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Recent Submissions
Current Practice of Children With Primary Hypertension: A Survey of Pediatricians in Thailand
(2025-01-01) Saelee S.; Pirojsakul K.; Saelee S.; Mahidol University
Background: Being able to detect, assess, and manage children with primary hypertension is one of the requirements of the Thai pediatric residency training curriculum. The present study aimed to survey the practice of pediatric primary hypertension care by Thai pediatricians. Materials and Methods: Participants’ demographic information, educational background, and practice, including diagnosis, investigation, and treatment in children with primary hypertension at an outpatient setting, were all included in the surveys and were distributed to pediatric residents, general pediatricians, and pediatric subspecialists in Thailand using the online survey. The results were defined as appropriate answers if they were aligned with the guidelines recommended by the American Academy of Pediatrics. Results: 342 (79 males) with a mean age of 37.6 years and a mean duration since residency training of 10.4 years were included. The proportion of participants who answered appropriately was 188 (55%), 190 (55.6%), and 169 (49.4%) in the diagnosis, investigation, and treatment parts, respectively. However, only 43 (12.6%) participants could answer appropriately for all 3 parts. Compared to the inappropriate group, experience in diagnosis was higher in the appropriate group (44.2% vs 28.4%, P-value = 0.036), but the duration since residency training < 5 years and being a nephrologist were not different between the 2 groups (41.9% vs 43.5%, P = .849 and 7 vs 6%, P = .807, respectively). Conclusions: Experience in diagnosis, rather than the duration after the residency training or being a nephrologist, had a favorable impact on the appropriate practices of children with primary hypertension among Thai pediatricians.
PISA AND SUSTAINABLE DEVELOPMENT GOALS: COMPARING SCIENCE CURRICULA IN SECONDARY SCHOOLS IN INDONESIA, SINGAPORE, AUSTRALIA, AND CANADA IN THE CONTENT ASPECT BASED ON THE PISA 2025 FRAMEWORK
(2025-12-01) Hakim A.; Safrudiannur; Zahra I.R.; Mannan M.N.; Sundari P.D.; Norsaputra A.; Hakim A.; Mahidol University
Continuous curriculum updates are crucial for enhancing the quality of education, improving citizens’ global competitiveness, and supporting Sustainable Development Goal (SDG) 4, particularly the goal of achieving quality education for all. International studies, such as PISA, have attracted many researchers interested in comparative curricula across PISA-participating countries. Unlike previous studies, this research compares the science curricula of Indonesia, Singapore, Australia, and Canada based on the science content tested in the PISA 2015, PISA 2021, and PISA 2025 frameworks. The method used in this study is content analysis. We searched for documents from the four countries on their respective Ministries of Education websites. After obtaining the documents, two researchers independently conducted the coding analysis. After that, the researchers validated the content analysis through inter-rater agreement. The results show that the science curricula of Indonesia, Sin-gapore, Australia, and Canada do not specifically cover all content in the PISA 2015, PISA 2021, and PISA 2025 frameworks. Specifically, Singapore’s curriculum documents do not cover Earth and Space System content, while Labrador, Alberta, and British Columbia cover all themes. The Indonesian science curriculum encompasses all themes assessed in PISA questions and the PISA 2025 framework, although it does not yet cover all topics. How-ever, it remains challenging to pinpoint the reasons for the differences in PISA results among the four countries in this comparative study.
Personalized mechanical ventilation guided by lung ultrasound in patients with ARDS: a pilot phase of a randomized clinical trial
(2025-12-01) Sinnige J.S.; Smit M.R.; Alam M.J.; Chowdhury M.N.H.; Costa V.; de Castro H.S.M.B.; Daszuta D.; Filippini D.F.L.; Ghose A.; de Grooth H.J.; Hein L.; Hermans G.; Hildebrandt T.; Itenov T.S.; Ischaki E.; Klompmaker P.; Laffey J.; McMahon A.; McNicholas B.; Mousa A.; Paulus F.; Pedersen U.G.; Pellegrini M.; Pezzuto M.; Póvoa P.; Pierrakos C.; Pisani L.; Roca O.; Schultz M.J.; Spadaro S.; Szuldrzynski K.; Theodorou E.; Tuinman P.R.; Wamberg C.A.; Zimatore C.; Bos L.D.J.; Ahmed A.U.; Barua S.; Nowroz N.; Hassan N.; Vaporidi K.; Siempos I.; Kanavou A.; Giannopoulos H.; Kawati R.; Bjarnadottir K.J.; Mason S.; Kelly Y.; Bergin P.; Basappakokati D.R.; Caldicott R.; Ferguson L.; Bates J.; Young E.; Moran P.; Carey M.; Thomas C.; Giacomini C.; Barbeta E.; Torres A.; Huguet M.; Acilu M.G.d.; Christiansen L.; Jensen J.V.; Herløv L.S.; Poulsen L.M.; Bertelsen D.; Pedersen A.M.F.; Lauritzen S.; Allingstrup M.; Christensen L.; Bestle M.; Zuzda K.; Janowska J.; Jankowski M.; Magnesa G.; Massaro F.; Caracciolo A.; Alvisi V.; Maurmo L.; Grasso S.; Sente S.; Peetermans M.; Gerits A.; Ceunen H.; Nicolai S.; Attou R.; Talpos M.T.; Aragao I.; Torrão C.; Nora D.; Sinnige J.S.; Mahidol University
