Osteosarcoma is the most common primary malignant bone tumor, predominantly affecting adolescents and young adults. Advances in therapeutic strategies, including neoadjuvant chemotherapy, surgery, and limb reconstruction, have significantly improved the 5-year survival rate for non-metastatic cases to 60–70%, compared to historical rates of only 10–20%. Key prognostic factors include histological response to preoperative chemotherapy, alkaline phosphatase levels, and lactate dehydrogenase. However, prognosis remains poor for patients with metastases, particularly pulmonary metastases, or tumors located in the pelvis and axial skeleton. Data from Indonesia reveal relatively low survival rates, with a mean survival of only 28 months, indicating limited access to optimal treatment. Recent research developments, such as gene therapy, immunotherapy, and advanced reconstructive techniques, hold promises for improving therapeutic outcomes and patient quality of life in the future. Keywords: Osteosarcoma, neoadjuvant chemotherapy, prognosis, limb reconstruction, gene therapy.
Integrating Artificial Intelligence (AI), specifically Large Language Models like ChatGPT-4, into English as a Foreign Language (EFL) instruction offers significant pedagogical opportunities, yet its qualitative impact on higher-order cognitive processing remains nuanced. This study provides an in-depth qualitative thematic analysis examining how ChatGPT-4 is integrated into Extensive Reading classes to foster critical thinking skills, evaluating the resulting cognitive transformations, identifying learner challenges, and capturing instructional reflections. Using a convergent parallel mixed-method design grounded in Facione's Critical Thinking Framework and Vygotsky's Social Constructivism, data were collected from 48 second-semester EFL undergraduate students and their instructor at University X, Kudus, Java, using classroom observations, semi-structured interviews, student worksheets, and standardized pre-/post-tests. Thematic analysis of qualitative data revealed five major thematic dimensions: (1) Guided Pedagogical Integration & Scaffolding, (2) Cognitive Deepening in Textual Processing, (3) Collaborative Critical Dialogue & Peer Evaluation, (4) Operational & Epistemic Challenges, and (5) Instructional Reflection on AI Mediation. Quantitative findings corroborated these thematic insights, demonstrating a statistically meaningful improvement in critical thinking scores (Pre-test M = 49.7; Post-test M = 73.5; Normalized Gain g = 0.65, Moderate). The findings demonstrate that ChatGPT-4 operates effectively as an artificial mediational tool within the Zone of Proximal Development when paired with structured prompts and teacher-led reflection, transforming learners from passive consumers into active, analytical evaluators. Keywords: ChatGPT-4, Extensive Reading, Critical Thinking, Thematic Analysis, EFL, Artificial Intelligence in education.
Duplication of the vermiform appendix is an exceedingly rare congenital anomaly, with an estimated incidence of 0.004–0.009% and fewer than 150 cases reported worldwide since it was first described by Picoli in 1892. Preoperative diagnosis is difficult, and the condition is usually identified incidentally at surgery. We report the case of a 24-year-old male who presented with classical features of acute appendicitis, in whom intraoperative exploration revealed two adherent tubular structures with separate bases, one of which showed a necrosed base. Appendicectomy was performed on both structures, and histopathology confirmed appendiceal duplication with acute appendicitis in one specimen and acute suppurative necrotizing appendicitis in the other. The patient recovered uneventfully. This case highlights the need for careful intraoperative exploration in cases of right iliac fossa pain, as a missed second appendix can result in recurrent or unresolved symptoms. Keywords: duplicated appendix, appendiceal duplication, acute appendicitis, congenital anomaly, appendicectomy
