Journal articles on the topic 'Reading level 7-9'

This study investigates the manner in which reading achievement at the elementary level relates to the development of behavioral disorders at the secondary level. Selected were 90 students in grades 7 through 12; 45 had been identified as behaviorally disordered only at the secondary level and 45 were normal students. Significant relationships were found between behavioral disorders and early reading achievement (grades 3, 4, and 5) and current reading achievement (grades 7 and 9). A significant and increasing discrepancy in reading achievement was obtained between groups. Results support the interpretation that a pattern of relatively poor reading achievement is associated with behavioral disorders and continuing, poor performance in reading at the secondary level. Findings are discussed in reference to an attributional model of achievement behavior and the development of interventions that account for teachers' and behaviorally disordered students' attributions for performance.

The article studies and analyzes the principles of optimization of the learning process of Ukrainian language by foreign students. At the present stage, an important problem for methodologists and teachers of Ukrainian as a foreign language is the improvement and use of certain methods and techniques. Yes, reading as a language activity is extremely important because it helps to develop the speaking and writing of foreign students. The purpose of reading is to uncover meaningful connections, to understand the visual message. It is worth noting that learning to read is a complex process. It is extremely important in the system of teaching Ukrainian as a foreign language, as it contributes to mastering the language, as well as a way to familiarize students with Ukraine and its culture. There are the following types of reading: review, introductory, educational, abstract (some methodologists). At a high level, foreign language proficiency in foreign students should be equal to their native language reading mechanism. But when choosing text, the teacher should be clearly aware of its volume, logical and compositional structure, the complexity of the language material. It is from the text that a foreign student receives information that shapes his or her outlook, enriches country-specific data about Ukraine. We considered the thematic filling of texts for level C1, as well as the system of tasks that is necessary for students to master the actual material.

The Advanced Stanford Achievement Test (SAT) Reading Comprehension subtest was administered to a group of 36 Caucasian learning disabled children (6 girls and 30 boys) in Grades 7 through 9 who were classified by the clinical Lexical Paradigm as either good readers or poor readers. Using the standardized (silent reading) method of administration, these learning disabled children all scored below the normative (50th percentile) level of performance and the poor readers scored substantially lower than good readers. When the child was allowed to listen and read silently, however, while the test material was read aloud, both poor readers and good readers showed significantly improved performance. This improvement which allowed the average of the poor readers to approach the normative level and the good readers to exceed it, supports the argument that a “bypass approach” to education of poor readers which includes listening-reading tasks might greatly enhance their learning and performance in school-related reading tasks.

Abstract: The objective of this study was to investigate English reading motivation, reading strategy, reading attitude and reading interest of junior high school students (Year 7, 8 and 9) in Palembang. The sample of this study was three-hundred students selected randomly from ten schools. In accordance with quantitative research design, English reading motivation, reading strategy, reading attitude and reading interest questionnaires were used as the instruments to collect the data which were statistically analyzed. The findings of this study showed that the students demonstrated a high level of English reading motivation; specifically, their instrumental motivation for reading was higher than the integrative one. Next, there was a high use of reading strategies, with Problem-Solving reading strategy as the highly used ones. The finding also revealed that the students demonstrated a positive reading attitude and their reading interest showed their reading preference was adventure stories. Keywords: English reading motivation, reading strategies, reading attitude, reading interest, self-efficacy, junior high school students

e18662 Background: Smoking cessation after a cancer diagnosis improves cancer outcomes. Therefore, it is important for cancer centers to provide educational resources to encourage patients to quit smoking. The NIH recommends that patient reading materials be written at a grade 6-7 reading level to maximize comprehension. As smokers on average have lower educational attainment than the general population, they may have particular difficulty comprehending smoking cessation materials written at advanced grade levels. Methods: This study evaluated the reading level of online resources via textual analysis of smoking cessation webpages associated with 63 NCI-Designated Cancer Centers or their affiliated medical centers or universities. Reading level was assessed using the WebFx Readability Test Tool. Differences in grade level were calculated by Mood’s Median Test. Content was evaluated for the quality of information, including textual analysis of print-out pamphlets. Non-English content and ease of navigation to webpages was documented. Results: Availability: Of 63 cancer centers, 42 (67%) had smoking cessation webpages. Among centers that did not have their own webpages, 14 had smoking cessation webpages hosted by affiliated medical centers and the remaining 7 had webpages hosted by affiliated universities. Reading Level: The median grade level for online smoking cessation materials was 9 (interquartile range IQR 8-10). There was no significant difference in grade level based on cancer center region, ranking, or whether the webpage was hosted by the cancer center, medical center or university. 17 webpages (27%) had print out pamphlets available, which had a median reading level of 8.5 (IQR 7-10). Information Quality: 27 webpages (43%) explicitly stated that smoking cessation improves cancer outcomes, 15 (24%) included details about smoking cessation medications, 16 (25%) provided information on behavioral counseling, and 14 (22%) described the risks/benefits of e-cigarette use. Only 4 (6%) had information on all four topics, while 21 (33%) did not have information on any of these four topics. Accessibility: Only 3 webpages (5%) were available in multiple languages. 12 webpages (19%) were inaccessible by search from the homepage with common terms (i.e. smoking, quit smoking, tobacco, etc). 38 webpages (60%) required 3 or more clicks to reach from the center homepage. Conclusions: Online smoking cessation materials at leading cancer centers exceed recommended reading levels, which can inhibit comprehension for patients trying to quit smoking. These webpages do not routinely include information on cancer outcomes or on evidence-based medications and behavioral change interventions to assist patients in quitting. Given the survival benefit found in cancer patients who quit smoking, it is imperative that educational materials from cancer centers maximize comprehension and accessibility.

ABSTRACTThis study examines the contribution of early phonological processing (PP) and language skills on later phonological awareness (PA) and morphological awareness (MA), as well as the links among PA, MA, and reading. Children 4–6 years of age with poor PP at the start of school showed weaker PA and MA 3 years later (age 7–9), regardless of their language skills. PA and phonological and morphological strategies predict reading accuracy, whereas MA predicts reading comprehension. Our findings suggest that children with poor early PP are more at risk of developing deficits in MA and PA than children with poor language. They also suggest that there is a direct link between PA and reading accuracy and between MA and reading comprehension that cannot be accounted for by strategy use at the word level.

This research aims to examine the metaphors on the concepts of reading and listening of the secondary school students and is based on phenomenology. 390 randomly selected secondary school students participated in this study in the 2016–2017 academic year in Turkey. The study includes all the grades (5, 6, 7, & 8th) at the secondary school level. “Reading is like ..................., because .....................”, “Listening is like ..............., because ..................” were the two sentences given to the students and they were asked to fill in the blanks. The data were analyzed by the content analysis. The students created 385 metaphors about the concept of reading and 329 metaphors about the concept of listening. Metaphors on the concept of reading were divided into 11 categories: A source of knowledge/learning, development, necessity, imagination, life, finding peace, sincerity, boredom/suffocation, eternity, guidance, enjoyment. Metaphors on the concept of listening were divided into 9 categories: A source of knowledge/learning, necessity, imagination, life, finding peace, communication, boredom, guidance, enjoyment. In this research, metaphors were used to reveal the thoughts of secondary school students on the concepts of reading and listening.

ABSTRACTBackground:Cognition is multidimensional, and each domain plays a unique and crucial part in successful daily life engagement. However, less attention has been paid to multi-domain cognitive health for the elderly, and the role of lifestyle factors in each domain remains unclear.Methods:We conducted a cross-sectional study of 3,230 older adults aged 60+ years in Xiamen, China, in 2016. The Montreal Cognitive Assessment (MoCA) was used to measure general cognition and six specific sub-domains. To account for educational effects, we adjusted the MoCA score and divided respondents into three education-specific groups (low, moderate, and high education groups with ≤5, 6~8, and ≥9 years of education, respectively). A series of proportional odds models were used to detect the associations between two categories of lifestyle factors – substance abuse (cigarette and alcohol) and leisure activity (TV watching, reading, smartphone use, social activity, and exercise) – and general cognition and the six sub-domains in those three groups.Results:Among the 3,230 respondents, 2,617 eligible participants were included with a mean age of 69.05 ± 7.07 years. Previous or current smoking/drinking was not associated with MoCA scores in the whole population, but unexpectedly, the ex-smokers in the low education group performed better in general cognition (OR = 2.22) and attention (OR = 2.05) than their never-smoking counterparts. Modest TV watching, reading, and smartphone use also contributed to better cognition among elderly participants in the low education group. For the highly educated elderly, comparatively longer reading (>3.5 hours/week) was inversely associated with general cognition (OR = 0.53), memory (OR = 0.59), and language (OR = 0.54), while adequate exercise (5~7 days/week) was positively related to these factors with OR = 1.48, OR = 1.49, and OR = 1.53, respectively. For the moderately educated elderly, only modest reading was significantly beneficial.Conclusions:Lifestyle factors play different roles in multidimensional cognitive health in different educational groups, indicating that individual intervention strategies should be designed according to specific educational groups and different cognitive sub-domains.

Analyzed with the Flesch formula for reading ease and interest were 28 textbooks on the education of children with behavioral disorders and/or emotional disturbance. Reading levels were surprisingly low with one book in the “standard, grade 8 to 9” category, 8 in the “fairly difficult, grade 10 to 12” category, and the other 19 in the “difficult, college level” category; 11 of the books were classifed as “dull”, 15 as “mildly interesting”, one as “interesting”, and one as “highly interesting”. Textbook coverage on 25 topics was also analyzed and charted. Great disparity was found in the topics treated by the various authors. Near-unanimous coverage of the topic of behavioral theory was found, while coverage was sparse on the topics of normal development, counter theory, and motivation. Some of the textbooks were found to have inadequate subject and author indices and only 7 of the books contain a glossary.

Machine Reading Comprehension (MRC) is a challenging Natural Language Processing (NLP) research field with wide real-world applications. The great progress of this field in recent years is mainly due to the emergence of large-scale datasets and deep learning. At present, a lot of MRC models have already surpassed human performance on various benchmark datasets despite the obvious giant gap between existing MRC models and genuine human-level reading comprehension. This shows the need for improving existing datasets, evaluation metrics, and models to move current MRC models toward “real” understanding. To address the current lack of comprehensive survey of existing MRC tasks, evaluation metrics, and datasets, herein, (1) we analyze 57 MRC tasks and datasets and propose a more precise classification method of MRC tasks with 4 different attributes; (2) we summarized 9 evaluation metrics of MRC tasks, 7 attributes and 10 characteristics of MRC datasets; (3) We also discuss key open issues in MRC research and highlighted future research directions. In addition, we have collected, organized, and published our data on the companion website where MRC researchers could directly access each MRC dataset, papers, baseline projects, and the leaderboard.