Background: The “Personalized Mechanical Ventilation Guided by Lung UltraSound in Patients with Acute Respiratory Distress Syndrome” (PEGASUS) study aims to evaluate personalized mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) compared to the standard of care. However, misclassification and misaligned MV strategies were shown to be harmful. We therefore aimed to assess the interobserver agreement of lung ultrasound (LUS) between the local investigator and an expert panel in classifying ARDS subphenotypes alongside protocol adherence and safety endpoints, as a pilot phase of the ongoing PEGASUS study. Methods: The first 80 mechanically ventilated patients with moderate-to-severe ARDS were enrolled in the ongoing PEGASUS study, a randomized clinical trial (RCT), and were included in the pilot phase. Focal or non-focal subphenotypes were classified using a LUS. Positive end-expiratory pressures (PEEP), tidal volumes (VT), the application of recruitment manoeuvres, and proning were performed according to randomization arm and subphenotype. Safety limits for MV followed current guidelines. Agreement in subphenotype classification between local investigators and a panel of three experts was evaluated using Cohen’s κ coefficient. Results: In 68 out of 80 exams, the images were of sufficient quality for assessment. The interobserver agreement for the lung morphology had a Cohen’s kappa of 0.72 (95% CI 0.53–0.9) and accuracy of 88% between local investigator and the expert panel. Misclassification occurred in 8/68 exams (11.8%). Among these 8 misclassified cases, 6 (75%) also showed disagreement between experts due to different LUS scores of the anterior regions. Tidal volume and PEEP were generally set according to the protocol. An exception was the TV in the non-focal ARDS patients randomized to personalized MV, where the median (6.2 ml/kg/PBW) was above the target range (4–6 ml/kg/PBW). Patients exceeding safety limits of MV were low. Conclusion: In the pilot phase of an ongoing international subphenotype-targeted RCT, we found that local investigators’ assessments agreed with expert panel consensus assessments in the large majority of cases, and nearly always when the expert panel assessment was unanimous. Protocol adherence was sufficient, but tidal volume in the non-focal subphenotype deserves attention during continuation of the study. Trial registration: The study was registered on clinicaltrial.gov (ID: NCT05492344, date 2022-08-05).
COMPARISONS OF DELAYS AND CO₂ EMISSIONS BETWEEN FIXED-TIME AND WEBSTER'S OPTIMAL SIGNAL TIMING AT INTERSECTION
(2025-01-01) Khieowan A.; Satitsakhon T.; Mongtewin M.; Soe T.N.; Sapsathiarn Y.; Srisurin P.; Khieowan A.; Mahidol University
This study aims at comparing the average delay and carbon emissions between the existing conditions, in which traffic flows are controlled by a fixed-time signal controller, and the scenarios where signal timings are optimized using Webster’s method. This study opts to optimize signal timing at an isolated signalized intersection by minimizing the total vehicular delay that occurs as a result of queuing. The layout of Saphan Khwai Intersection, an at-grade four-legged intersection located in Bangkok, Thailand, was adopted as a case study for comparing the two types of signal controls. Sixteen scenarios with varying traffic flows, ranging from 100 pc/h/ln to 1,600 pc/h/ln, were coded in Microsoft Excel using macros to compare the resultant delays and carbon emissions between five different fixed-time signal controls, spanning a cycle length of 50 seconds to 250 seconds, and the optimized signal timing using Webster's method. The results show that Webster’s method produces lower delays and carbon emissions than adopting the fixed cycle length at low to moderate traffic flows. However, the effectiveness of Webster’s method starts to be diminished as the average demand flow is approaching the saturation flow rate under the same conditions. This study intends to investigate how much delays and carbon emissions would be reduced if a real-time signal controller using Webster’s method is adopted to replace the current fixed-time controller at the intersection.
Clinical prediction rules of postoperative reintubation within 24 hours after general anesthesia: a retrospective case-control study
(2025-12-01) Morakul S.; Charernboon T.; Patumanond J.; Sombatthaveekul P.; Eowsakul N.; Morakul S.; Mahidol University
Background: Reintubation after planned extubation (RAP) following general anesthesia is a serious complication associated with intensive care unit admission, prolonged hospitalization, and increased mortality. Despite its clinical significance, no routinely validated clinical scoring system currently exists for predicting RAP. This study aimed to develop a clinical prediction rule for reintubation within 24 h after general anesthesia. Methods: This retrospective case-control study included 657 patients (235 cases and 422 controls) who underwent general anesthesia at Ramathibodi Hospital between 2014 and 2018. Cases were defined as patients reintubated within 24 h after planned extubation, and controls were randomly selected from those with successful extubation on the same operative day. Multivariable logistic regression was used to identify predictive factors, and significant predictors were transformed into a point-based risk score. Results: Significant predictors of reintubation included age < 1 or > 65 years, ASA classification ≥ III, emergency surgery, neurosurgical or thoracic procedures, vasopressor or inotrope use, positive fluid balance ≥ 40 mL/kg, and failure to follow commands after anesthesia. The score-based model demonstrated strong discrimination with an area under the receiver operating characteristic curve (AUROC) of 0.831 (95% CI: 0.795–0.868). Hosmer–Lemeshow goodness-of-fit test using 9 groups: χ²(df = 7) = 10.67, p = 0.154. Bootstrap validation confirmed consistent performance, with an optimism-adjusted AUROC of 0.831 (95% CI: 0.798–0.870). Based on total score ranges, patients were stratified into two risk categories. Those with a score of 0–9 was classified as low risk with a positive likelihood ratio (LHR+) of 0.693 (95% CI: 0.526–0.913, p = 0.004), and scores of 9.5–20 were considered high risk with an LHR + of 11.363 (95% CI: 5.611–25.306, p < 0.001). Conclusion: The RAP prediction score is a validated clinical prediction tool with good discrimination of postoperative RAP. It effectively stratifies postoperative patients into distinct risk categories and may guide for recognition and decision making for extubation during postoperative period.