Background: Core stability, mediated by the transversus abdominis (TrA), is vital for spinal protection and functional movement. Impaired activation of these deep stabilizers is a recognized precursor to musculoskeletal dysfunction and low back pain. While the Pressure Biofeedback Unit (PBU) is a validated tool for assessing TrA recruitment during the abdominal drawing-in maneuver, normative data for healthy young adults is limited. Objectives: This study sought to quantify transversus abdominis activation using the Pressure Biofeedback Unit (PBU) and categorize the distribution of core stability levels among healthy college students aged 18–22 years. Methods: A community-based cross-sectional study was conducted at the NAMO College of Allied Health Sciences among 185 participants recruited via purposive sampling. Healthy students aged 18–22 years were included, while those with a history of low back pain, fractures, or neuromuscular disorders were excluded. Core activation was assessed using a Pressure Biofeedback Unit (PBU) in a supine crook-lying position during the Abdominal Drawing-in Maneuver (ADIM) from a 40-mmHg baseline. Participants were categorized into three functional activation patterns based on pressure readings: Optimal TrA Control (40-50 mmHg hold), Compensatory Global Bracing (>50mmHg), and Weak/Insufficient Recruitment (< 40 mmHg). Results: The mean pressure deviation during the hold phase across the cohort was 41.69 ± 5.62 mmHg. Overall, only 41.1% (n = 76) of participants demonstrated optimal core activation. Suboptimal core control was observed in 58.9% (n = 109) of the sample: 42.7% (n = 79) exhibited compensatory global stabilizer activation (pressure increase > 50 mmHg), and 16.2% (n = 30) demonstrated insufficient recruitment (pressure drop < 40 mmHg or inability to sustain baseline control). Conclusion: The study identifies a significant prevalence (58.9%) of suboptimal core stabilizer control among college students. The high rate of compensatory global muscle recruitment underscores a critical need for targeted neuromuscular re-education and core stability programming to prevent early-onset postural and musculoskeletal dysfunctions. Keywords: Core Stability, Pressure Biofeedback Unit, Transversus Abdominis, College Students
Background: Smartphones have become an essential part of daily life, particularly among young adults. Excessive smartphone use may lead to smartphone addiction, which has been associated with psychological stress and musculoskeletal problems, including altered pain sensitivity in cervical muscles. Aim: To evaluate the association between perceived stress and pressure pain threshold (PPT) of the upper trapezius and sternocleidomastoid muscles in smartphone-addicted young adults. Methods: This pilot cross-sectional observational study included 10 smartphone-addicted young adults aged 18–25 years selected through convenience sampling after obtaining written informed consent. Smartphone addiction was assessed using the Smartphone Addiction Scale–Short Version (SAS-SV), perceived stress using the Perceived Stress Scale (PSS-10), and PPT of the upper trapezius and sternocleidomastoid muscles using a handheld pressure algometer. Correlation analysis was performed to examine the relationship between perceived stress and PPT. Results: The mean age of participants was 22.80 ± 0.79 years, with equal numbers of males and females. The mean SAS-SV score was 33.00 ± 1.41 and the mean PSS score was 26.80 ± 3.99. Mean PPT was 2.18 ± 0.14 kg/cm² for the upper trapezius and 1.67 ± 0.42 kg/cm² for the sternocleidomastoid. Perceived stress showed a moderate negative correlation with upper trapezius PPT (r = −0.585, p = 0.076) and a weak negative correlation with sternocleidomastoid PPT (r = −0.378, p = 0.281). These correlations were not statistically significant. Conclusion: Smartphone-addicted young adults demonstrated moderate perceived stress and reduced cervical muscle PPT. Although higher perceived stress was associated with lower PPT, the associations were not statistically significant. Larger studies are needed to confirm these findings. Keywords: Smartphone addiction, perceived stress, pressure pain threshold, upper trapezius, sternocleidomastoid.
Naturalism, as a literary movement, aims to depict human life objectively and realistically, in a manner that shows social, psychological and biological realities. Initially, Santali poetry focused on nature and the spirit world, as well as folk life and community, and since independence, there has been a major change in themes, including naturalistic tendencies. This paper traces Santali poetry's evolution from aesthetic of naturalism in the 1950s to 1980s. The study examines how the poets Gorachand Tudu, Krishna Chandra Tudu, Aditya Mitra 'Santhali' and Basudeb Besra represented death consciousness, psychological conflict, sensuality, instinctive human behaviour and other socially suppressed aspects in their selected poems. The study is qualitative and adopts a textual analysis approach. The paper purports that the naturalistic poetic style emerged as an alternative style of poetry that turned away from idealized image of nature to its complexities of human life. The study also shows that Santali notion of Churitan has its own indigenous dimension to explain naturalistic expression in Santali literature. Keywords: Santali literature; Poetry; Literary movement; Naturalism.
