doing follow-up with the students through social media. This study recommended the implementation of the proposed action plan to improve the modalities of teachers in teaching Physical Education and to help them avoid problems they may encounter.

Evaluation of ethanol extract of Allium cepa and fractions on haematological parameters in doxorubicin-induced Cardiotoxicity using Wistar rats

This research study evaluated the effects of Ethanol extract of Allium cepa (A. cepa) popularly known as Onions and its fractions on haematological parameters in doxorubicin-induced cardiotoxicity using Wistar rats. A total of 45 Wistar rats weighing between 150-200 g were recruited for this study. They were randomly divided into 9 groups of 5 animals each; as follows: Group 1: served as control and received 10 ml /kg/ body weight (b.w) per oral (p.o) of normal saline. Group II: received 3.5 mg / kg b.w intraperitoneal (i.p) of Doxorubicin (Dox). Group III: received 500 mg/kg/ b.w p.o of vitamin E plus Dox. Group IV: received 1000 mg/kg/ b.w of crude extract (C.E) of A. cepa plus Dox. Group V: received 1000 mg/kg b.w of n-Hexane fraction of A. cepa plus Dox. Group VI: received 1000 mg/kg b.w of dichloromethane (DCM) fraction of A. cepa plus Dox. Group VII received 1000 mg/kg b.w of ethyl acetate (E.A) fraction of A. cepa plus Dox. Group VIII: received 1000 mg/kg b.w of methanol (METH) fraction, and Group IX received Combinations of C.E of A. cepa + vitamin E and Dox respectively for 14days. Groups I and II treatments lasted for 14 days, while treatments for groups III-IX lasted for 16 days (making 14 days for respective treatments and additional 2 days for doxorubicin administered once 48 hourly before sacrificing. All substances in this study were administered orally except doxorubicin that was administered intraperitoneally. Haematology results obtained from this study showed Dox administration negatively altered full blood count; Red blood cell (RBC), White blood cell (WBC) and Platelets levels significantly (p<0.05). However, pre-treatment administration with Allium cepa showed significant (p<0.05) improvement of full blood count levels from the effects of singular administration of Dox. Injury to the myocardium was also observed on histological examination in the Dox treated group. Our findings indicate that haematological parameters RBC, WBC, Platelets could be useful diagnostic tools in prediction and evaluation of Cardiotoxicity. Haematology results obtained from this study showed Doxorubicin administration significantly altered (p<0.05) full blood count; Red blood cell (RBC), White blood cell (WBC) and Platelets levels. However, pre-treatment administration with Allium cepa showed significant (p<0.05) improvement of full blood count levels from the effects of singular administration of Doxorubicin. Injury to the myocardium was also observed on histological examination in the Doxorubicin treated group. Our findings indicate that haematological parameters RBC, WBC, Platelets could be useful diagnostic tools in prediction and evaluation of Cardiotoxicity.

Credential Method as A Measurement Tool for Nurses' Professionalism in A Hospital

Credentials as an effort to maintain nurse competency and become the basis for granting clinical authority to nurses have not been implemented well. Implementation of processes for achieving goals varies across institutions. This research aims to identify the relationship between credentialing methods and the outcomes of the Ongoing Professional Practice Evaluation (OPPE) by investigating differences in OPPE scores based on years of experience. This is a quantitative research study with a descriptive correlational and comparative approach, involving 66 respondents who meet the criteria: Nurse PK I; less than 5 years of experience. Data analysis was conducted using Rank Spearman correlation and Kruskal-Wallis tests. The credentialing test method used a portfolio, interview, written test, and practical examination. The research results indicate that 48.48% of credentialing is done using these four methods. The majority of OPPE scores are rated as Good, accounting for 66.67%. The longer a nurse works, the better their performance rating. The Spearman rank test obtained a correlation coefficient of 0.353 with p= 0.004 (p<0.05), and the Kruskal-Wallis test obtained a Kruskal-Wallis value of 41.289 with p=0.000 (p<0.05). Conclusion: There is a relationship between credentialing methods and OPPE scores. The more credentialing methods used, the better the OPPE scores.