The Australian Defence Force English Language Profiling System (ADFELPS) is an English language proficiency rating system used to assess the English language skills of Malaysian candidates and to describe the levels of English required for target courses conducted by the Australian Defence Forces (ADF) and the New Zealand Defence Forces (NZDF). It covers all the four language skills i.e. Reading, Writing, Listening and Speaking and it is graded from Level 1 to a maximum of Level 9 which is a native speakers proficiency. Currently, Malaysian officers have some difficulty getting a Level 7 and above for the ADFELPS Writing Scale. Although there are some officers who are at Level 7 or Level 8 at the other language skills, they have difficulty going from Level 6 to Level 7 for the Writing skill. An English language writing workshop was held at the Armed Forces Library over three days to improve the writing skills of Malaysian Armed Forces (MAF) Officers. The main aim of this course was to improve the writing skills for MAF officers especially for officers who are going for overseas courses where the minimum ADFELPS level is a Level 6. The course covered grammar, coherent and cohesive writing, analyzing a typical five paragraph essay, culminating in the students being given two essays and being graded at ADFELPS writing scales. The results show that there has been a deterioration of writing skills of MAF officers and some of the problems related to writing will be discussed in this paper.

AbstractObjectiveThe present study aimed to evaluate the quality of Internet information on the Mediterranean diet and to determine the relationship between the quality of information and the website source.DesignWebsite sources were categorized as institutional, pharmaceutical, non-pharmaceutical commercial, charitable, support and alternative medicine. Content quality was evaluated using the DISCERN rating instrument, the Health On the Net Foundation's (HON) code principles, andJournal of the American Medical Association(JAMA) benchmarks. Readability was graded by the Flesch Reading Ease score and Flesch–Kincaid Grade Level score.SettingThe phrase ‘Mediterranean diet’ was entered as a search term into the six most commonly used English-language search engines.SubjectsThe first thirty websites forthcoming by each engine were examined.ResultsOf the 180 websites identified, thirty-two met our inclusion criteria. Distribution of the website sources was: institutional,n8 (25 %); non-pharmaceutical commercial,n12 (38 %); and support,n12 (38 %). As evaluated by the DISCERN, thirty-one of the thirty-two websites were rated as fair to very poor. Non-pharmaceutical commercial sites scored significantly lower than institutional and support sites (P= 0·002). The mean Flesch Reading Ease score and mean Flesch–Kincaid Grade Level were 55·9 (fairly difficult) and 7·2, respectively. The Flesch–Kincaid Grade Level score determines the difficulty of material by measuring the length of words and sentences and converting the results into a grade level ranging from 0 to 12 (US grade level).ConclusionsDue to the poor quality of website information on the Mediterranean diet, patients or consumers who are interested in the Mediterranean diet should get advice from physicians or dietitians.

<p class="abstrak"><em>The objective of this research was to find out the correlation between students’ reading interest and reading comprehension. The method used in this study was quantitative and the technique used was a correlational study. The population of the research was taken from students of the eighth grade of SMP Ahmad Dahlan Kota Jambi. The numbers of the population were 47 students. The Total sampling </em><em>which used all the population </em><em>was applied as the technique in taking the sample of the research. The data were obtained by using two instruments which were reading interest questionnaires</em><em> </em><em>and reading comprehension tests. </em><em>To measure the correlation Spearman’s Rho was used. </em><em>The result of this study showed that there was a high correlation between students’ reading interest and their reading comprehension. It was proven by coefficient correlational between students’ reading interest and their reading comprehension was r (0.983), it means those variables were significantly correlated. The result of analyzing the significant value is 0.01, it means that 0.01&lt;0.05, thus, the null hypothesis (Ho) rejected and the alternative hypothesis (Ha) was accepted. </em></p><p class="abstrak">Tujuan dari penelitian ini adalah untuk menemukan apakah ada hubungan antara minat baca siswa dan kemampuan membaca mereke. Metode yang di gunakan dalam penelitian ini dengan menggunakan pendekatan kuantitatif melalui penelitian korelasi. Populasi pada penelitian ini adalah seluruh siswa kelas VIII SMP Ahmad Dahlan Kota Jambi. Jumlah populasi adalah 47 siswa. Pengambilan sampel penelitian diperoleh melalui total sampling. Dalam mengumpulkan data, peneliti menggunakan kuesioner untuk mengukur minat baca siswa dan memberikan tes pada siswa untuk mengetahui level pemahaman membaca siswa. Untuk mengukur korelasi peneliti menggunakan teori Spearman’s Rho. Hasil dari penelitian ini menunjukkan bahwa terdapat korelasi yang tinggi antara minat baca dan pemahaman membaca. Terbukti dari hasil perhitungan korelasi ditemukan bahwa hubungan antara minat baca dan pemahaman membaca siswa adalah r (0.983), ini menunjukkan bahwa variabel tersebut memiliki korelasi yang signifikan. Hasil dari signifikansi adalah 0.01, hal ini menunjukkan bahwa 0.01&lt;0.05. Sehingga hipotesa nol (Ho) ditolak dan hipotesa alternatif (Ha) diterima</p><p class="abstrak" style="margin-top: 12.0pt; margin-right: 1.0cm; margin-bottom: 2.0pt; margin-left: 1.0cm;"><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">The objective of this study was to find out the correlation between reading interest and reading comprehension</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN"> of the students</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">. Quantitative</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN"> was used as the approach</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';"> and the technique used was a correlational study. </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN">T</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">he eighth grade</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN"> students</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';"> of SMP Ahmad Dahlan Kota Jambi</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN"> were taken as the population.</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';"> The numbers of the population were 47 students. In taking the sample, total sampling </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN">which used all the population </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">was applied as the technique. Reading interest questionnaires</span></em><em></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">and reading comprehension tests</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN"> were distributed to obtain the data.</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">. </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN">Spearman’s Rho was used to measure the correlation. </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">The result showed that there was a high correlation between reading interest and reading comprehension</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN"> of the students</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">. It was proven by coefficient correlational between those two variables and it was r (0.983). It means </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN">that </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">those variables were significantly correlated. The result of analyzing the significant value was 0.01, </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN">means that</span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';"> 0.01&lt;0.05. Thus, the null hypothesis (Ho) </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif'; mso-ansi-language: IN;" lang="IN">was </span></em><em><span style="font-size: 11.0pt; font-family: 'Garamond','serif';">rejected and the alternative hypothesis (Ha) was accepted. </span></em></p><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> 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Circadian clock is usually involved in many physiological processes of plants, including responses to abiotic stress, whilst pseudo-response regulator 7 (PRR7) gene is the main component of the circadian clock. In this study, the cDNA of the PRR7 gene was obtained from trifoliate orange (Poncirus trifoliata). Based on the sequence analysis, the PtPRR7 gene had an open reading frame of 2343 bp, encoded 780 amino acids, and contained proteins of the REC and CCT domains. Subcellular localization indicated that PtPRR7 was mainly localized in the nucleus and a small amount of cytoplasm. qRT-PCR analysis revealed the highest expression level of PtPRR7 in roots than in both shoots and leaves. The PtPRR7 gene during 24 hours of soil water deficit exhibited a circadian rhythmic expression pattern: the expression peak at 9:00 am in leaves and at 21:00 pm in roots. Drought treatment affected PtPRR7 gene expression. Such data provide important references for understanding the characteristics of PtPRR7 gene in citrus plants.

Background: While the assessment of symptoms, cognition, balance, and oculomotor function is common among sports medicine clinicians, there has been increased attention on assessing the patient’s perception of their health status following concussion. Recent recommendations suggest the use of patient-report outcome instruments (PROs) as part of the concussion evaluation to assess health-related quality of life (HRQOL) to aid in managing the injury. At present, there is not a concussion-specific PRO developed for the assessment of HRQOL in the pediatric population. Therefore, our purpose was to develop and assess the readability of a concussion-specific HRQOL measure, the Concussion Quality of Life Scale-Youth (CQOL-Y), using a mixed method approach. Methods: For instrument development and initial item generation, we analyzed prospectively collected data from three prior studies of HRQOL that used the Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale, Headache Impact Test, and Patient-Reported Outcomes Measurement Information System outcome scales. Additionally, categories and themes from a prospective qualitative study of HRQOL following concussion were analyzed. Item themes were included in the initial item generation if the item was endorsed by greater than 15% of participants at day 3 or day 10 post-injury. As part of the gap analysis, a review of the literature was also conducted for studies of HRQOL following concussion to determine domains affected after injury and to review individual items on the PROs utilized in those studies. For readability assessment, we used two approaches: participant-based and computer-based assessments. For participant-based assessment of readability sixteen participants (7 children; 10.3±1.4 years, 5.4±1.5 grade level; 9 adolescents 14.2±1.7 years, 9.4±1.6 grade level) were recruited. The San Diego Quick Assessment of Reading Ability was used to determine each participant’s reading grade level. Participants then read each item of the CQOL-Y and circled words that they did not understand. Frequency counts were determined for each word identified by participants, for each item, domain, and the total CQOL-Y. For computer-based assessment of readability, the Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Level (FK) scores were calculated for each item, domain, and the total CQOL-Y. The FRE is scored 0-100, with lower scores indicating more difficult reading material. The FRE score is converted to the FK, an approximate reading level, ranging from pre-primer (<0) to college (>12), with higher reading level indicating more difficult reading material. Summary statistics were used to report scores for each item, domain, and the total CQOL-Y. Independent t-tests were used to determine whether differences existed between children (7-12 years) and adolescents (13-18 years) on the San Diego Quick Assessment of Reading Ability and the word difficulty endorsement. Results: For instrument development, after eliminating items that were endorsed by fewer than 15% of patients, we had a total of 27 items from the established PROs related to school and cognition, social, sleep and fatigue, activities of daily living, and sport participation that were reworded to be more specific to the athletic population. The gap analysis also identified a lack of emotion or mood related items. The initial item generation phase resulted in 50 HRQOL items and 3 single-item questions in the following domains identified as important to adolescents following concussion: cognitive and school (12 items), social (11 items), mood and emotions (13 items), sleep (8 items), and activities of daily living and sport participation (6 items). For participant-based assessment of readability, the average reading levels of the participants was 6.14±1.07 (range 5-8) in children and 8.78±1.40 (range 6-10) in adolescents, which was significantly different between groups (p=.001). For the total CQOL-Y scale, children identified difficulty with .44±.73 words (range 0-4) and adolescents identified 0.33±0.71 (range 0-2 words), which was not different between groups (p=.263). Among children, difficulty was noted with irritable, errands, isolated, and occurred, whereas adolescents identified irritable and cognitive. The computer-based readability analysis of the FRE for items ranged from 34.5 to 100. The FRE of the scale as a whole was 67.6 with domains ranging from 75.4-95.3. The FK reading level ranged from 0 to 9.8 across items with a total FK score of 5.6 and domain scores ranging from 2.2-5.6. Conclusion and Significance: Using a mixed methods approach to scale development, including context identification, concept elicitation, and item pool development, we have identified a 50-item scale to assess HRQOL following concussion. The initial analysis of readability suggests the overall scale was written at an appropriate reading level for children and adolescents. Future steps of scale development, including an expert panel review, item response theory model selection, item reduction, and field-testing will be conducted to improve readability of individual items and the patient acceptability of the CQOL-Y.