Stroke is one of the leading causes of long-term disability worldwide, and gait impairment is a major factor affecting mobility, independence, and quality of life in stroke survivors. Rhythmic Auditory Stimulation (RAS) is a treatment method used with conventional physiotherapy by providing rhythmic auditory cues such as metronome beat or music that helps to improve walking performance. This review aimed to evaluate the effectiveness of Rhythmic Auditory Stimulation on gait training in individuals with stroke. A literature review was conducted using studies published between 2015 and 2026 that were identified through electronic databases, including PubMed, Google Scholar and Scopus. Studies involving adults aged 18 years and above with stroke and evaluating the effects of RAS on gait-related outcomes were included. The reviewed evidence demonstrated that combining RAS with conventional rehabilitation improved gait speed, cadence, step length, stride length, gait symmetry, balance, and functional mobility compared with conventional therapy alone. Rhythmic auditory cues also enhanced movement synchronization, increased patient participation, and promoted more efficient walking patterns. Overall, the findings suggest that Rhythmic Auditory Stimulation is a safe, effective, and clinically useful adjunct to conventional physiotherapy for improving gait in individuals with stroke. Keywords: Rhythmic Auditory Stimulation, Gait Training, Gait Parameters, Stroke Rehabilitation.
This study examined the effect of Yu-Gi-Oh! TCG-generated complex sentences on EFL reading comprehension at 11th students of SMK PGRI 2 Kudus. A mixed-methods research design was employed, involving intact class consist of 32 students assigned to a pre-experimental research design. The effect size analysis revealed a very large practical impact of the intervention (Cohen’s d = 2.275), demonstrating the substantial effectiveness of YuGiOh TCG-Generated complexes sentence in enhancing reading comprehension. Qualitative findings further supported the quantitative results, revealing the perceptions of students and teachers regarding the use of Yu-Gi-Oh! TCG in the reading classroom are positives as an innovative bridge between difficult grammar and student interest. The observable behaviors and quality of interactions characterize the learning environment during Yu-Gi-Oh! TCG-based reading activities successfully transform the classroom into an active, low-difficulty, and highly collaborative learning community. Overall, the study concludes that Yu-Gi-Oh! TCG-generated complex sentences is an effective media to increase students reading comprehension in English as a Foreign Language learning content. Keywords: Effect, Yu-Gi-Oh! TCG-generated complex sentences, EFL, reading comprehension
Background: Chronic stroke survivors frequently experience persistent deficits in gait, balance, and functional mobility despite receiving conventional rehabilitation. These impairments reduce independence, increase the risk of falls, and limit participation in daily and community activities. Backward walking training (BWT) has emerged as a promising supplementary rehabilitation approach because it places greater demands on neuromuscular coordination, postural control, and lower-limb muscle activation than conventional forward walking. Objective: To review the effectiveness of backward walking training on gait, balance, and functional mobility in middle-aged adults with chronic stroke. Methods: A narrative literature review was conducted using electronic databases including PubMed, Google Scholar, PEDro, ScienceDirect, Cochrane Library, and PubMed Central. Studies published in English between 2020 and 2025 involving middle-aged adults with chronic stroke (≥6 months post-stroke) were included. Eligible studies evaluated backward walking training as the primary intervention and assessed gait, balance, or functional mobility outcomes. A total of nine studies, including randomized controlled trials, prospective studies, and meta-analyses, met the inclusion criteria. Results: Backward walking training consistently improved gait speed, stride length, step length, gait symmetry, balance, and functional mobility among middle-aged adults with chronic stroke. Improvements were reported in outcome measures such as the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and 10-Meter Walk Test (10MWT). Individuals with severe walking impairment also demonstrated meaningful functional gains following backward walking training. Evidence further suggested that improvements achieved through backward walking may transfer to forward walking performance. Conclusion: Backward walking training appears to be an effective and feasible intervention for improving gait, balance, and functional mobility in middle-aged adults with chronic stroke when combined with conventional rehabilitation. However, further high-quality randomized controlled trials with standardized intervention protocols and longer follow-up periods are required to strengthen the current evidence and support wider clinical application. Keywords: Backward walking training, chronic stroke, gait, balance, functional mobility, stroke rehabilitation.