Reducing the equity gap in under-5 mortality through an innovative community health program in Ethiopia: an implementation research study

BackgroundThe Ethiopian government implemented a national community health program, the Health Extension Program (HEP), to provide community-based health services to address persisting access-related barriers to care using health extension workers (HEWs). We used implementation research to understand how Ethiopia leveraged the HEP to widely implement evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) and address health inequities.MethodsThis study was part of a six-country case study series using implementation research to understand how countries implemented EBIs between 2000–2015. Our mixed-methods research was informed by a hybrid implementation science framework using desk review of published and gray literature, analysis of existing data sources, and 11 key informant interviews. We used implementation of pneumococcal conjugate vaccine (PCV-10) and integrated community case management (iCCM) to illustrate Ethiopia’s ability to rapidly integrate interventions into existing systems at a national level through leveraging the HEP and other implementation strategies and contextual factors which influenced implementation outcomes.ResultsEthiopia implemented numerous EBIs known to address leading causes of U5M, leveraging the HEP as a platform for delivery to successfully introduce and scale new EBIs nationally. By 2014/15, estimated coverage of three doses of PCV-10 was at 76%, with high acceptability (nearly 100%) of vaccines in the community. Between 2000 and 2015, we found evidence of improved care-seeking; coverage of oral rehydration solution for treatment of diarrhea, a service included in iCCM, doubled over this period. HEWs made health services more accessible to rural and pastoralist communities, which account for over 80% of the population, with previously low access, a contextual factor that had been a barrier to high coverage of interventions.ConclusionsLeveraging the HEP as a platform for service delivery allowed Ethiopia to successfully introduce and scale existing and new EBIs nationally, improving feasibility and reach of introduction and scale-up of interventions. Additional efforts are required to reduce the equity gap in coverage of EBIs including PCV-10 and iCCM among pastoralist and rural communities. As other countries continue to work towards reducing U5M, Ethiopia’s experience provides important lessons in effectively delivering key EBIs in the presence of challenging contextual factors.

Strength, deformation, and environmental impact assessment of cement stabilized mine overburden soil

Mine haul roads are the unpaved roads that are constructed from the overburden materials obtained from the mining operations and are used for the movement of heavily loaded dumpers and trucks. The haul roads constructed from this overburden material shows continuous distress in the form of over ruts, potholes, and shear failures, creating major issues in the movement of dumpers. In the present research study, an experimental investigation was conducted based on mechanistic empirical design to evaluate the strength-deformation characteristics, durability, and environmental emissions of cement stabilized overburden soil of a local mine. The unconfined compression tests were conducted at cement dosages varying from 1 to 6% of dry soil mass and increase in the unconfined compressive strength were examined at different intervals of time until 28 days of the curing period. In the case of static triaxial tests, the enhancement in undrained shear strength and elastic modulus of stabilized specimens was determined in comparison to the untreated specimens, whereas in cyclic triaxial tests, the reduction in permanent deformations and increase in resilient modulus were evaluated under different confining pressures and cyclic deviatoric stresses. An empirical model has been proposed to predict the long-term rutting of overburden under repeated loading. The proposed model is based on the behaviour of various parameters, such as applied cyclic deviatoric stress, number of load repetitions, loading frequencies, and on the permanent deformation characteristic of mine overburden soil. In addition, durability and environmental sustainability aspects of the treatment has also been studied to determine the optimal dose of cement.

Factors Affecting Construction Delay in Residences

Construction projects in India are facing delays. It is essential to create a clear understanding among experts in the field and carry out an in-depth analysis of the causes of delays because the volume and capacity of the Indian construction sector have changed significantly over the past ten years. Construction delays have a considerable influence on residential projects budgets, schedules, and stakeholder satisfaction. Construction delays are a big issue in the residential construction industry since they increase costs, cause time delays, and disrupt quality. It is crucial to pinpoint the primary causes of these delays in order to reduce the effect they have on project performance. This research study attempts to give a thorough understanding of the factors that contribute to construction delays in residences. This study synthesises previous literature and research findings to investigate a number of factors, their interactions, and their influence on project delays. In order to properly manage and reduce construction delays in residential construction projects, the review underlines the relevance of recognising these aspects.

Evaluation of analgesic and anti-inflammatory activities of ethanolic fruit extract of Terminalia chebula

Analgesic and Anti-inflammatory activities of ethanolic fruit extract of Terminalia chebula was evaluated using tail-flick method, eddy’s hot plate method, acetic acid induced writhing responses and in-vivo anti-inflammatory property was determined using carrageenan rat paw edema. The ethanolic fruit extract of Terminalia chebula at different concentrations significantly inhibited the nociception in comparision with different standard drugs that showed anti-nociception. The test extract also reduced the edema induced in rats using carrageenan paw edema method as compared with the standard drug Diclofenac sodium 10mg/kg. The results obtained in this research study found to be very significant when compared to standard reference drug.