ObjectivesPatients are often provided with medicine information sheets (MIS). However, up to 60% of patients have low health literacy. The recommended readability level for health-related information is ≤grade 8. We sought to assess the readability of MIS given to patients by rheumatologists in Australia, the UK and Canada and to examine Australian patient comprehension of these documents.DesignCross-sectional study.SettingCommunity-based regional rheumatology practice.ParticipantsRandom sample of patients attending the rheumatology practice.Outcome measuresReadability of MIS was assessed using readability formulae (Flesch Reading Ease formula, Simple Measure of Gobbledygook scale, FORCAST (named after the authors FORd, CAylor, STicht) and the Gunning Fog scale). Literal comprehension was assessed by asking patients to read various Australian MIS and immediately answer five simple multiple choice questions about the MIS.ResultsThe mean (±SD) grade level for the MIS from Australia, the UK and Canada was 11.6±0.1, 11.8±0.1 and 9.7±0.1 respectively. The Flesch Reading Ease score for the Australian (50.8±0.6) and UK (48.5±1.5) MIS classified the documents as ‘fairly difficult’ to ‘difficult’. The Canadian MIS (66.1±1.0) were classified as ‘standard’. The five questions assessing comprehension were correctly answered by 9/21 patients for the adalimumab MIS, 7/11 for the methotrexate MIS, 6/28 for the non-steroidal anti-inflammatory MIS, 10/11 for the prednisone MIS and 13/24 for the abatacept MIS.ConclusionsThe readability of MIS used by rheumatologists in Australia, the UK and Canada exceeds grade 8 level. This may explain why patient literal comprehension of these documents may be poor. Simpler, shorter MIS with pictures and infographics may improve patient comprehension. This may lead to improved medication adherence and better health outcomes.

Child and adolescences experience a wide range of anxiety during their growth that some of them result in academic and daily difficulties. Test Anxiety as one of these anxieties, is common and important phenomenon in education and have a close relation with educational and academic achievement.Because of importance of physical and mental health of these groups, this study was performed.MethodsThis descriptive study was performed with 1321 students selected from six middle schools (through random cluster) from schools in one area education of Sanandaj. For data Collection, Sarason test anxiety and demographic characters questionnaire was used.Sampling was done before end year examinationResultsIn this study, 51/9% of subjects were girls and 48/1% were boy. 29/7% of units were in first degree; 28/2% second and 42/1% in third year degree. Also, 35/4% of boys and 37/8% of girls were 14 years old. Severity of test anxiety in 20/2% was mild, 44/9% moderate and 34/9% was severe. In this research, we found statistical differences between severity of test anxiety and gender (p = /.001).DiscussionThe results showed high rate of test anxiety in middle school students. In our opinion, addition to gender effect on test anxiety levels, other factors such as stress of transition from one level to another level and access in special schools have significant role. Therefore, school coaches should attention to pathology and therapeutic methods for reducing test anxiety such as relaxation, systematic desensitization, immunization against stress and skills of reading correction in these groups.

SummaryCognitive abilities of children in Costa Rica and Austria were compared using three age groups (N=385/366). Cognitive ability tests (mental speed, culture reduced/fluid intelligence, literacy/crystallized intelligence) were applied that differed in the extent to which they refer to school-related knowledge. Preschool children (kindergarten, 5–6 years old,NCR=80,NAu=51) were assessed with the Coloured Progressive Matrices (CPM), primary school children (4th grade, 9–11 years old,NCR=71,NAu=71) with ZVT (a trail-making test), Standard Progressive Matrices (SPM) and items from PIRLS-Reading and TIMSS-Mathematics, and secondary school students (15–16 years old,NCR=48,NAu=48) with ZVT, Advanced Progressive Matrices (APM) and items from PISA-Reading and PISA-Mathematics. Additionally, parents and pupils were given questionnaires covering family characteristics and instruction. Average cognitive abilities were higher in Austria (Greenwich-IQMCR=87 andMAu=99,dIQ=12 points) and differences were smaller in preschool than in secondary school (dIQ=7 vs 20 points). Differences in crystallized intelligence were larger than in fluid intelligence (mental speed:dIQ=12, Raven:dIQ=10, student achievement tests:dIQ=17 IQ points). Differences were larger in comparisons at the level ofg-factors. Austrian children were also taller (6.80 cm,d=1.07 SD), but had lower body mass index (BMICR=19.35 vs BMIAu=17.59,d=−0.89 SD). Different causal hypotheses explaining these differences are compared.

ABSTRACT Bacterial pathogens in the genera Anaplasma and Ehrlichia encode a protein superfamily, pfam01617, which includes the predominant outer membrane proteins (OMPs) of each species, major surface protein 2 (MSP2) and MSP3 of Anaplasma marginale and Anaplasma ovis, Anaplasma phagocytophilum MSP2 (p44), Ehrlichia chaffeensis p28-OMP, Ehrlichia canis p30, and Ehrlichia ruminantium MAP1, and has been shown to be involved in both antigenic variation within the mammalian host and differential expression between the mammalian and arthropod hosts. Recently, complete sequencing of the A. marginale genome has identified an expanded set of genes, designated omp1-14, encoding new members of this superfamily. Transcriptional analysis indicated that, with the exception of the three smallest open reading frames, omp2, omp3, and omp6, these superfamily genes are transcribed in A. marginale-infected erythrocytes, tick midgut and salivary glands, and the IDE8 tick cell line. OMPs 1, 4, 7 to 9, and 11 were confirmed to be expressed as proteins by A. marginale within infected erythrocytes, with expression being either markedly lower (OMPs 1, 4, and 7 to 9) or absent (OMP11) in infected tick cells, which reflected regulation at the transcript level. Although the pfam01617 superfamily includes the antigenically variable MSP2 and MSP3 surface proteins, analysis of the omp1-14 sequences throughout a cycle of acute and persistent infection in the mammalian host and tick transmission reveals a high degree of conservation, an observation supported by sequence comparisons between the St. Maries strain and Florida strain genomes.

Abstract BACKGROUND Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with eloquent area gliomas. Language errors (paraphasias) are detected with DES and they indicate functional boundaries that need to be maintained to preserve quality of life. However, it is not fully clear in which brain locations paraphasias at different linguistic modalities and levels (production, comprehension, reading, writing, phonology, semantics, syntax) occur. MATERIALS AND METHODS A systematic review was conducted. We included 102 studies reporting on specific paraphasias and the corresponding brain locations during awake craniotomy with DES in adult glioma patients. RESULTS First, a wide distribution of brain locations for all paraphasias (n=930) was found, but patterns were observed. Cortically, paraphasias occurred most often in the precentral gyrus (22%), while subcortically, they occurred mainly at the inferior fronto-occipital fascicle (IFOF: 10%). Localization patterns for different paraphasia types and the corresponding language functions were also found: production/articulation (n=393)-precentral gyrus (41%), inferior frontal gyrus (9%), frontal aslant/striatal tract (4%), postcentral gyrus (3%); semantics (n=128)-IFOF (57%), superior temporal gyrus (9%); phonology (n=115)-arcuate fascicle (52%), superior longitudinal fascicle (10%), uncinate fascicle (3%); reading (n=25)-temporal lobe (48%), inferior longitudinal fascicle (32%); syntax (n=15)-inferior frontal gyrus (27%); speech initiation (n=9)-supplementary motor area (33%), frontal aslant tract (22%), frontal striatal tract (22%); writing (n=7)-superior parietal gyrus (71%). Second, 59% of all paraphasias occurred cortically, 40% subcortically and 1% at both levels. CONCLUSION The localization of most paraphasias are consistent with the assumed functionality of those brain locations as presented in the Dutch Linguistic Intraoperative Protocol model. However, new locations for production/articulation, phonology, reading and writing were found. This needs to be taken into consideration for future selection of pre, intra and postoperative language tasks at different language modalities and levels. Additionally, DES should always be applied at the subcortical level as a standard addition to the routine cortical mapping during awake craniotomy. In conclusion, this is the first systematic review on the localization of specific paraphasias during awake craniotomy. Based on the identified language localization patterns, language tasks could be selected more accurately. This could guide, and perhaps improve, pre, intra and postoperative language testing and monitoring, which in turn, may pave the way to a better postoperative language outcome. The possible relation between different intraoperative paraphasias and language outcome has yet to be determined.

The National Assessment Program - Literacy and Numeracy (NAPLAN) assessments are designed to assess literacy and numeracy of all Australian school children in years 3, 5, 7 and 9, and to act as diagnostics as to whether children are meeting intended educational outcomes. Tests began in May 2008, and have been run annually since then. Results of the 2008 tests indicated that Indigenous children in remote communities had the lowest test scores, and results were used to make a policy decision that effectively scrapped bilingual education in the Northern Territory. In this paper, we evaluate the literacy component of the NAPLAN test for Year 3, and the language samples for each year level. Literacy components assess reading, writing and language conventions (grammar, spelling and punctuation), and we focus on the reading and language conventions components. We argue that the NAPLAN tests need to be very carefully monitored for appropriateness for the assessment of children living in remote Indigenous communities. This is because tests are standardised on groups of English language speaking children. The content of some sample tests relies on cultural knowledge which Indigenous children cannot be expected to have. Spelling tests need to be monitored to ensure that they are testing spelling rather than grammatical knowledge. Finally, it is difficult to create language convention tests which are truly diagnostic because of the mixed test population of native English speakers, ESL learners and EFL learners in remote Indigenous communities.

Purpose The purpose of this study was to prospectively examine changes in gender-related voice domain of pitch measured by fundamental frequency, function-related domains of vocal quality, range, and habitual pitch level and the self-perceptions of transmasculine people during their first year of testosterone treatment. Method Seven trans men received 2 voice assessments at baseline and 1 assessment at 3, 6, 9, and 12 months after starting treatment. Results Vocal quality measures varied between and within participants but were generally within normal limits throughout the year. Mean fundamental frequency (MF0) during reading decreased, although to variable extents and rates. Phonation frequency range shifted down the scale, although it increased in some participants and decreased in others. Considering MF0 and phonation frequency range together in a measure of habitual pitch level revealed that the majority of participants spoke using an MF0 that was low within their range compared with cisgender norms. Although the trans men generally self-reported voice masculinization, it was not correlated with MF0, frequency range, or habitual pitch level at any time point or with MF0 note change from baseline to 1 year of testosterone treatment, but correlations should be interpreted with caution due to the heterogeneous responses of the 7 participants. Conclusion In trans men, consideration of voice deepening in the context of objective and subjective measures of voice can reveal unique profiles and inform patient care.

Readability are all elements that exist in the text (including the interaction between text) that affect the success of the reader in understanding the material they read on the speed reading is optimal. Measure the readability of a discourse needs to be done by educators to the material presented on target. There are many ways to measure the readability level of discourse, one formula Fry Graph. Fry Graph formula is quite popular because the procedure is easy. Curriculum 2013, the government issued textbooks thematic. This study aims to determine the readability level of discourse using the formula Fru Graph in this thematic books, especially books Elementary School 4th grade thematic themes ”Indahnya Kebersamaan” and “Selalu Menghemat Energi”. This study is a descriptive analysis method, namely: based on readability formulas introduced by Edward Fry, who became known as "Fry Graph". Fry suggests that the main factor affecting the readability of a discourse or book there are two things, namely the length of the short sentence and word, difficulty level is also characterized by the number of syllables that make up each word in the discourse. Based on these results take the number of discourses that were sampled were 14 themes for “Indahnya Kebersamaan” and 10 pieces for the theme “Selalu Berhemat Energi. The discourse is measured based on the steps of the Fry graph readability formula. The results using Fry graphs readability formula to conclude that the book theme package “Indahnya Kebersamaan” more suitable for level 7, 8, and 9. While on the theme”Selalu Berhemat Energi” more suitable for level 1, 2, and 3.

