The Impact of Blended Learning on Writing Accuracy for Iraqi EFL Intermediate School Learners

هدف هذا البحث إلى معرفة كيف أثر التعلم المدمج على دقة الكتابة لمتعلمي اللغة الإنجليزية كلغة أجنبية لطلاب المدارس المتوسطة في العراق. لتحقيق هذا الهدف، شارك في هذه الدراسة 70 طالبا من طلاب المدارس المتوسطة في العراق اعتمادا على نتائج اختبار أكسفورد لتحديد المستوى. تراوحت أعمار الطلبة بين 18 و32 عامًا مع العلم ان اللغة العربية هي لغتهم الأولى، وكانوا يتمتعون بنفس مستوى إجادة اللغة الإنجليزية (OPT). كان تقسيمهم إلى المجموعة التجريبية (ن=35) والمجموعة الضابطة (ن=35) بشكل عشوائي. تلقت المجموعة الضابطة التعليمات المتطابقة باستخدام المنهج التقليدي الذي يركز على المعلم وجهاً لوجه بينما تلقته المجموعة التجريبية باستخدام منهج التعلم المدمج. وكان استخدام الاختبار القبلي والبعدي للحصول على البيانات، التي جرى تحليلها بعد ذلك باستخدام اختبارات t للعينة المزدوجة واختبارات T المستقلة للعينة. أظهرت النتائج في الاختبار القبلي أن متوسط المجموعة الضابطة كان أكثر من المجموعة التجريبية ولكن الفرق لم يكن معنوياً. ومع ذلك، تفوقت المجموعة التجريبية بشكل كبير على المجموعة الضابطة بعد استخدام إستراتيجية التعلم المدمج. أظهرت النتائج أن لها بعض الآثار المترتبة حيث يمكن لمعلمي اللغة الإنجليزية كلغة أجنبية ومطوري المواد وصانعي السياسات التعليمية من اتباعها.This research aimed to find out how blended learning affected the writing accuracy of intermediate Iraqi EFL learners. 70 intermediate EFL learners from Iraq took part in this study to achieve this goal. Based on the results of the Oxford Placement Test, they were between the ages of 18 and 32, had Arabic as their first language, and had the same level of English proficiency (OPT). They were divided into the experimental group (n=35) and the control group (n=35) at random. The control group received the identical instruction using a face-to-face, traditional teacher-centered approach while the experimental group received it using a blended learning approach. Pre- and post-testing was used to obtain the data, which was then analyzed using paired sample t-tests and independent sample T-tests. The results showed that, in the pre-test, the mean of the control group was more than the experimental group but the difference was not significant. The experimental group, nevertheless, significantly outperformed the control group after using the blended learning strategy. The findings have some implications for EFL teachers, materials developers, and policymakers

Low-Noise Speed-Optimized Large Area CMOS Avalanche Photodetector for Visible Light Communication

Mean-gain and excess-noise measurements are presented for a 350 × 350 μm 2 P+/N-well/P-sub and a 270 × 270 μm 2 N-well/P-sub avalanche photodetectors fabricated using 0.13-μm CMOS technology. The active area of the P+/N-well/P-sub device was divided into multiple subsections to decrease transit time and increase speed. For the P+/N-well structure, remarkably low excess-noise factors of 4.1 and 4 were measured at a mean gain of 16 corresponding to a k value of approximately 0.1, using a 542 (633) nm laser. For a variant N-well/P-sub structure, excess-noise factors of 6.5 and 6.2 were measured at a mean-gain of 16 corresponding to a k value of approximately 0.3. The proposed CMOS APDs with high gain, low noise, low avalanche breakdown voltage (below approximately 12 V) and low dark-currents (approximately nA) would be attractive for low-cost optical receivers in visible-light communication systems

Exploring the micromorphological diversity of palynomorphic flora from lesser Himalaya biodiversity hotspot