Meta-analysis: The effect of the discovery learning model on indonesian students’ mathematics reasoning

The ability of mathematical reasoning is one of the important skills for students. The discovery learning model is a suitable learning model to enhance students' mathematical reasoning abilities. The research uses meta-analysis methods through a review of articles in Indonesian national journals. From Google Scholar, Portal Garuda, and Sinta ristekbrin, the author obtained 10 studies that met the inclusion criteria for analysis on the Meta-Mar website to obtain a combined effect size. From the interpretation of this combined effect size, it can be concluded that the overall implementation of the discovery learning model has a moderate effect on students' mathematical reasoning abilities. The characteristics of this research study include educational level, year of research, and sample size. From the statistics, it was found that implementing the discovery learning model to improve students' mathematical reasoning abilities is influenced by educational level, year of research, and sample size.

Effects of perceptions of the importance of patient safety management and patient safety competency on patient safety management activities among nurses at unaccredited general hospitals

Purpose: This descriptive research study attempted to determine how general hospital nurses’ awareness of the importance of patient safety management and patient safety competency affected patient safety management activities.Methods: From September 13 to 26, 2022, a survey was administered to 230 ward nurses who provided direct care to patients at five non-accredited general hospitals being evaluated for accreditation located in metropolitan cities. The collected data were analyzed with descriptive statistics, the t-test, one-way analysis, the Scheffé test, Pearson correlation coefficients, and hierarchical regression using SPSS for Windows version 26.0.Results: In total, 221 (96.1%) respondents were female. The average age was 32.2 years, and the average clinical experience was 3.5 years; 196 participants (85.2%) were general nurses. Patient safety competency (β = .44, p < .001), awareness of the importance of safety management (β = .31, p < .001), and medication error experience (β = -.15, p = .002) all had statistically significant associations with patient safety management activities. The explanatory power of these variables for patient safety management activities was 50.7%. Conclusion: This study confirmed that patient safety competency, awareness of the importance of patient safety management, and experience with medication errors significantly influenced patient safety management activities.

Effect of Art Integrated Learning on Knowledge Retention Ability of Students at Upper Primary Level

The presented research study is related to the study of the effect of art-integrated learning strategies on the knowledge retention ability of students. The main objective was to examine the effect of art-integrated learning strategies on the knowledge retention ability of students. The researcher used an experimental research method to achieve the objectives. The researcher selected RS Public School, Sikandra, Agra governed by CBSE Board, India by Convenience sampling method, and the Random sampling method was used for the selection of class 7, 2 groups (Experimental and Control group). The number of students in both groups (experimental and control group) was equal 35-35. After conducting a pre-test using the Self-constructed Knowledge Retention Inventory to evaluate the knowledge retention ability of students in both experimental and control groups, the researcher taught social science using 20 lesson plans based on Art Integrated learning strategies to the experimental group. Meanwhile, in the control group, the same subject matter was taught by using conventional teaching methods. Afterward, a post-test of the knowledge retention ability of students was conducted by the researcher. In the context of students' knowledge retention ability, statistical analysis was performed on the obtained pre-test and post-test scores. Using the pre-test and post-test scores obtained in the context of students' knowledge retention ability, statistical tests such as mean, standard deviation, and critical ratio were used to examine the significance of Art Integrated learning strategies. Based on the results of the present research study, it was found that the use of Art Integrated learning strategies in teaching has a significant impact on students' knowledge retention ability. Therefore, the hypothesis made in the context of ‘There is no significant effect of Art Integrated Learning Strategies on the Knowledge Retention Ability of students at upper primary level in experimental after treatment.’ has been rejected. Based on the results of this research, it can be said that teachers should use Art Integrated learning strategies in their teaching-learning activities, so that students' knowledge retention ability can be raised to a higher level regarding social sciences, and they can also express their proficiencies in the context of various aspects of education.

A Research Study on the Process of Creation of Awareness and Sensitivity to the Total Environment

Environmental Education is therefore the process of creation of awareness and sensitivity to the total environment, acquisition of knowledge, creation of appropriate attitudes and acquisition of skills for solving the environmental problems. The International conference recommended that "A basic aim of Environmental Education is to succeed in making individual and Communities understand the Complex nature of environment and to acquire the Knowledge values and attitudes which will help in the management of quality of environment.

A novel approach has been developed to produce pure plant-based gel soy yogurt by combining soy proteins (7S/11S), high pressure homogenization, and glycation reaction

This research sought to examine how the physicochemical characteristics of soy globulins and different processing techniques influence the gel properties of soy yogurt. The goal was to improve these gel properties and rectify any texture issues in soy yogurt, ultimately aiming to produce premium-quality plant-based soy yogurt. In this research study, the investigation focused on examining the impact of 7S/11S, homogenization pressure, and glycation modified with glucose on the gel properties of soy yogurt. A plant-based soy yogurt with superior gel and texture properties was successfully developed using a 7S/11S globulin-glucose conjugate at a 1:3 ratio and a homogenization pressure of 110 MPa. Compared to soy yogurt supplemented with pectin or gelatin, this yogurt demonstrated enhanced characteristics. These findings provide valuable insights into advancing plant protein gels and serve as a reference for cultivating new soybean varieties by soybean breeding experts.