ABSTRACT Objective: Spastic cerebral palsy (sCP) is a cause of early onset scoliosis, although there are no data on its prevalence. Our objective was to determine the prevalence of early onset neuromuscular spinal deformities (SD) in severely compromised children with sCP. Methods: Cross-sectional quantitative, observational, exploratory, and descriptive study. Review of clinical records. Inclusion criteria: age 2 to 5 years, sCP, level V of the GMFCS, residents in our province. X-ray blind reading by 2 observers. The Student t test was used for parametric data and the chi-square test for non-parametric data. Level of statistical significance: p < 0.05. Results: Thirty-eight cases of 158 registered were included. Average age: 3 years 7 months (2 years – 5 years 2 months). Sex: 21 male/17 female. The predominant etiologies were perinatal: 21 (55.3%), and the prevalent nutritional status was eutrophic: 28 cases (73.7%). SD was very frequent: 32 patients (84.2%) without statistical differences between sexes; there were 20 kyphoscoliosis, 1 lordoscoliosis, 6 scoliosis, 5 hyperkyphosis. Mean angular values: 23.9° (10°- 50°) for the frontal plane deformities and 58° (9°- 92º) for the sagittal deformities. Seventeen patients (44.7%) had average pelvic obliquity of 15° (2°- 30°) without differences in patients with and without SD. There was no association between SD and etiology, digestive disorders, seizures, nutritional status, hip excentration, or limb deformities. Conclusions: The prevalence of SD in children up to 5 years old with severe sCP is high: 84.2% (32/38 cases). The orthopedic profile is children with sCP of any etiology at GMFCS level V, with multiple disabilities and independently of associated limb deformities. Level of evidence I; Diagnostic Studies - Investigating a Diagnostic Test: Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

AbstractIntroduction:It is important that patients have a good understanding of surgery-related risks, particularly for mastoid surgery, which exposes patients to the risk of very serious complications, despite addressing conditions which often have only minor symptoms.Materials and methods:A patient information leaflet describing the risks of mastoid surgery was prepared. However, the Hospital Patient Advice and Liaison Services team thought it was too long and complicated. It was introduced unchanged. Fifty-four consecutive mastoidectomy patients were given a questionnaire asking for their opinion of the leaflet. The leaflet was also assessed with readability formulae and the Ensuring Quality Information for Patients tool.Results and analysis:Ninety-eight per cent of respondents thought the leaflet's writing style was easy to understand. The majority (96 per cent) thought the length was ‘just right’. The 7 readability formulae used established readability at a grade 9 level (i.e. appropriate for a reading age of 13–15 years). The Ensuring Quality Information for Patients score was 87.5 per cent.Discussion:Despite the drive to simplify patient information leaflets, quite detailed information is sometimes required. A style which is too simple may be perceived as patronising and may encourage patients to underestimate potential risks. It is important to ask patients their opinion.

<b><i>Introduction:</i></b> Recent studies suggest that nonoperative management of appendicitis (NOMA) may be a reasonable option for managing uncomplicated acute appendicitis. We examined the Internet to see if patients are likely to find the information they need to make an informed decision between the 2 options. <b><i>Methods:</i></b> A list of 29 search terms was established by a focus group and then entered into Google, resulting in 49 unique webpages, each reviewed by 3 reviewers. Consensus was obtained for bias (surgery, NOMA, or balanced), webpage type, JAMA score, reading grade, and DISCERN score, a measure of quality of written information for patients. <b><i>Results:</i></b> Thirty of the 49 websites (61%) favored surgery, while 13 (27%) favored NOMA, and 6 sites (12%) provided balanced information. Twelve of 49 sites (24%) did not list NOMA as an option. The majority of patient-directed (11/12 = 92%) and physician-directed (7/9 = 78%) webpages favored surgery, whereas academic webpages presented a more balanced distribution. Academic and physician-directed webpages ranked higher than commercial and news webpages (median ranks 3 and 4 vs. 7.5 and 8). Only 8/49 sites (16%) mentioned that the presence of a fecalith predicts the failure of NOMA. Reading grades were almost all well above the recommended grade 8 level. <b><i>Conclusion:</i></b> Most of the webpages available on the Internet do not provide enough information, nor are they sufficiently understandable to allow most patients to make an informed decision about the current options for the management of acute appendicitis.

Abstract Objectives - In current era of information technology, there is abundance of medical information for the patients and families. It is recommended that the online patient information (OPI) should be written no greater than sixth grade as per The National Institute of Health (NIH), American Medical Association, Department of Health & Human Services. We aim is to assess whether OPI on lymphoma from NCI-Designated Cancer Center (NCIDCC) and various cancer associations websites meet the current recommendations on a panel of readability indexes. Methods - OPI from patient only section of NCIDCC and cancer associations websites were collected. This text was analyzed by 7 commonly used readability tests - Flesch Reading Ease score(FRE), Gunning Fog(GF), Flesch-Kincaid Grade Level(FKGL), The Coleman-Liau Index(CLI), The Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index(ARI) and Linsear Write Formula(LWF). Text from each article was pasted into Microsoft Word and analyzed using the online software Readability formulas. Results - The mean FRE score is 55.4 (range 37.4-67.9) which corresponded to difficult level grade. The mean GF score is 12.9 (range 10.8-15.2) that comes between difficult and hard. The FKGL score is 9.9 (range 7.2-11.9) that corresponds to above the level of ninth grader.The mean CLI score is 11.09 (range 9-12) which represented text of twelfth grade. The mean SMOG index is 9.6 (range 8.1-11.1) which corresponded to greater than seventh grade level. While the mean ARI score was 10.5 (range 7.7-12.5) which represents readability suitable for people more than tenth grade. The mean LWF was 11.29 (range 7.8-14.4) that corresponds to tenth grade level of text. Conclusion - The currently available OPI on lymphoma did not met the set national recommendations level on seven different validated readability indexes. Currently, available literature is difficult to understand and comprehend for average patient and their kins. There is a dire need to revise the currently available material for easy comprehension and understanding by the general patient population. Disclosures No relevant conflicts of interest to declare.

OBJECTIVES The objective of this study was to determine if education material targeting children would improve understanding of medication indication, administration, and common side effects in pediatric subjects. METHODS This cross-sectional pilot study included students 7 to 11 years old from a suburban elementary school. Study participants were read either the US Food and Drug Administration–approved adult medication leaflet or a pediatric medication leaflet created at a first-grade reading level for levetiracetam (Keppra, UCB, Inc, Atlanta, GA). Students were asked a set of standardized survey questions to evaluate comprehension of side effects, medication indication, dosing frequency, administration, and overall impression of the leaflet. RESULTS Fifty-eight children were included. Fifty percent of the children were male, 79% were Caucasian, and the average age was 9 years. There was no statistical difference for demographics in the adult leaflet versus the pediatric leaflet group. Children correctly stated the indication for the medication in 30% of participants (9/30) in the adult leaflet group and 79% of participants (22/28) in the pediatric leaflet group, p = 0.002. The administration frequency question was answered correctly in 93% of the pediatric leaflet group (26/28) as compared to 73% in the adult leaflet group (22/30), p = 0.05. For questions about side effects and how to administer the medication, there was no difference between the groups. The responses regarding readability and understanding of the leaflets were significantly different in the pediatric leaflet group compared to the adult leaflet group, p = 0.001 and p = 0.001, respectively. CONCLUSIONS Leaflets designed for pediatric patients resulted in an improvement in the understanding of the indication for levetiracetam.

Abstract Background: Slightly less than half of the patients with essential thrombocytosis (ET) and primary myelofibrosis (PMF) do not have specific gene mutations. Recent discovery of CALR mutation in JAK2V617F-negative ET and PMF patients have accounted for 20-25% of ET and PMF patients, and therefore redefining diagnostic approach to ET or PMF. Here we reported the incidence of CALR mutation and clinical features of clinically diagnosed Jak2V617F-negative ET and PMF in Singapore. Method: We retrospectively identified 140 cases of Jak2V617F-negative ET and PMF from two healthcare institutions in Singapore since 2006. Sanger sequencing was performed for the targeted detection of CALR exon 9 mutations. Clinicopathologic correlation was carried out by assessing relevant clinical data and the CALR mutation status, and compared with JAK2-positive cases (25 cases of ET and 9 cases of PMF). Results: The Jak2V617-negative ET/PMF patients were ethnic Chinese (76.2%), Malay (13.9%) and others (9.9%). CALR mutations were detected in 32.8% (40/122) of Jak2V617-negative ET and 55.6% (10/18) Jak2V617-negative PMF patients. Higher platelet count was observed in CALR-positive ET patients with median platelet count of 1056.5 x 109/L and 637.5 x 109/L for CALR-positive and -negative patients respectively (p<0.001). CALR-positive ET also required higher doses of hydroxyurea to maintain platelet count below 600 x 109/L (p=0.038). There was no difference in thrombotic events, presence of splenomegaly, presenting WBC count or hemoglobin (Hb) level between CALR-positive and -negative ET. However, when compared to Jak2-positive ET, Jak2-negative ET had a significantly lower incidence of thrombotic events (Jak2-negative ET, 8.2%; Jak2-positive ET, 50.0%, p<0.001), and lower Hb level (p<0.001). The incidence of thrombotic events in CALR-positive ET and PMF were 10.3% and 10.0% respectively. There was also no significant difference in presenting WBC count, platelet count, Hb level, presence of splenomegaly, or thrombotic event between CALR-positive vs -negative PMF. Lactic acid dehydrogenase (LDH) level at diagnosis however, was significantly higher in CALR-positive ET/PMF when compared to CALR-negative group (p=0.011). There was also significantly higher incidence of elevated peripheral blasts of >1% in CALR-positive ET/PMF (12% in CALR-positive and 3.3% in CALR-negative group, p=0.045). Blast transformation occurred in 6% of patients with CALR-positive PMF while only 1.1% in CALR-negative PMF. Besides the two commonly reported mutations (CALR52del, 30.8%; CALR5ins, 33.3%) in our screening of the CALR exon 9 in Jak2V617F-negative ET and PMF patients, 7 other novel mutations (c.1098_1137delinsTTTCTT, c.1102_1104delAAG, c.1122_1155delinsGGGCCAGGCACTTGTCG, c.1129_1153delinsCTTTGCGTTTCTTTT, c.1132_1155delinsTGTCG, c.1139delA, c.1141delG) were also found individually. All mutant CALR proteins possess an altered C-terminus with a longer peptide stretch caused by a disrupted reading frame due to these frameshift mutations. Conclusion: CALR mutation is common in Jak2V617F-negative PMF and ET in this multiracial Singaporean cohort, and has similar frequency when compared with Western report. It was associated with higher platelet count in ET, higher level of LDH and possibly a higher risk of blast transformation in PMF. 7 novel CALR mutations were identified and more subtypes of CALRmutation variants are expected to be uncovered in the near future. Disclosures No relevant conflicts of interest to declare.