The retail business is changing due to the growth of digital technologies and online shopping. Many retailers started adopting omnichannel strategies to connect their online and offline businesses. This increases the sales and revenue of the concern. So, the study focuses on examining the impact of the adoption of omnichannel strategies on business performance and customer experience. A sample of 150 retail shops was taken for the study. Statistical tools such as descriptive statistics, chi-square and ANOVA are applied to analyse the data. The findings of the study reveal that retailers have agreed that an omnichannel strategy in the retail business has improved their overall sales and reached wider customers. Keywords: Traditional Retailing, Omnichannel Strategies, E-Commerce, Competitiveness, Economic Growth
Professor, Department of Pediatric Neurology, Government Medical College, Thiruvananthapuram.
The aim of this study is to analyse the stability of the Poponguine rock cliff using the SMR methods. The SMR and CSMR methods are based on the RMR geomechanical classification and on the identification of potential kinematic failures using stereographic projection. Three stations, designated S1, S2 and S3, were defined in order to apply the SMR methods to the Poponguine cliff. The RMR values at the three stations indicate an average rock mass, with respective RMR ratings of 48 (S1), 50 (S2) and 46 (S3). The main discontinuities identified were projected, and the kinematic analysis highlighted potential failure modes involving sliding and toppling. For the various failure types, the SMR and CSMR scores generally correspond to stable to partially stable slopes, with the exception of wedges 1 and 2 at station S1, for which the failure probabilities are 0.6 and 0.9, respectively, indicating unstable to completely unstable slopes. Keywords: Poponguine cliff, Slope stability, RMR, SMR, CSMR
Fusion is an uncommon developmental anomaly resulting from the union of two adjacent tooth germs during odontogenesis, producing variations in crown and root morphology that can complicate diagnosis and treatment. The intricate root canal anatomy associated with fused teeth presents significant challenges for endodontic therapy, often necessitating meticulous treatment planning. This case report describes the diagnosis and multidisciplinary management of a fused maxillary lateral incisor and a supernumerary tooth presenting with pulpal and periapical involvement. This report emphasizes the importance of accurate diagnosis, individualized treatment planning, and a conservative approach in achieving predictable outcomes when managing fused teeth. Keywords: Tooth fusion; Developmental dental anomaly; Supernumerary tooth; Endodontic treatment; Restorative management.
The study investigated digital competence and career progression of female academics in universities in Rivers State. Three research questions were answered and three hypotheses tested in the study. The study adopted a correlation survey design targeting all 1,806 female lecturers in Rivers State’s three public universities. A stratified random sample of 327 lecturers was selected, with 317 valid responses collected via two structured questionnaires: the “Digital Competence Questionnaire” (15 items) and the “Career Progression Questionnaire” (10 items), using a four-point Likert scale. Instruments were validated by three Measurement and Evaluation experts and demonstrated high reliability (DCQ = 0.88, CPQ = 0.81). Data were analyzed using Pearson Product Moment Correlation and t-tests associated with simple regression at a 0.05 significance level. Digital literacy showed a moderate positive correlation with career progression (r = 0.447), digital communication a strong positive correlation (r = 0.676), and digital creativity a very strong positive correlation (r = 0.855). Hypothesis testing confirmed that all relationships were statistically significant (p < 0.05). The results indicate that while foundational digital skills support professional growth, digital communication facilitates visibility and networking, and digital creativity most powerfully predicts career advancement through innovative teaching, research output, and leadership attainment. It was concluded that digital competencies significantly influence female academics’ career progression, with creativity being the most decisive factor. The study recommended that universities should provide targeted digital skills training, mentorship, and resources to enhance female lecturers’ digital creativity, communication, and literacy, thereby promoting equitable academic advancement. Keywords311: Digital Competence, Career Progression, Females, Lecturers, Universities