The Mothers’ Role in the Children’s Choice of a Career in Entrepreneurship: An Examination of Mothers in Sri Lanka

Making the choice of individuals to choose a career in self-employment is critical as an entrepreneur contributing to a county’s economy. Entrepreneurship as a choice is influenced by many contemporaneous variables such as household wealth, gender, spouse's education, family composition, along with health. This paper examined the mothers’ influence on the choice of individuals to engage in entrepreneurship. Even though many studies have been conducted in understanding the various factors that prevent an individual from becoming an entrepreneur limited studies have been conducted in understanding the mother’s contribution to creating or crushing entrepreneurial mind set of a child especially in the Sri Lankan context. Having understood that a qualitative research study supported by twenty in-depth interviews were conducted among mothers and children to explore their influence on the child’s choice of becoming an entrepreneur. The findings imply that there is a significant impact of a mother on the probability of an individual to become an entrepreneur. Keywords: Entrepreneurship, Entrepreneurial Education, Entrepreneurial Intention, Entrepreneurial Orientation, Mothers’ Influence.

Engineering Students' Acceptance of Augmented Reality Technology Integrated with E-Worksheet in The Laboratory Learning

The use of augmented reality (AR) technology in the field of education has emerged as a rapidly growing trend. However, there is an urgent need for more comprehensive research to determine the reactions of engineering students and their acceptance of this technology in laboratory learning. This study investigates the acceptance of integrated augmented reality with e-worksheet (IARE-W) among engineering students in the laboratory learning (IARE-W) among engineering students the electrical machines course (EMC). This research empirically uncovers the factors that influence it based on the technology acceptance model (TAM), specifically perceived ease of use (PEU) and perceived usefulness (PU). Acceptance is indicated by students’ attitudes toward the use. A survey-based quantitative research study using questionnaires was conducted to collect data, involving 102 students in the field of industrial electrical engineering. The partial least squares structural equation modeling (PLS-SEM) analysis was used to analyze the research data. The results demonstrated that engineering students had a highly positive attitude toward the use of the IARE-W in the EMC. Additionally, both PEU and PU had a positive and significant direct effect on engineering students’ attitudes toward using IARE-W. Furthermore, PEU also had a significant and positive indirect effect through PU as a mediating variable. These findings have significant implications for the development of engineering education and the integration of AR technology in laboratory learning contexts. The results of this study underscore the importance of taking into account PEU and PU in the design, development, and implementation of the IARE-W.

KMS Infrastructure for KM Practice in Two Mobile Telecommunication Companies in Namibia

Knowledge management system infrastructure is at the forefront of knowledge management practice. Knowledge must be identified, captured, and shared to improve KM practices; however, little is known about the successful implementation of KMS infrastructure by Namibian mobile telecommunications companies. This mixed-methods research study employed a convergent parallel design and parallel sampling techniques. Three hundred and nine online questionnaires were distributed to a representative sample, with a response rate of 57%. Computer software packages were used to analyse quantitative data quantitatively, and qualitative data from interviews with 11 participants and analysis of documents were analysed thematically. Findings showed that infrastructure, management support, and employee participation were necessary for a successful KMS infrastructure implementation for effective and efficient KM practices. The study provides MT companies with a foundational understanding of how the infrastructure for KMS is essential for effective and efficient KM practice.

Experiences of a Circus Performance Among Patients with Depressive Symptoms: A Phenomenological Study.

Introduction: Depression is the leading cause of disability worldwide. Support can be provided by the arts. Objective: The aim of the study was to explore the experiences of patients with depressive symptoms after a circus performance. Methods: A qualitative research study using a phenomenological approach was carried out. The design was approved by an ethics committee. Volunteers were referred by general practitioners to an ambulatory cultural program and were invited to express their experience throughout interviews that were analyzed with the interpretative phenomenological analysis method. Results: Twelve patients participated in the interviews. The effect on the patient was linked to interactions with the performance. It was an effective way of socializing for patients. The show offered patients distance from their daily difficulties. The circus provided specific elements as a resource for patient empowerment. The experience lived by patients during a circus performance is a cognitive phenomenon inducing an influence on the spectator with depressive symptoms. A beneficial effect depended on the artistic content selected, the support offered by the organization operator, and the medical orientation. Conclusions: The observations characterized the emotional reception of a circus show among people. This study invites further exploration of the impact of circus art on the quality of life of patients with depressive symptoms.