AbstractObjectiveEducation is a crucial social determinant of health. Food insecurity can be detrimental to children’s academic achievement, potentially perpetuating a cycle of poverty and food insecurity. We aimed to assess the relationship between food insecurity and academic achievement in Canadian school-aged children.DesignCross-sectional study of children and parents. Parents completed the short-form Household Food Security Survey Module and questions about income and education level (socio-economic status). Children completed FFQ. Data were prospectively linked to children’s performance on standardized exams written one year later. Mixed-effect logistic regression was employed to assess the relationship between food insecurity and likelihood of meeting academic expectations adjusting for socio-economic status, diet quality and potential confounders.SettingNova Scotia, Canada in 2011–2012.SubjectsStudents (n4105) in grade 5 (10–11 years; 2167 girls) and their parents.ResultsLow food security was reported by 9·8 % of households; very low food security by 7·1 % of households. Students from low-income households and reporting poor diet quality were less likely to do well in school. Children who lived in households reporting very low food security had 0·65 times the odds (OR=0·65; 95 % CI 0·44, 0·96) of meeting expectations for reading and 0·62 times the odds (OR=0·62; 95 % CI 0·45, 0·86) of meeting expectations for mathematics.ConclusionsVery low household insecurity is associated with poor academic achievement among children in Nova Scotia.

Summary Introduction: Diabetes therapeutic education and information by leaflets is important. This study aimed to understand the effectiveness of written information to diabetic patients, after six months, in the control of diabetes and medication adherence. Method: Non-pharmacological clinical trial. Randomized sample of diabetic patients of 65 volunteer doctors, distributed among the five health regions in Portugal. At the first appointment, patients were randomized in four groups (three intervention with validated leaflets and one control), leaflet reading being reinforced at the follow-up appointments in a 6-months period. Variables collected: HbA1c, home blood glucose, weight, waist circumference, blood pressure, cigarettes smoked, physical activity level, adherence to medication, medication, height, diabetes progression, age, sex and educational background. Descriptive and inferential statistics. Results: From the 709 patients recruited, 702 were studied in this 6-months period with no statistical differences in the baseline variables studied. After six months of intervention, the adherence to medication improved in the leaflet group (p=0.034). This was noticed in those under 65 years of age (p=0.027), with diabetes for ≤ 5 years (p=0.010), with educational background up to 4 years (p=0.030) and 9 years (p=0.006) and with HbA1c ≥ 7% at the beginning of the study. Conclusion: Interventions with leaflets handed in primary healthcare to people with diabetes type 2 can bring benefits in what concerns adherence to therapeutics, namely in younger people with a less studies.

AbstractThe various divisions suggested for Mark 1:14-3:35 (4:1) show that the problem of the delimitation and arrangement of concentric structures calls for a criterion by which it is possible to decide between conflicting divisions. The Gospel of Mark originated in a semi-literature culture where texts were read to an audience from manuscripts written in scription continua. The criterion required is based on the assumption that concentric structures were designed to structure the reading/hearing process by distinguishing between segments. Since concentric structures consist in the repetition of elements used before, easily recognizable repetitions take priority over those less identifiable. On the basis of this criterion indicators of macro-divisions are preferred to those of micro-divisions, so that, e.g., the parable discourse in 4:2-34 is regarded as an individual section and thus becomes the centre of the second main part. The criterion is also used for segmenting the text at micro-level, e.g., in Mark 3, where 3:7-9 + 4:1 is preferred to 3:21 + 3:31-35. With the help of the usual criteria 1:14-4:1 is analyzed and identified as the first section. It consists of three segments, each concentric in structure. Standing in the centre of the middle segment, 2:18-22, the discussion about fasting and the two sayings related to it are about the relation between old and new, which is the theme of the whole section.

Purpose: Accurately measuring sedentary behavior (SB) in children is challenging by virtue of its complex nature. While self-report questionnaires are susceptible to recall errors, accelerometer data lacks contextual information. This study aimed to explore the efficacy of using accelerometry combined with the Digitising Children’s Data Collection (DCDC) for Health application (app), to capture SB comprehensively. Methods: 74 children (9–10 years old) wore ActiGraph GT9X accelerometers for 7 days. Each received a SAMSUNG Galaxy Tab4 (SM-T230) tablet, with the DCDC app installed and a specially designed sedentary behavior study downloaded. The app uses four data collection tools: 1) Questionnaire, 2) Take a photograph, 3) Draw a picture, and 4) Record my voice. Children self-reported their SB daily. Accelerometer data were analyzed using R-package GGIR. App data were downloaded and individual participant profiles created. SBs reported were grouped into categories and reported as frequencies. Results: Participants spent, on average, 629 min (i.e., 73% of their waking time) sedentary. App data revealed most of their out-of-school SB consisted of screen time (112 photos, 114 drawings, and screen time mentioned 135 times during voice recordings). Playing with toys, reading, arts and crafts, and homework were also reported across all four data capturing tools on the app. On an individual level, data from the app often explained irregular patterns in physical activity and SB observed in accelerometer data. Conclusion: This mixed methods approach to assessing SB adds context to accelerometer data, providing researchers with information needed for intervention design.

Chronic carriers of hepatitis B virus (HBV) usually show hepatitis B surface antigen (HBsAg) in their sera, which is considered the best marker for acute and chronic HBV infection. In some individuals, however, this antigen cannot be detected by routine serological assays despite the presence of virus in liver and peripheral blood. One reason for this lack of HBsAg might be mutations in the part of the molecule recognized by specific antibodies. To test this hypothesis, the HBV S gene sequences were determined of isolates from 33 virus carriers who were negative for HBsAg but showed antibodies against the virus core (anti-HBc) as the only serological marker of hepatitis B. Isolates from 36 HBsAg-positive patients served as controls. In both groups, a considerable number of novel mutations were found. In isolates from individuals with anti-HBc reactivity only, the variability of the major hydrophilic loop of HBsAg, the main target for neutralizing and diagnostic antibodies, was raised significantly when compared with the residual protein (22·6 vs 9·4 mutations per 1000 amino acids; P<0·001) and with the corresponding region in the controls (22·6 vs 7·5 exchanges per 1000 residues; P<0·001). A similar hypervariable spot was identified in the reverse transcriptase domain of the viral polymerase, encoded by the same nucleotide sequence in an overlapping reading frame. These findings suggest that at least some of the chronic low-level carriers of HBV, where surface antigen is not detected, could be infected by diagnostic escape mutants and/or by variants with impaired replication.

Rote counting skills have found to be a strong predictor of later arithmetic and reading fluency. However, knowledge of the underlying cognitive factors influencing counting skill is very limited. Present study examined to what extent language skills (phonology, vocabulary, and morphology), nonverbal reasoning skills, and memory at the age of five could explain counting skill at the beginning of first grade. Gender, parents’ education level and child’s persistence were included as control variables. The question was examined in a longitudinal sample (N = 101) with a structural equation model. Results showed that language skills together with memory, nonverbal reasoning skills and parent’s education explained only 22% of the variance in counting at the beginning of the first grade. Vocabulary, morphology, and verbal short-term memory were found to be interchangeable predictors, each explaining approximately 7%–9%, of counting skill. These findings challenge the interpretation of counting as a strongly language-based number skill. However, additional analysis among children with dyslexia revealed that memory and language skills, together with a child’s persistence and gender, had a rather strong predictive value, explaining 34%–46% of counting skill. Together these results suggest that verbal short-term memory and language skills at the age of five have not the same predictive value on counting skill at the beginning of school among a population-based sample as found in subjects with language impairment or learning difficulties, and thus, other cognitive factors should be taken into account in further research related to typical development of counting skill.

The purpose of the present study was to evaluate English language textbooks of grade 7, 8 and 9 in theIranian Pedagogical curriculum to see to what extent students are exposed to national, international and target cultural familiar content in their classes. As Gurkan (2012) and Ganjabi (2014) say students who are familiar to cultural content of the target language have better reading comprehension scores than those who lack familiarity to target language cultural content. Since culturally familiar content of language in international and target level increases learners‟ comprehension almost in all skills, textbooks are one of their real manifestations in curriculum.The study also intended to investigate how the content of English textbooks represents national, international and target culturally familiar content for students to be well-prepared to convey their own culture to foreigners as well as to be acquainted with other cultures that they have contact with for any means anywhere in the virtual and real places. Content analysis method was used and a coding scheme was designed according to items listed in Byram‟scultural content checklist (1993). The findings of this qualitative study showed that ELT textbooks covered a restricted range of international cultural content as well as target cultural content; moreover, the result revealed that just restricted amount of national culturally familiar content are applied in the English language textbooks. Based on the results of the study, some directions would be suggested to be appliedin the English language syllabus; moreover, the results can be used by teachers as a direction for adding some supplementary and complementary materials to develop English language textbooks in education for effective communication.

Background : Language acquisition skills talk to a child is most important because it is closely related to the phonology ability and relates to the ability of semantic and syntax acquisition. Children who experience Keretlambatan speaking language are at risk of learning difficulties, difficulty in reading and writing and will lead to less thorough academic achievement, this can continue to be young. Thus, the need for early detection of the phonological ability will be seen as a result of the estimated proportion of the phonological errors in the child. Method: This research uses the survey method. Research location in PAUD Al-Kautsar and PAUD Budi Karya Mojosongo Surakarta. With samples of PAUD children aged 3-5 years, 45 children with independent variables are phonological errors and their variable dependencies are phonological errors, with technical Purposive sampling. The technique of collecting observation data with articulated observation sheet with a word-level image. Results: That there are 16 children or 34.04% of 47 samples with an estimated proportion of 20,50 < π < 47,59 of PAUD Children at the age of 3-5 who have phonological pronunciation errors.That PAUD children at the age of 3-5 who had the misspelling of phonology of female sex, more percentage of his phonological error, which is as much as 9 children (56,25%) With an estimate of the proportion of 42.07 < π < 70.43 compared to boys, as many as 7 children (43,75%) With an estimate 29.57 < π < 57.93. Conclusion: There are phonological errors in children aged 3-5 years old, but based on his/her age is still in the process of phoneologically (Phonological Prosesses).

Purpose: This study centers on the significant role of Reader Response theory in instruction literary text, this study also, affirms that there is a useful and progressive influence of the Reader-response strategy in the literary text to enhance and improve the level of EFL Iraqi learners’ critical thinking. This study proves that teaching literature, without Reader response strategies, the level of development of critical thinking becomes very passive and slow. Methodology: The researcher used one group “pre-post-test”. The study was conducted at the English department, Faculty of Education in Iraq. This study was carried out for fifteen weeks. The researcher administered Cornell Class-Reasoning Test as a pre-test in week 4 while post-test in week 12.The researcher used non-probability convenient sampling because it was probably the most common of all sampling techniques in social sciences and the proximity of the samples to the researchers (Patton, 1990).This test was run twice with intensive interventions for five weeks implemented between the two tests. Main Findings. Findings showed that there was a statistically significant difference in the EFL Iraqi learners' critical thinking skills between pre-test scores and post-test scores. There are statistically significant differences at the “p ≤ 0.05” level for the following item groups: 1, 2, 3, 4, 5, 6, 7, 8, 9, and 12. This study confirmed that participants significantly improved their level of critical thinking skills by implementing Reader- Response activities in teaching literary texts. Implications: This study proposes applying the strategies of reader-response theory as an effective and encouraging concept or stimulating approach to enhance the level of recognition and appreciation of the texts in literature. This experiment could be a positive study and applicable to different educational centers to teach all the texts in English literature. This study helps instructors to change their old-style manners of instructions. Novelty: The experiment focused on the vital and encouraging role of reader-response theory in fostering EFL Iraqi readers’ capacity to generate multi-layers of versions and meanings during reading literature. The study presents a helpful and successful manner to all the persons who work as teachers in educational systems. The study directs the instructors to follow the modern approaches in explaining the literary text to their learners instead of the old-style manner. EFL tutors should practice these strategies in EFL English classes of literature so that they could make the lecture full of activity and enjoyment throughout the interesting themes of literature.

Abstract. A landslide affecting two small villages located on the Northwestern Italian Apennines has been investigated since the year 2000 through the use of different equipment. A complex monitoring system has been installed in the area. The system includes several inclinometers, piezometers and a raingauge. An Automatic Inclinometric System (AIS) has been also installed that automatically performs measurements, twice a day, along the entire length of a pipe that is 45 m deep. This monitoring system has been set up to identify a methodology that allowed to deal with landslides, trying to predict their behaviour beforehand for warning purposes. Previous researches carried out in the same area for a period of about 7 months, in the year 2000, have allowed to identify a correlation between deep slope movements and rainfalls. In particular, it has been possible to determine the time lag needed for a rainfall peak to produce a corresponding peak of the landslide movements; this time lag was of 9 days. This result was possible because the AIS allows to obtain, as mentioned, daily inclinometric measurements that can be correlated with the recorded rainfalls. In the present report we have extended the analysis of the correlation between deep slope movements and rainfalls to a greater period of observation (2 years) to verify over this period the consistency of the time lag mentioned above. The time lag previously found has been confirmed. We have also examined the possibility to extend to the entire landslide body the correlation that has been found locally, analyzing the results of the remaining inclinometric tubes with traditional reading installed on the landslide and comparing them with the results of the AIS. The output of the tubes equipped with piezometric cells has also been analyzed. The relations existing among rainfalls, ground water level oscillations and the related slope movements have been explored

This study aims to describe the structure of Rindu by Tere Liye, and the character education values ​​available in the Rindu novel written by Tere Liye. The method used in this research is a qualitative descriptive method, with content handling techniques. The instrument of this research is the researchers themselves who are assisted by the analysis table using the Character Psychology approach. The data mentioned is the structure of the novel Rindu, the novel theme of Rindu by Tere Liye is a Hajj journey. Grooves that are mixed channels. The main character in this novel is Gurutta. Timeline in 1938. The setting where the Rindu novel is most dominant is on the Dutch Blitar ship. Merging data, obtained information that the education education in the novel Rindu written by Tere Liye was 132 data (80%) and that did not contain 33 data data (20%). Data surface: There are 22 religious values ​​(13.33%), there are 7 data values ​​(4.24%), 9 data values ​​(5.45%), 9 data values ​​(5.45%) , the value of love for peace there are 7 data (4.24%), communicative value there are 29 data (17.57%), value of reading likes there are 10 data (6.06%), government value is 6 data (3.63%) , the value of national spirit is 11 data (6.67%), and social care value is 23 data (13.93%). Rindu novel by Tere Liye is more dominant in having friendly / communicative values. This research also implies the topic of language for special novels for the high school (XII) level of the XII KD class. 3.9 Analyzing the content and linguistics of novels and KD. 4.9 Designing novels or novelet by expressing content and language. Suggestions for further researchers to conduct research with the object of the novel Rindu written by Tere Liye with other aspects of character education and also supported by other sciences outside of literature. Keywords: value of character education, novel Rindu, Tere Liye Abstrak Penelitian ini bertujuan untuk mendeskripsikan struktur novel Rindu karangan Tere Liye dan nilai pendidikan karakter yangterdapat dalam novel Rindu karangan Tere Liye.Metode yang digunakan dalam penlitian ini ialah metode deskriptif kualitatif, dengan teknik analisis isi. Instrumen penelitian ini ialah peneliti sendiri yang dibantu oleh tabel analisis dengan menggunakan pendekatan Psikologi Karakter. Data yang diambil ialah struktur novel Rindu,tema novel Rindu karya Tere Liye ini ialahperjalanan haji. Alur yang digunakan ialah alur campuran. Tokoh utama dalam novel ini adalah Gurutta. Latar waktu pada tahun 1938. Latar tempat novel Rindu yang paling dominan yaitu di atas kapal Blitar Holland.Berdasarkan analisis data, diperoleh informasi bahwa nilai pendidikan karakter yang terdapat dalam novel Rindu karangan Tere Liye sebanyak 132 data (80%) dan yang tidak terdapat niai pendidikan karakter terdapat 33 data (20%). Dengan rincian sebagai berikut: nilai religius terdapat 22 data (13,33%), nilai toleransi terdapat 7 data (4,24%), nilai disiplin terdapat 9 data (5,45%), nilai mandiri terdapat 9 data(5,45%), nilai cinta damai terdapat 7 data (4,24%), nilai komunikatif terdapat 29 data (17,57%), nilai gemar membaca terdapat 10 data (6,06%), nilai demokratis terdapat 6 data (3,63%), nilai semangat kebangsaan terdapat 11 data (6,67%), dan nilai peduli sosial terdapat 23 data (13,93%). Novel Rindu karangan Tere Liye lebih dominan memiliki nilai bersahabat/komunikatif. Penelitian ini juga diimplikasikan pada pembelajaran bahasa, khususnya materi teks novel untuk tingkat sekolah menengah atas (SMA) kelas XII KD. 3.9 Menganalisis isi dan kebahasaan novel dan KD. 4.9 Merancang novel atau novelet dengan memerhatikan isi dan kebahasaan. Saran untuk peneliti selanjutnya agar melakukan penelitian dengan objek novel Rindu karangan Tere Liye ini dengan aspek selain nilai pendidikan karakter serta didukung oleh ilmu-ilmu lain di luar sastra. Kata kunci: nilai pendidikan karakter, novel Rindu, Tere Liye

Abstract Objectives Dietary counselling is an effective nutritional strategy for improving dietary quality and cardiometabolic health, but these beneficial effects have not been well studied in older adults, especially in Asia. Therefore, this study aimed to assess the impact of dietary counselling on cardiometabolic health outcomes and dietary quality in older Singaporean adults. Methods This was a 12-week, parallel design, randomized controlled trial. Twenty-six women aged above 60 y were randomized where the intervention group received dietary counselling (n = 14) and the control group did not receive dietary counselling (n = 12). Anthropometric measurement, blood pressure, fasting lipid-lipoprotein, glucose and insulin levels were examined at baseline and week 12. The interactive dietary counselling sessions were conducted by a qualified nutritionist every week and each session took 60 minutes. The counselling topics included healthy eating pattern, proper food proportioning, food label reading and several age-related diseases. All participants completed a 3-day food record and the dietary quality was assessed using the Alternative Healthy Eating Index 2010 (AHEI-2010). All results were reported as least square means ± SD. Results A significant decrease in serum low density lipoprotein cholesterol level was detected in the intervention group (3.3 mmol/L ± 1.0 to 3.1 mmol/L ± 0.8, P &lt; 0.05) whereas the control group unchanged (3.8 mmol/L ± 0.6 to 3.7 mmol/L ± 0.7). Moreover, although there was an increase in waist circumference in the control group (76 cm ± 7 to 80 cm ± 6, P &lt; 0.05), no change was observed in the intervention group (76 cm ± 7 to 77 cm ± 9). Other anthropometric and cardiometabolic measurements were not changed after intervention. Both groups showed an increase in dietary quality based on the AHEI-2010 score after intervention however change was only significant in the intervention group (44.0 ± 9.1 to 48.9 ± 8.7, P &lt; 0.05). l group, but a significant time effect was observed (P = 0.009). Conclusions The provision of dietary counselling confers the benefits in the cardiometabolic health outcomes and these benefits may be explained by the improvement in dietary quality in Singaporean older adults. Funding Sources National University of Singapore (NUS), NUS-Mind Science Centre.

Background: Heart failure (HF) is a serious problem with an increasing prevalence globally. Low level of HF knowledge may cause low compliance and low quality of life and, poor self-care. On the other hand, assessing the level of HF knowledge is necessary in order to apply educational programs. Aims and objectives: the aim was to determine knowledge regarding HF among Iranian patients with HF. Study Design: This was a cross sectional study. Setting: We conducted this study at the HF clinic of Tehran Heart Center (THC) affiliated with Tehran University of Medical Sciences (TUMS, Tehran, Iran). Materials and Methods: In this cross-sectional study, 190 patients older than 18 years old, with confirmed diagnosis of HF for at least 3 months by an HF specialist, NYHA function class II to IV and an ability of reading and writing Farsi language were included during June 2017 and January 2018 by consecutive sampling. Data were gathered in a short form, including demographic and clinical variables. Knowledge regarding HF was measured by the Dutch HF knowledge scale (Cronbach’s alpha=0.62) with 15- multiple choice item. The score range varied between 0 (no knowledge) and 15 (optimum knowledge). Scores were reported totally and in 3 areas of knowledge. Scores higher than the median was considered as higher knowledge. Statistics: The SPSS software version 16 was used to describe data. Normality of continuous variables was checked by the Kolmogorov-Smirnoff test. Frequency and partial frequency distribution were used to describe Categorical variables. While, we used mean, median, standard deviation, and IQR for describing continuous variables. Results: From June 2017 to January 2018, 160/190 patients with median age (IQR) of 59 (16) years old participated in the study (response rate of 84.2%). 67.5% of study patients were male (83.5%). 87.5% of then were married. The majority of patients were with NYHA function class II (60.6%), and with an etiology of ischemic heart disease (65.0%). The median and IQR of total, general, HF treatment, and symptoms/ symptom recognition knowledge were 8 (7-10), 12 (9-14), 2 (1.25-3), and 4 (3-5), respectively. Low level of total, general, HF treatment, and symptoms and symptom recognition knowledge among Iranian patients with HF were 55%, 60%, 58.8%, and 71.9%, respectively. Conclusion: Patients with HF had low levels of total, general, HF treatment, and symptoms/symptom recognition knowledge. Thus, there is an essential need to be improved by an appropriate intervention, especially on knowledge of symptoms /symptom recognition.

Abstract Objectives This study aims to define consensus-based criteria for acquiring and reporting prostate MRI and establishing prerequisites for image quality. Methods A total of 44 leading urologists and urogenital radiologists who are experts in prostate cancer imaging from the European Society of Urogenital Radiology (ESUR) and EAU Section of Urologic Imaging (ESUI) participated in a Delphi consensus process. Panellists completed two rounds of questionnaires with 55 items under three headings: image quality assessment, interpretation and reporting, and radiologists’ experience plus training centres. Of 55 questions, 31 were rated for agreement on a 9-point scale, and 24 were multiple-choice or open. For agreement items, there was consensus agreement with an agreement ≥ 70% (score 7–9) and disagreement of ≤ 15% of the panellists. For the other questions, a consensus was considered with ≥ 50% of votes. Results Twenty-four out of 31 of agreement items and 11/16 of other questions reached consensus. Agreement statements were (1) reporting of image quality should be performed and implemented into clinical practice; (2) for interpretation performance, radiologists should use self-performance tests with histopathology feedback, compare their interpretation with expert-reading and use external performance assessments; and (3) radiologists must attend theoretical and hands-on courses before interpreting prostate MRI. Limitations are that the results are expert opinions and not based on systematic reviews or meta-analyses. There was no consensus on outcomes statements of prostate MRI assessment as quality marker. Conclusions An ESUR and ESUI expert panel showed high agreement (74%) on issues improving prostate MRI quality. Checking and reporting of image quality are mandatory. Prostate radiologists should attend theoretical and hands-on courses, followed by supervised education, and must perform regular performance assessments. Key Points • Multi-parametric MRI in the diagnostic pathway of prostate cancer has a well-established upfront role in the recently updated European Association of Urology guideline and American Urological Association recommendations. • Suboptimal image acquisition and reporting at an individual level will result in clinicians losing confidence in the technique and returning to the (non-MRI) systematic biopsy pathway. Therefore, it is crucial to establish quality criteria for the acquisition and reporting of mpMRI. • To ensure high-quality prostate MRI, experts consider checking and reporting of image quality mandatory. Prostate radiologists must attend theoretical and hands-on courses, followed by supervised education, and must perform regular self- and external performance assessments.

Abstract Abstract 755 Second hematologic malignancies in non-syndromic children without a pronounced family history for cancer may be mistaken for relapses or therapy-related malignancies. Recently, we characterized diagnosis and presumed relapse samples of 22 patients with very late disease recurrences (>2.5 years), and identified 8 patients with leukemic presentations that were fully discordant at the level of TCR-rearrangements and DNA copy number aberrations (J Clin Oncol 2011; 29:1643-9). One of these patients showed a germline deletion comprising the recombination activating genes RAG1 and RAG2, and regulatory sequences of LMO2, genes frequently affected somatically in T-ALL, suggesting a genetic predisposition to leukemia. In the current study, we performed exome sequencing to assess whether consecutive leukemic presentations in such patients are indeed fully discordant, also at the sequence level, and to identify candidate pathogenic germline variants that point at a genetic predisposition. We sequenced the exomes in samples obtained from 2 consecutive leukemic presentations, and intermittent complete remissions, from 2 patients with very late disease recurrences (>2.5 years) and discordant leukemic presentations. We found on average 26,600 variants per exome. Recurrent variants recorded in the dbSNP and/or 1000 Genomes databases, or those present in our in-house database (>300 exomes) were excluded, resulting in an average of 989 private variants per exome. We divided these variants into 3 groups (i) somatic variants shared between the consecutive leukemic samples but not detected in remission (ii) somatic variants present in only one of the leukemic samples and (iii) germline variants present in the remission samples of the patients. All candidate somatic variants shared between two consecutive leukemic samples were re-sequenced by Sanger sequencing and were shown to be either present in all three samples, and thus originally missed in the remission sample, or falsely detected in one or more leukemic samples. Therefore, we conclude that in both patients no somatic variants were shared between the first and second leukemic presentations, which confirms that these patients suffered from clonally unrelated second T-ALLs. From all somatic variants present in only one of the leukemic samples, we focused on variants in exons or splice junction sites. We found 4 nonsense mutations, 9 frame-shift mutations, 12 in-frame in/dels and 7 non-synonymous missense variants with a high interspecies conservation score (PhyloP>3.0), mostly affecting genes implicated in oncogenesis like PTEN, TET3, CDKN2C, CD109, and GLRX2. Each leukemic sample harbored 2–11 of these putative deleterious variants. In the germline of the two patients, we identified 314 and 190 non-synonymous unknown variants in exons or splice junction sites, respectively. Among these were 12 nonsense mutations, 7 canonical splice-site mutations, 20 frame-shift mutations, 11 in-frame in/dels and 143 non-synonymous missense variants at highly conserved positions (PhyloP>3.0). Filtering of these variants for known T-ALL associated genes resulted in several interesting novel candidate predisposing genes such as, among others, RANBP17 and HOXC13. Sequencing of the entire RANBP17 open reading frame in a cohort of 24 sporadic T-ALL samples revealed that this gene was somatically affected in one of them. In conclusion, we confirmed by exome sequencing that consecutive leukemic presentations in patients with late T-ALL recurrences may be fully discordant and thus represent independent leukemia occurrences, most likely caused by predisposing germline abnormalities. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract: Background: Thrombotic Thrombocytopenic Purpura( TTP) is a rare life threatening disease. It is caused by congenital deficiency of metalloprotease ADAMTS -13 or acquired autoantibodies to this enzyme which normally cleaves vWF macromolecules. This results in Microangiopathic hemolytic anemia (haemolytic anemia, low platelets, and schiztocytes), systemic microvascular thrombi formation and subsequent end organ ischemia (renal and neurological manifestations). Nowadays the early recognition and treatment modalities resulted in survival rate reaching up to >=90%. So far, in Oman there have been no studies evaluating this rare disease. Aim: This is a retrospective study conducted in a tertiary center in Oman aims to describe the clinical and the demographic characteristics of Omani patients diagnosed of TTP, their remission rate, and survival. Methods:. We included all patients who were diagnosed between 2006 and 2018 who meet the diagnostic criteria of TTP and aged ≥ 12 years old. Data on patients' age, gender, region, ADAMTS-13 level, clinical presentation, lab results, treatment modalities and condition on discharge are described. Results: Total of 38 patients met diagnostic criteria of TTP during the study period. 25 Females (66%) and 13 Males (34%),with Female: Male ratio was 1.9:1. Age ranges between12-83 years (mean: 42 years). Mean age at onset: 36 years (range 1- 79 years). Majority of patients were from Governates Al-Batinah 39% and Muscat 21%. Clinical features in descending order of frequency: fever (63%), petechiae/ ecchymosis (31%), seizures (21%), high BP reading(21%), headache(15%) , confusion(15%), postpartum presentation(15%) and stroke (7.9%). The mean values at presentation are consistent with microangiopathic hemolytic anemia. Deranged RFT was found in 19 patients (50%), ADAMTS 13% was tested in 18 cases, congenital deficiency was found in 4 patients, deficiency due to autoantibodies was found in 7 patients. Treatment modality received were steroids and Plasma exchange (number of sessions ranges between 3-30 sessions, average 9 sessions). 19 cases required rituximab and 10 patients required cyclosporin. 5 patients (13%) had renal derangement requiring dialysis as inpatients, only 1 patient continued to dialyze after discharge. None of the 3 patients with documented stroke had neurological deficits on discharge. Patients who had seizures (3 patients) were free of seizures and on maintenance antiepileptic medications. Relapses after first presentation was noted in 7 patients (17%) with mean relapse ranges 1 to 7 years (mean of 3 years) after first presentation. There was 1 death with TTP in a relapsed Non- Hodgkin's lymphoma pateint. Overall survival rate was 97% at 10 years study period. Conclusion:This is the first study that demonstrates the demographic, clinical and survival rate of TTP patients in Oman, and provides a general picture of the TTP patients in our country Disclosures No relevant conflicts of interest to declare.

Abstract Background: CMV-related complications are a major cause of morbidity and mortality post allogeneic stem cell transplantation (ASCT). Where a pre-emptive strategy is used, early detection is crucial as this will minimise the risk of CMV infection progressing to CMV disease. As a result, PCR techniques are increasingly replacing pp65 antigen detection as a means of monitoring CMV viral load in at-risk patients. Initiating treatment at too low a cut-off may result in over-treatment since very low level viraemia may not necessarily represent live or replicating virus. However, using too high a cut-off might lead to unacceptable treatment delay. As a result of these uncertainties the optimal pre-emptive strategy remains unknown. We therefore sought to determine whether, using quantitative real time PCR, the manufacturer’s detection cut-off or the validated lower quantitation limit (LQL) was the more appropriate treatment trigger. Methods: CMV surveillance was done by weekly (twice weekly for positive results) quantitative real time PCR (Artus RealArt™ CMV LC PCR Kit, Hamburg, Germany) until immunosuppression was stopped. The manufacturer’s detection cut-off was 6.5 × 102 copies/ml and the validated LQL was 1 × 104 copies/ml. Treatment was initiated following two consecutive results above the LQL. Below the LQL, treatment was only started if symptoms of CMV infection (e.g. fever, cytopenia) were also present. Results: Between 01/04 and 12/05 fourty four patients, median age 43y (range 18–69), underwent ASCT from sibling (n=27) or unrelated (n=17) donors for AML/MDS (n=22), ALL (n=8), CML (n=5), NHL (n=5), myeloma (n=3) and osteogenesis imperfecta (n=1). The conditioning regimen was myeloablative (Cy-TBI, Bu-Cy) in 21/44 and reduced intensity (Flu-Mel, Flu-Cy) in 23/44. Campath-1H was used in 16/44. The recipient/donor CMV serostatus was R+/D+ (n=11), R+/D− (n=9), R−/D+ (n=4) and R−/D− (n=20). With a median follow up of 10 months (range <1–26), 12/24 (50%) patients at high risk of CMV reactivation (6 of 11 R+/D+, 6 of 9 R+/D−, 0 of 4 R−/D+) had CMV detected compared with 1/20 (5%) low risk R−/D− patients. CMV detection occurred at a median of 21d (range 3–128) post ASCT. 12/13 patients with detectable CMV had initial levels below the LQL. All required treatment, 5 because of co-existent symptoms of CMV infection despite consecutive readings below the LQL and 7 because the second reading was above the LQL. Conditioning therapy, donor type and use of CAMPATH-1H did not appear to influence risk of CMV detection. There was no CMV related death in this cohort. Conclusion: We conclude that, using the above kit, the detection cut-off of 6.5 × 102 copies/ml rather than the manufacturer’s validated LQL of 1 × 104/ml is the more appropriate trigger for initiating pre-emptive anti-CMV therapy in patients undergoing ASCT. Since manufacturers do not consider quantification below the LQL to be reliable, we recommend that where the detection cut-off is significantly lower than the LQL, transplant centres seek to determine their own appropriate treatment trigger.

Post-transplant erythrocytosis is an ominous complication of kidney transplantation, occurring in the first 8 to 24 months after surgery in 10% to 15% of transplant recipients; this is frequently associated with significant thromboembolic events and sometimes death. In patients undergoing allogeneic hematopoietic cell transplantation (HCT), erythrocytosis has not been previously well described. At our institution, we observed that some aplastic anemia (AA), and Fanconi anemia (FA) patients developed progressively increased hemoglobin (HB), hematocrit (HCT) and RBC readings on long term follow up. Thus, this study was conducted to assess the validity of this observation in AA/FA patients post HCT, and its impact on their health. Patients and Methods From January 1993 until December 2011, 144 pediatric patients underwent successful allogeneic HCT for AA or FA; median age at HCT 11.6 years (range, 6.6 -15). All patients included were alive at the time of the analysis, and had sustained engraftment; all have had a follow up time of ≥ 12 months. For those who underwent more than one HCT, only events after the last HCT were included. We retrospectively examined the HB levels as an indicator for erythrocytosis (Corresponding RBC, HCT, WBC, and platelet counts were also collected). HB values of 150, and 160 gm/l were considered the trigger value in females and males, respectively. Patients who reached this value were studied for higher values on follow up, and only those whose HB persisted for at least 3 months above trigger value were included in the analysis; 29 patients (15 females, 14 males) were identified after causes of secondary erythrocytosis were ruled out. Erythrocytosis was defined as HB ≥ 160 gm/l in females, a HB ≥ 170 gm/l in males. Results Median time to trigger HB was 51.4 months (range, 15-121) in females, and 65 months (range, 23.3-114) in males, and median age at trigger HB was 14.7 years (range, 8.6-21.4) in females, and 16.9 years (range, 13.4-20.6) in males. Median highest HB reached was 160 gm/l (range, 151-162) in females, and 172 gm/l (range, 164-189) in males, with a median time of 67 months (range, 17-164) in females, and 103 months (range, 23.3-206) in males; the median age at highest HB was 16 years (range, 9.7-24.8) in females, and 20.2 years (range, 13.4-27.4) in males. Upon follow up, the HB fell below the trigger level in 16 patients (9 females, 7 males) (55.2%), at a median time of 37.2 months from the trigger value (range, 3.6-104). Seventeen patients qualified for the diagnosis of erythrocytosis (12%); 8 females, and 9 males. In all 8 females and in 4 males, HB fell below the erythrocytosis value upon follow up. All HB values correlated positively with HCT and RBC, no correlation was detected with platelet count or WBC. On univariate analysis, patients with older age at HCT (≥ 10 years) appeared to be more likely to develop elevated HB (P=0.003); and those who had radiation in the conditioning regimen were less likely to develop elevated HB (P=0.008). Three of the males with persistent erythrocytosis were tested further and all 3 had normal erythropoietin levels and were negative for JAK-2 mutations. None of the 29 patients had any adverse clinical symptoms during the follow up visits, and no thromboembolic events were reported. Conclusion A proportion of patients with AA/FA who undergo HCT may experience elevated HB on long term follow up; 12% subsequently qualifying as erythrocytosis, with the highest reading requiring between 1.5-2 years to evolve. Unlike erythrocytosis post renal transplant, the phenomenon we are describing in our patient cohort does not appear to be associated with any adverse symptoms, or any increased risk of thrombosis. More in depth investigation to study the potential pathophysiology behind it is currently underway at our institution, together with further exploration of this observation in patients with other illnesses undergoing allogeneic HCT. Disclosures: No relevant conflicts of interest to declare.

Abstract Due to their small size, low-power demands, and customizability, low-cost sensors can be deployed in collections that are spatially distributed in the environment, known as sensor networks. The literature contains examples of such networks in the ambient environment; this article describes the development and deployment of a 40-node multi-hazard network, constructed with low-cost sensors for particulate matter (SHARP GP2Y1010AU0F), carbon monoxide (Alphasense CO-B4), oxidizing gases (Alphasense OX-B421), and noise (developed in-house) in a heavy-vehicle manufacturing facility. Network nodes communicated wirelessly with a central database in order to record hazard measurements at 5-min intervals. Here, we report on the temporal and spatial measurements from the network, precision of network measurements, and accuracy of network measurements with respect to field reference instruments through 8 months of continuous deployment. During typical production periods, 1-h mean hazard levels ± standard deviation across all monitors for particulate matter (PM), carbon monoxide (CO), oxidizing gases (OX), and noise were 0.62 ± 0.2 mg m−3, 7 ± 2 ppm, 155 ± 58 ppb, and 82 ± 1 dBA, respectively. We observed clear diurnal and weekly temporal patterns for all hazards and daily, hazard-specific spatial patterns attributable to general manufacturing processes in the facility. Processes associated with the highest hazard levels were machining and welding (PM and noise), staging (CO), and manual and robotic welding (OX). Network sensors exhibited varying degrees of precision with 95% of measurements among three collocated nodes within 0.21 mg m−3 for PM, 0.4 ppm for CO, 9 ppb for OX, and 1 dBA for noise of each other. The median percent bias with reference to direct-reading instruments was 27%, 11%, 45%, and 1%, for PM, CO, OX, and noise, respectively. This study demonstrates the successful long-term deployment of a multi-hazard sensor network in an industrial manufacturing setting and illustrates the high temporal and spatial resolution of hazard data that sensor and monitor networks are capable of. We show that network-derived hazard measurements offer rich datasets to comprehensively assess occupational hazards. Our network sets the stage for the characterization of occupational exposures on the individual level with wireless sensor networks.

Objective – To explore student thought on both reflection and reflective writing as a process, and to analyze the writing by the application of clearly defined and identifiable outcomes. Design – Mixed method approach consisting of a qualitative analysis of 116 written reflections from master’s level students as well as a quantitative statistical analysis. Setting –The University of Sheffield masters-level librarianship program’s course INF6005, “Management for LIS.” Subjects – Of the 31 students registered the course during the 2007-2008 academic year, 22 (71%), allowed their reflections to be used for the purposes of research. Of these, 7 students identified themselves as male, and 15 were female. All students included were over 21 years of age and had previous library experience, with varying degrees of management experience in supervisory roles. Not all supervisory experience was gathered within the library domain. Methods –A total of 116 reflective journal entries were submitted by the participating students during the eight month period from October 2008 to May 2009. In order to identify themes, qualitative analysis was applied to the reflective writing responses. Descriptive statistics were also applied to test the hypothesis, illustrate the relationships between reflective writing and outcomes, and locate identifiable outcomes. Main Results – Practising reflection demonstrated benefits for individuals and groups both in and outside of the workplace. On the whole, individuals gained the most from reflection and saw it in the most positive light when it was practised as a daily activity. Quantitatively, when students began to master the practice of reflection, they demonstrated an increase in their ability to learn and an overall improvement of self-development and critical thinking skills, and gained a defined awareness of personal mental function. When decision making became easier, students understood they had begun to master the art of reflective practice and analytical reflective writing. Qualitatively, when the students’ reflections were assessed, ten different themes emerged: (1) Nature of reflection (2) Reflection seen as useful in providing support for a career and professional development (3) Reflective writing – benefits (4) Reflective writing – potential in future employment and workplace (5) Encouraging others to use reflective practice (6) Reflecting positively (7) Reflection applicable to both individuals and groups (8) Reflection in support of personal awareness (9) Exploration of different methods of reflection (10) Difficulties in focusing enough to be able to reflect deeply Conclusion – Reflection is a skill that can be practised and developed. Initially, not all students enrolled in the class and participating in the study knew what reflective writing was or what it entailed. Students were given support to educate them in this area. Support included academic reading, lectures, reflective writing workshops and an overall opportunity to develop their skills further. Reflective writing was demonstrated to have a very positive relationship with several key outcomes. The areas impacted include academic learning, self-development, and critical review, with key outcomes including an increased awareness of personal mental function and increased support for decision making, as well as empowerment and emancipation. The clearest benefit was represented when students wrote about their analytical reflections.

Abstract. During COVID-19 pandemic, educators implement online learning in the education process. Basic interactive models of online learning available, such as synchronous learning, as a face-to-face learning process through online media. This research investigates the students’ perception toward the implementation of synchronous learning in ELT especially TOEFL. This research is qualitative. The results show that: 1) 51 % of students use Zoom and Live YouTube in learning TOEFL. 2) 89.7 % of students use mobile phones in online learning. 3) 49.7 % of students agree that Zoom has complete features. 4) 83.2 % of students agree that operating Zoom’s features is very easy. 5) 74.2 % of students agree that Zoom is easy-used. 6) 72.9 % of students agree that using Zoom in learning TOEFL is effective. 7) 73 % of students agree that using Live YouTube in learning TOEFL also effective. 8) 63.9 % agree that in Zoom, they can participate by face-to-face interactions (e.g. question-answer even discussion with lecturer and classmates. 9) 95.5 % of students agree that using YouTube, videos can be seen anytime and anywhere because videos are stored on the lecturer’s channel. In the understanding level of TOEFL, 83.2 % of students really understand in the listening section, 89.7 % of students understand the reading section, and 81.3 % of students understand the Structure and Written Expression section. Several problems affect learning TOEFL with Zoom and YouTube. Students have a problem with an internet connection. The other problems are internet quota, technical problems of the device (e.g battery, device dead suddenly, audio quality, device’s video/audio, and others), device’s type used, and surrounding conditions (e.g light conditions, sounds, or other disturbances). In the next learning system, 80.6 % of students agree that the next learning system implements face-to-face learning and still uses Zoom and YouTube Live Streaming. Keywords: ELT, synchronous learning, TOEFL, YouTube, Zoom Abstrak. Selama pandemi COVID-19, para pendidik menerapkan pembelajaran online dalam proses pendidikan. Model pembelajaran online interaktif dasar yang tersedia, seperti pembelajaran sinkron, sebagai proses pembelajaran tatap muka melalui media online. Penelitian ini mengkaji persepsi siswa terhadap penerapan pembelajaran sinkron di ELT khususnya TOEFL. Penelitian ini bersifat kualitatif. Hasil penelitian menunjukkan bahwa: 1) 51% siswa menggunakan Zoom dan Live YouTube dalam pembelajaran TOEFL. 2) 89,7% siswa menggunakan ponsel dalam pembelajaran online. 3) 49,7% siswa setuju bahwa Zoom memiliki fitur yang lengkap. 4) 83,2% siswa setuju bahwa mengoperasikan fitur Zoom sangat mudah. 5) 74,2% siswa setuju bahwa Zoom mudah digunakan. 6) 72,9% siswa setuju bahwa menggunakan Zoom in learning TOEFL efektif. 7) 73% siswa setuju bahwa menggunakan Live YouTube dalam pembelajaran TOEFL juga efektif. 8) 63,9% setuju bahwa dengan Zoom, mereka dapat berpartisipasi dengan interaksi tatap muka (misalnya tanya jawab bahkan diskusi dengan dosen dan teman sekelas. 9) 95,5% mahasiswa setuju bahwa dengan menggunakan YouTube, video dapat dilihat kapan saja dan di mana saja karena video disimpan di saluran dosen. Pada tingkat pemahaman TOEFL, 83,2% siswa sangat memahami bagian menyimak, 89,7% siswa memahami bagian membaca, dan 81,3% siswa memahami bagian Struktur dan Ekspresi Tertulis. Beberapa masalah memengaruhi pembelajaran TOEFL dengan Zoom dan YouTube. Siswa memiliki masalah dengan koneksi internet. Masalah lainnya adalah kuota internet, masalah teknis perangkat (misal baterai, perangkat mati mendadak, kualitas audio, video/audio perangkat, dan lain-lain), jenis perangkat yang digunakan, dan kondisi sekitarnya (misal kondisi cahaya, suara, atau gangguan lainnya). Pada sistem pembelajaran selanjutnya, 80,6% siswa setuju bahwa sistem pembelajaran selanjutnya menerapkan pembelajaran tatap muka dan masih menggunakan Zoom dan YouTube Live Streaming.Kata kunci: ELT, pembelajaran sinkronus, TOEFL, YouTube, Zoom