Background: Gout, a chronic crystallo-metabolic condition that necessitates early metabolic intervention. Employing a treat-to-target urate-lowering approach is crucial to prevent systemic complications, rather than simply managing acute inflammatory events. Methodology: This article reviews current scientific literature on gout and hyperuricemia, focusing on their metabolic connections. It examines clinical guidelines and research supporting early urate-lowering therapy and a treat-to-target approach, emphasizing the value of early intervention to prevent disease progression and related health issues. Main body of the abstract: The prevalence of hyperuricemia-related diseases is rising rapidly worldwide, imposing significant health and economic burdens. This trend is largely attributed to substantial lifestyle changes in both urban and rural populations. Hyperuricemia extends beyond joint pain; it represents a spectrum of diseases that can metabolically affect almost all bodily systems, and uric acid can be deposited in all organs. Addressing gout with a focus on its metabolic origins can mitigate the detrimental effects of hyperuricemia on other systems. Since gout is fundamentally a metabolic disorder, initiating early uric acid-lowering therapy can help preserve joint and organ health, mainly the vascular endothelium, rather than merely waiting for flare-ups. The current approach to gout management emphasizes a 'treat to target' strategy, aiming to lower serum uric acid levels below 6 mg/dL, rather than simply alleviating symptoms like pain. Furthermore, there is little justification for delaying the start of uric acid-lowering therapy; screening at the pre-hyperuricemia stage can help prevent the onset of gout. Conclusion: Gout is fundamentally a metabolic disease with multisystem implications. Effective management requires early identification of hyperuricemia, prompt initiation of urate-lowering therapy, and adherence to a treat-to-target strategy, as well as managing comorbidities. In today's metabolic landscape, gout is both preventable and curable. Keywords: Gout, hyperuricemia, extra-articular manifestations of hyperuricemia, extra-articular uric acid deposition, advantages of early treatments of gout, treat to target, pitfalls in the current gout management, treatment of gout on metabolic background, gout is a curable disease.
One of the most prevalent digestive issues is constipation. This problem can be brought on by low fiber consumption, dehydration, inactivity, stress, and occasionally adverse drug reactions. It causes discomfort in our lives. Constipation that is persistent requires medical intervention right away. Treatment entails improving a healthy lifestyle and consuming more fiber and drinks. Many polyherbal natural medicines have been produced for human consumption in addition to allopathic and single-ingredient medications. These medicines have been shown to be safe and effective due to their synergistic impact. The authors made an effort to describe the many natural purgatives and laxatives that are accessible. The added benefit of a synergistic impact is explained by the use of conventional medicinal substances in two different formulations: tablets and powders. By focusing on the mechanism of each ingredient and its corresponding impact, the significance of both formulations in relieving constipation and bloating is highlighted. In the end, this determines the overall impact of the corresponding formulation. Tablets are easier to administer than powder, even though powder is more quickly effective. Keywords: Constipation, Laxatives, Synergistic impact, Polyherbal formulations,
Background: The increasing use of digital devices among college students has raised concerns about its impact on digital fatigue, blue light exposure, and sleep quality. This study is grounded in Cognitive Load Theory and Arousal Theory. According to Cognitive Load Theory, excessive screen exposure increases mental workload, leading to cognitive exertion and digital fatigue. Arousal Theory suggests that exposure to artificial blue light, particularly during nighttime, suppresses melatonin secretion, increases physiological arousal, disrupts circadian rhythms, and impairs sleep quality. Previous research has highlighted links between prolonged screen use, eye strain, and sleep disturbances, though evidence on the independent effects of blue light and digital fatigue on sleep quality remains mixed. Aim: The present study aimed to assess levels of screen exposure, digital fatigue, blue light exposure, and sleep quality among college students, examine their interrelationships, and investigate predictors of digital fatigue. Methods: A cross-sectional correlational design was employed. A convenience sample of 123 college students aged 18-25 years participated. Data were collected through an online survey administered via Google Forms. Screen exposure was assessed using the Computer Vision Syndrome Questionnaire, digital fatigue with the Screen Fatigue Scale), blue light exposure using a custom 3-item self-report measure, and sleep quality using the PROMIS Sleep Disturbance Short Form (8 items). Descriptive statistics, Pearson correlations, and multiple linear regression were performed using SPSS. Results: Mean scores were: screen exposure, M = 70.90 (SD = 15.70); digital fatigue, M = 3.90 (SD = 2.74); blue light exposure, M = 8.11 (SD = 2.56); sleep quality, M = 26.49 (SD = 4.67). Screen exposure was positively correlated with digital fatigue (r = 0.480, p < 0.01). No significant associations were observed between blue light exposure and sleep quality (r = -0.046, p = 0.610) or between digital fatigue and sleep quality (r = 0.021, p = 0.814). Multiple regression indicated that screen exposure, blue light exposure, and sleep quality together predicted digital fatigue, explaining 23.6% of variance (R² = 0.236, p < 0.001). Conclusions: Digital fatigue among college students appears to be primarily influenced by screen exposure, with secondary contributions from sleep patterns and blue light exposure. These findings highlight the need for interventions promoting screen hygiene, digital well-being, and healthy sleep behaviors among students. Keywords: digital fatigue, digital mindfulness, blue light exposure, sleep quality
Emotional states impair one’s ability to regulate and focus cognitive processes. Mood can arise at any time—a person who was laughing, joking, and highly enthusiastic in conversation an hour prior may become withdrawn for the rest of the day without any apparent reason or due to other factors affecting their mood. The research problem investigated whether mood exerts an influence on academic procrastination among Psychology students in the 2022 cohort. The objective of this study was to determine whether mood influences academic procrastination among Psychology students in the 2022 cohort. This study employed a quantitative research design with a population of 237 students from the 2022 cohort. A sample of 130 students was selected using the Isaac and Michael table with a simple random sampling technique. Data were collected using a Likert-scale questionnaire and psychological scale instruments. Prerequisite tests included normality and linearity tests. Hypothesis testing employed Simple Linear Regression analysis and the coefficient of determination test, conducted using SPSS Version 26. The regression coefficient in this study yielded a positive value, indicating that the direction of the influence of Mood (Variable X) on Academic Procrastination (Variable Y) is positive. Based on the significance value obtained from the regression test (0.000 < 0.05), it can be concluded that the Mood variable (X) significantly influences Academic Procrastination. The coefficient of determination for the influence of Mood on Academic Procrastination was 0.246, equivalent to 24.6%, indicating that mood accounts for 24.6% of the variance in academic procrastination. The remaining 75.4% is attributable to other factors influencing academic procrastination among Psychology students in the 2022 cohort. Keywords: Mood, Academic Procrastination, University Students
A quasi-experimental study was conducted to assess the effectiveness of stretching exercises on muscle cramps among geriatric patients in Government Tiruvannamalai Medical College and Hospital, Tiruvannamalai. The geriatric patients were selected by using a convenience sampling technique based on sample selection criteria. A total of 60 geriatric patients were recruited in this study (30 experimental and 30 control). The modified muscle cramps assessment scale was used to assess the level of muscle cramps. The study result shows that, comparing the pre-test and post-test levels of muscle cramps among geriatric patients in the experimental group, the pre-test mean value of muscle cramps was 20.87 with (SD) ±2.81, and the post-test mean value was 15.53 with SD±2.78. The calculated paired ‘t’ value was t = 7.98 found to be statistically significant at p<0.001 level. In control group, the pre test mean value of muscle cramps was mean 21.13 with SD±2.94 and the post test mean value was 21.70 with SD±2.97. The calculated paired ‘t’ value was t= 0.74 found to be statistically non-significant at p< 0.05 level. The pre test mean value level of muscle cramps in experimental group mean was 20.87 with SD±2.81 and control group mean was 21.13 with SD ±2.94. The calculated unpaired ‘t’ value=0.35 was found to be statistically non significant at p<0.05 level. The post test mean value of muscle cramps in experimental group mean was 15.53 with SD± 2.78 and control group mean was 21.70 with SD±2.97. The calculated unpaired ‘t’ value was t=8.30 shows statistically significant at p< 0.001 level. The study findings revealed that there was a highly significant difference in the level of muscle cramps among geriatric patients after implemented stretching exercise in experimental group then the control group. Keywords: Muscle cramps, Geriatric patients, modified muscle cramps assessment scale and stretching exercises.