Palynology, a prominent field in plant systematics and biodiversity studies, plays a vital role in identifying and determining the plant species present in a specific region. The current study was performed to evaluate the micromorphological traits of pollen from flora of Lesser Himalaya. Pollen microstructural variations aid in the identification of species belonging to specific botanical families and various geographic habitats. Flowers of 24 selected species categorized into 16 families were collected, preserved and then acetolysis protocol followed. Pollen was examined under a light and scanning microscopy (LM and SEM) for palynomorph description. The palynomorphs characteristics such as size, shape, exine surface, and aperture orientation, were examined. Status of these plants show that herbs are being dominant (11 species), while shrubs (7 species), climbers (3 species), bulbous plants (2 species), small tree, sedge, weed (1 species each).  Pollen shape determined in equatorial view were; spheroidal, sub-prolate, oblate-spheroidal, prolate, spherical and sub-oblate. The variations were seen among pollen types; tricolpate, tricolporate and polyporate in most of the species. Exine stratification was observed mostly scabrate while echinate, cristate-reticulate, granulate, punctate, rugulate-perforate, striate-rugulate, verrucate, cristate-foveolate was visualized in each different species. Palynomorph apertural patterns were observed sunken, furrowed, slightly bulged, scabrate, granulate, slit like, and perforate. The largest polar diameter was measured in Hymenocallis littoralis (138.6 µm) whereas smallest in Parthenium hysterophorus (14.70 µm). Equatorial distance was calculated maximum for Cascabela thevetia (110.1 µm) and minimum for Hibiscus rosa-sinensis (1.7 µm). P/E ratio was calculated largest in Hymenocallis littoralis (1.8) and lowest in Duranta erecta (0.89). The palynomorphs taxonomic characters investigated can be helpful in species level identification and provide a baseline to conduct more systematic research with respect to specific plant families and genera

Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study

Background Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. Methods We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. Results The top three problems were incomplete reconciliation of medication during patient ‘hand-overs’, inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. Conclusions Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism

Prioritizing problems in and solutions to homecare safety of people with dementia:supporting carers, streamlining care

Abstract Background Dementia care is predominantly provided by carers in home settings. We aimed to identify the priorities for homecare safety of people with dementia according to dementia health and social care professionals using a novel priority-setting method. Methods The project steering group determined the scope, the context and the criteria for prioritization. We then invited 185 North-West London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to homecare safety of people with dementia. 76 clinicians submitted their suggestions which were thematically synthesized into a composite list of 27 distinct problems and 30 solutions. A group of 49 clinicians arbitrarily selected from the initial cohort ranked the composite list of suggestions using predetermined criteria. Results Inadequate education of carers of people with dementia (both family and professional) is seen as a key problem that needs addressing in addition to challenges of self-neglect, social isolation, medication nonadherence. Seven out of top 10 problems related to patients and/or carers signalling clearly where help and support are needed. The top ranked solutions focused on involvement and education of family carers, their supervision and continuing support. Several suggestions highlighted a need for improvement of recruitment, oversight and working conditions of professional carers and for different home safety-proofing strategies. Conclusions Clinicians identified a range of suggestions for improving homecare safety of people with dementia. Better equipping carers was seen as fundamental for ensuring homecare safety. Many of the identified suggestions are highly challenging and not easily changeable, yet there are also many that are feasible, affordable and could contribute to substantial improvements to dementia homecare safety

HLA-Cw*0602 associates with a twofold higher prevalence of positive streptococcal throat swab at the onset of psoriasis: a case control study

<p>Abstract</p> <p>Background</p> <p>The influence of streptococcal infections in the pathogenesis of psoriasis is not yet understood. <it>In vitro </it>data suggest that streptococcal factors influence T-cell function in psoriasis in a HLA-dependent manner, but studies designed to measure the HLA-C/Streptococci interaction are lacking. In the present study, we hypothesized that there is a statistical interaction between the result of streptococcal throat cultures and the presence of the HLA-Cw*0602 allele in psoriasis patients.</p> <p>Methods</p> <p>We performed a case control study using the "Stockholm Psoriasis Cohort" consisting of patients consecutively recruited within 12 months of disease onset (Plaque psoriasis = 439, Guttate psoriasis = 143), matched to healthy controls (n = 454) randomly chosen from the Swedish Population Registry. All individuals underwent physical examination including throat swabs and DNA isolation for HLA-Cw*0602 genotyping.</p> <p>The prevalence of positive streptococcal throat swabs and HLA-Cw*0602 was compared between patients and controls and expressed as odds ratios with 95% confidence intervals. Associations were evaluated separately for guttate and plaque psoriasis by Fisher's exact test.</p> <p>Results</p> <p>Regardless of disease phenotype, the prevalence of positive streptococcal throat swabs in HLA-Cw*0602 positive patients was twice the prevalence among HLA-Cw*0602 negative patients (OR = 5.8 C.I. = 3.57–9.67, p < 0.001), while no difference was observed among Cw*0602 positive versus negative controls.</p> <p>The corresponding odds ratios for the guttate and plaque psoriasis phenotypes were 3.5 (CI = 1.5–8.7, p = 0.01) and 2.3 (CI = 1.0–5.1, p = 0.02) respectively.</p> <p>Conclusion</p> <p>These findings suggest that among HLA-Cw*0602 positive psoriasis patients, streptococci may contribute to the onset or exacerbation of the inflammatory process independent of the disease phenotype. However, studies on the functional interaction between HLA-C and streptococcal factors are needed.</p

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: A systematic analysis for the global burden of disease study 2017

© 2020 The Author(s). Background Oesophageal cancer is a common and often fatal cancer that has two main histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Updated statistics on the incidence and mortality of oesophageal cancer, and on the disability-adjusted life-years (DALYs) caused by the disease, can assist policy makers in allocating resources for prevention, treatment, and care of oesophageal cancer. We report the latest estimates of these statistics for 195 countries and territories between 1990 and 2017, by age, sex, and Socio-demographic Index (SDI), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD). Methods We used data from vital registration systems, vital registration-samples, verbal autopsy records, and cancer registries, combined with relevant modelling, to estimate the mortality, incidence, and burden of oesophageal cancer from 1990 to 2017. Mortality-to-incidence ratios (MIRs) were estimated and fed into a Cause of Death Ensemble model (CODEm) including risk factors. MIRs were used for mortality and non-fatal modelling. Estimates of DALYs attributable to the main risk factors of oesophageal cancer available in GBD were also calculated. The proportion of oesophageal squamous cell carcinoma to all oesophageal cancers was extracted by use of publicly available data, and its variation was examined against SDI, the Healthcare Access and Quality (HAQ) Index, and available risk factors in GBD that are specific for oesophageal squamous cell carcinoma (eg, unimproved water source and indoor air pollution) and for oesophageal adenocarcinoma (gastro-oesophageal reflux disease). Findings There were 473 000 (95% uncertainty interval [95% UI] 459 000-485 000) new cases of oesophageal cancer and 436 000 (425 000-448 000) deaths due to oesophageal cancer in 2017. Age-standardised incidence was 5.9 (5.7-6.1) per 100 000 population and age-standardised mortality was 5.5 (5.3-5.6) per 100 000. Oesophageal cancer caused 9.78 million (9.53-10.03) DALYs, with an age-standardised rate of 120 (117-123) per 100 000 population. Between 1990 and 2017, age-standardised incidence decreased by 22.0% (18.6-25.2), mortality decreased by 29.0% (25.8-32.0), and DALYs decreased by 33.4% (30.4-36.1) globally. However, as a result of population growth and ageing, the total number of new cases increased by 52.3% (45.9-58.9), from 310 000 (300 000-322 000) to 473 000 (459 000-485 000); the number of deaths increased by 40.0% (34.1-46.3), from 311 000 (301 000-323 000) to 436 000 (425 000-448 000); and total DALYs increased by 27.4% (22.1-33.1), from 7.68 million (7.42-7.97) to 9.78 million (9.53-10.03). At the national level, China had the highest number of incident cases (235 000 [223 000-246 000]), deaths (213 000 [203 000-223 000]), and DALYs (4.46 million [4.25-4.69]) in 2017. The highest national-level agestandardised incidence rates in 2017 were observed in Malawi (23.0 [19.4-26.5] per 100 000 population) and Mongolia (18.5 [16.4-20.8] per 100 000). In 2017, age-standardised incidence was 2.7 times higher, mortality 2.9 times higher, and DALYs 3.0 times higher in males than in females. In 2017, a substantial proportion of oesophageal cancer DALYs were attributable to known risk factors: tobacco smoking (39.0% [35.5-42.2]), alcohol consumption (33.8% [27.3-39.9]), high BMI (19.5% [6.3-36.0]), a diet low in fruits (19.1% [4.2-34.6]), and use of chewing tobacco (7.5% [5.2-9.6]). Countries with a low SDI and HAQ Index and high levels of indoor air pollution had a higher proportion of oesophageal squamous cell carcinoma to all oesophageal cancer cases than did countries with a high SDI and HAQ Index and with low levels of indoor air pollution. Interpretation Despite reductions in age-standardised incidence and mortality rates, oesophageal cancer remains a major cause of cancer mortality and burden across the world. Oesophageal cancer is a highly fatal disease, requiring increased primary prevention efforts and, possibly, screening in some high-risk areas. Substantial variation exists in age-standardised incidence rates across regions and countries, for reasons that are unclear

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations