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Constructed Response Questions (Crq) Test Results Of 6th-Year Medical Students, Faculty Of Medicine, Thammasat University In The Primary Medical Care Course, Academic Year 2024: A Descriptive Course Evaluation Study, Surasak Buranatrevedh

Asian Medical Journal and Alternative Medicine

Introduction: The Primary Medical Care course is a core subject for sixth-year Thammasat medical students. Knowledge assessment is conducted using 10 Constructed Response Questions (CRQ), mapped to the standards of the Medical Council of Thailand.

Objectives: To evaluate the performance of sixth-year Thammasat medical students in the Primary Medical Care course through CRQ examinations across multiple affiliated clinical training centers during the academic year 2024 and identify specific diseases or topics requiring improvement at each location.

Methods: Study was conducted using CRQ examination results from all 166 sixth-year medical students at five clinical training centers. Questions and corresponding rubric-scored answers …

Knowledge And Awareness Of Thalassemia Carrier Screening Among Thai Medical Students, Pawitchaya Jariyapongpaiboon, Boodchiya Rojsuriyawong, Suwijak Meenapa, Pacharapan Surapolchai, Prapasri Kulalert, Chanapat Chouwalit, Thanpisit Phanawal, Prapasiri Niamkamnoet, Parin Pongrungsee, Kitiwan Rojnueangnit

Asian Medical Journal and Alternative Medicine

Introduction: Thalassemia is the most common hereditary hemolytic anemia in Southeast Asia, including Thailand. Despite thalassemia screening tests being currently performed in all Thai pregnant women, this approach can sometimes be too late. Prevention would be improved if we could perform thalassemia screening tests prior to pregnancy.

Objectives: Assess the knowledge and awareness of thalassemia screening in medical students.

Methods: A descriptive cross-sectional survey among Thai medical students in 16 universities, during April 2022- May 2023, by using a valid set of research questions in the online-based questionnaire to assess their knowledge and awareness of carrier screening tests and intention …

Melatonin In Pediatric Critical Care: From Physiology To Bedside Roles, Chanapai Chaiyakulsil

Asian Medical Journal and Alternative Medicine

Melatonin is an endogenous indoleamine synthesized by the pineal gland. Though melatonin is best known for its chronobiologic effects, regulating the circadian rhythm and sleep, it might play a wider role in critical illness. It has been proposed for use as an analgesic and sedative, an antihypertensive, an anti-inflammatory, and for the prevention of delirium. Melatonin use in children has increased dramatically over the years, but the evidence on its use in critically ill children remains limited. This review article aimed to describe the basic physiology and biology of melatonin, including its production and functions, dosing, and side effects, …

Impact Of Naturopathic Intervention On Cholelithiasis And Symptomatic Urinary Complaints With Sonographic Bladder Wall Thickening: A Case Report, Suresh Abinaya, Narayanasamy Manavalan, Aruchunan Mooventhan

Asian Medical Journal and Alternative Medicine

This report describes a 20-year-old female with cholelithiasis and cystitis, diagnosed by ultrasonography, who underwent Gastro-Hepatic Pack, Warm Hip Bath, Castor Oil Pack, and Acupuncture for one month. Post-intervention ultrasonography demonstrated normal abdominal findings with symptom improvement, suggesting potential benefit of these combined naturopathy interventions in managing cholelithiasis and cystitis.

Frequency And Outcome Of Peg Tube Implantations In Hospitalized Parkinson's Disease Patients, Rachael M. Burke, Ruina He, Hikaru Kamo, Tejas R. Mehta, Anne Brooks, Adrianne Smiley, Michael S. Okun, Christopher W. Hess, Matthew A. Remz

Department of Neurology Faculty Papers

BACKGROUND: Dysphagia is a known complication of Parkinson's Disease (PD). Percutaneous endoscopic gastrostomy (PEG) tube placement is a therapy for select patients with dysphagia. There is a paucity of information on the role of PEG in PD management.

OBJECTIVES: To investigate the frequency and outcomes of PEG tube implantations in hospitalized patients with PD.

METHODS: We performed a retrospective review of the PINC AI™ Healthcare Database of hospitalized PD patients between 2017 and 2023. PEG implantation, discharge status, and aspiration pneumonia (AP) diagnoses were collected and analyzed. The relationships between AP and PEG were evaluated using logistic regression. Generalized estimating …

Corruption In The Service Of The Common Good: The Legitimation Of Traditional Practitioners In Cameroon, Victorine Oyane Ossah

Journal of Law and Public Policy

This article shows how health law and public policy, in seeking to regulate traditional medicine, without fully recognising it, paradoxically end up producing the very social conditions for the corruption that they are supposed to combat. The aim is to identify, based on the experience of traditional healers, the various factors that contribute to establishing corruption not as a moral choice, but as a pragmatic strategy for preserving their knowledge, resources, and place in the healthcare system. The analysis presented is based on a qualitative survey of 30 traditional medicine practitioners in Yaoundé and Douala between 2021 and 2026, in …

First Insular Record And Dna Barcoding Of Euscorpius Vailatii Tropea & Fet, 2015 From Trizonia Island (Fokida, Greece), Konstantinos Kalaentzis, Francesco Frigioni, Alexios Panagiotopoulos, Elias Tzoras, Styliani Minoudi, Alexandros Triantafyllidis

Euscorpius

Euscorpius vailatii Tropea & Fet, 2015 (Scorpiones: Euscorpiidae), originally described from Aitoloakarnania and Fokida (Greece), is herein reported from Trizonia Island in the Gulf of Corinth, representing the first insular record for the species. The examined specimens are consistent with the diagnostic morphology of E. vailatii. The first molecular data for the species are provided, based on both mainland and insular populations. Comparative analyses further highlight the distinctiveness of E. vailatii from geographically close congeners, while phylogenetic results indicate a sister-taxon relationship with E. erymanthius, supporting a Quaternary biogeographic history shaped by the evolution of the Gulf of …

Delirium Prevention In The Neuro/Medical Icu, Cathrene Ashika Deo

Master's Projects and Capstones

Abstract

Background: The following quality improvement project was performed in a 20-bed Neuro/Medical ICU in a large urban hospital in Northern California. Assessments with the IHI Clinical Microsystem Assessment Tool and the 5 P's framework indicated that the ICU had good practices in place to manage physiologic decompensation of ICU patients, but no practices to prevent delirium in those patients.

Problem: Delirium is associated with increased mortality rates for ICU patients, increased use of ICU ventilators, longer lengths of stay in the ICU, and long-term cognitive impairments (Devlin et al., 2018). The prevalence of delirium in patients who …

Bridging Fiscal Sustainability And Health Equity: A Policy Analysis Of California’S Healthcare Coverage Safeguards, Guadalupe Castaneda Martinez

Master's Projects and Capstones

Without structural policy intervention, approximately 4.6 million Californians remain at risk of being uninsured by 2030, worsening racial and ethnic health disparities and hospital uncompensated care burdens. This policy analysis advocates for a hybrid universal coverage model combining sliding-scale subsidies (California Senate Bill 78) with full-scope Medi-Cal expansion for all income-eligible residents regardless of legal status (California Assembly Bill 133). The framework relies on existing funding mechanisms, including the Managed Care Organization tax and the Health Care Affordability Reserve Fund. Comparative analysis indicates that market-only subsidies leave severe equity gaps, whereas immediate single-payer transitions pose substantial fiscal and administrative risks. …

Moss Biomonitoring And Isotopic Signatures Reveal Aviation Fuel As Local Lead Source Near Oregon Airports, Oluwaseyi E. Aderinboye, Alyssa E. Shiel, Lauren Stalford, Christina J. Murphy, Dean B. Atkinson

Chemistry Faculty Publications and Presentations

Lead emissions from piston-engine aircraft using leaded aviation gasoline (avgas) remain a significant source of environmental contamination near regional airports, posing potential health risks to nearby communities. Passive biomonitoring using the epiphytic moss Orthotrichum lyellii was combined with lead isotope fingerprinting to quantify lead concentrations and distinguish between legacy leaded gasoline and current avgas emissions near Hillsboro and Troutdale airports in Oregon. Here we show that lead levels are elevated by up to 50 times the rural background near airports, with isotopic signatures confirming avgas as a dominant local source. These findings indicate that avgas use contributes substantially to environmental …

Curious Minds, Critical Thinkers: Contextualization-Based Instruction In Secondary Social Studies, Kelcie J. Mashburn

Masters Projects

Research shows that many secondary students lack the critical thinking skills necessary for academic and civic success. Traditional instructional methods that prioritize content coverage and recall fail to help students develop and apply this skill. Effective instruction requires educators to move beyond these traditional methods and intentionally design curriculum that incorporates instructional strategies that engage students in analysis, investigation of diverse perspectives, and formulate evidence-based conclusions. This project addresses this gap by presenting a contextualization-based curriculum unit designed to support and build critical thinking skills among secondary Social Studies students. The result is a unit that immerses secondary Social Studies …

Reduction Of Length Of Stay For Total Joint Replacement Patients, Melody C. Golden

Master's Projects and Capstones

Abstract

Problem: Prolonged LOS in the PACU for patients undergoing total joint replacement surgery contributes to inefficiencies in patient flow, delayed throughput, and increased resource utilization. At Hospital A, recent LOS averages exceed internal and regional benchmarks, indicating a need for process improvement.

Context: The PACU is a high-volume, fast-paced environment requiring coordination among nursing, physical therapy, anesthesia, and discharge planning teams. Variability in workflow, communication gaps, and inconsistent timing of key processes contribute to delays in discharge readiness.

Interventions: From May through July 31^st, 2026, a quality improvement project was implemented using the Baldrige Excellence …

The Role Of Parents In Supporting Student Learning At Home, Lindsey M. Deblaay

Masters Projects

This study addresses the pedagogical disconnect between modern, inquiry-based mathematics instruction and traditional caregiver support structures. While caregiver involvement has proved to be helpful in student achievement, systematic barriers that limit family’s capacity, parent self-efficacy and their willingness to use learning strategies at home, the perception of the parent role of caregivers in their child’ s education makes it difficult. The curriculum prioritizes conceptual number sense and critical thinking rather than rote standard algorithm, so it has created a barrier in parent support among caregivers with these instructional shifts. It diminishes parent self-efficacy particularly in fifth grade. The project features …

Anatomiya Ng Karinderya: An Exploration On The Reflected Filipino Cultural Values On The Visual Identity Of Carinderias In Cavite, Dan Gabriel V. Bagadiong, Ellaine Marie L. De Castro, Miriam Joan C. Generoso, Ej Jimenez, Fernando R. Lacson

DLSU Arts Congress Conference Proceedings

This study explored Filipino cultural values reflected in the visual identity of carinderias and examined their sociocultural and psychological significance within Filipino society. Known for serving lutong bahay (home-cooked meals), carinderias have long been embedded in Filipino culture, embodying values such as bayanihan (community spirit), kapwa (shared identity), and resilience while fostering community connections through food. Grounded in the framework of Pantayong Pananaw, the study investigated how these cultural and psychological values shape the identity and perception of carinderias. Focusing on selected small carinderias in Cavite, the research analyzed their cultural relevance, visual identity, and sociopsychological dimensions. Findings revealed …

Information Resources Utilization, Organisational Culture And Motivation As Determinants Of Quality Service Delivery Of Researchers In Nigerian Institute For Trypanosomiasis Research, Kaduna State, Nigeria., Alegbeleye Gabriel Olubunmi, Ibrahim Awodi, Yemisi Tomilola Babalola

Library Philosophy and Practice (e-journal)

This study investigated the combined influence of information resources utilization, organizational culture, and motivation on quality service delivery in the Nigerian Institute for Trypanosomiasis Research (NITR), Kaduna State. The population comprised 206 researchers across the six research departments of NITR, and a total enumeration technique was employed to include all the researchers. Using a structured questionnaire, 172 valid responses were obtained representing an 83.5% response rate. Data were analyzed using descriptive and multiple regression statistics. Anchored on Uses and Gratification Theory of Information behavior, the Denison Organizational Culture Model, and Self-Determination Theory, the findings revealed that the independent variables jointly …

Bibliometric Analysis Of The Top 100 Most Cited Publications From Saudi Arabia Reveals The Predominance Of Medical Fields, Mahmoud Kandeel, Abdulla Al-Taher

Saudi Medical Journal

Objectives: To explore the citation impact, journals, international collaborations, trends of research topics and gain more visibility for the Saudi contribution to the global scientific landscape. Methods: This bibliometric study analyzes the top 100 cited publications affiliated with Saudi Arabia in Scopus, from inception to January 2026. The extracted bibliometric indicators include total citation metrics, sources, collaboration maps, and co-occurrence networks of keywords and collaborations. Results: The results indicate a strong predominance for medicine and health sciences as the subjects of the most prolific and significant number of citations. A substantial proportion of the most cited papers originates from major …

Comparison Of The Effects Of Spinal Versus General Anesthesia On The Perioperative Intraocular Pressure: A Prospective, Randomized Clinical Trial, Muzaffer Gencer, Mehmet Yalvaç

Saudi Medical Journal

Objectives: To evaluate the effects of spinal and general anesthesia on the intraocular pressure (IOP) in patients, who had lumbar spine and lower extremity orthopedic surgeries Methods: Sixty adult were randomly classified into Group spinal anesthesia (SA) and Group general anesthesia (GA). The IOP, mean systemic arterial pressure, and heart rhythm were measured at 6 pre-determined timepoints (T0: Baseline, T1: Before spinal procedure or anesthesia induction, T2: After injection with intrathecal or anesthesia induction, T3: 5th minutes (min) after spinal procedure or tracheal intubation, T4: 30th min intraoperative, T5: At the end of surgery, T6: 5th min after surgery or …

Establishment Of A Specialized Pectus Clinic: Referral Patterns, Diagnostic Characteristics, And Early Management Experience At A University Hospital, Zeead M. Alghamdi

Saudi Medical Journal

Objectives: To describe the establishment and early impact of a dedicated pectus clinic at a university hospital, focusing on patient characteristics, referral pathways, clinical presentation, and initial management strategies. Methods: A retrospective observational study was conducted at a university hospital between January 2020 and April 2025, with 153 patients included in the final analysis. Data collected included demographic characteristics, referral sources, clinical presentation, deformity type, and treatment options. Descriptive statistical analysis was performed. Results: The mean patient age was 18.3 (range 1–44) years, with males accounting for 83.9% of cases. Pectus carinatum was the most common diagnosis (48.1%), followed by …

Patterns And Determinants Of Medication Errors Across The Medication-Use Process: A 3-Year Retrospective Study In A Saudi Tertiary Hospital, Nawaf S. Alqurashi, Mazen S. Alshehri, Mohammed J. Almalki, Mustafa M. Muradkhudhari, Rozan M. Radwan, Mohammed M. Aldurdunji, Saleh A. Almazam, Ohood K. Almuzaini, Saad M. Wali

Saudi Medical Journal

Objective: To characterize medication errors across the full workflow and identify stage-specific predictors in a tertiary care setting. Medication errors remain a major global patient safety concern, with limited comprehensive analyses across all stages of the medication-use process in Saudi Arabia. Methods: A retrospective observational study was conducted using medication error reports from Al-Noor Specialist Hospital, Makkah, between January 2023 and August 2025. Errors were classified by stage and severity using the National Coordinating Council for Medication Error Reporting and Prevention index. Multivariable logistic regression was performed to identify predictors associated with each stage. Results: A total of 6,546 errors …

Gender Differences In Primary Care Utilization And Determinants Of General Practitioner Visits Among Saudi Females: A Cross-Sectional Analysis Using World Health Survey In The Kingdom Of Saudi Arabia 2019, Ali M. Alzahrani, Holly C. Felix, Abdulrhman A. Alzhrani

Saudi Medical Journal

Objective: To document the number of visits Saudi adults have with general practitioners (GP) or family medicine doctors (FD), determine if there is an association between GP/FD visits and sex, and then identify factors associated with GP/FD visits among Saudi females. Methods: A cross-sectional analysis was conducted using data from the 2019 World Health Survey in the Kingdom of Saudi Arabia (KSAWHS 2019), a nationally representative household survey. The outcome variable was number of visits to GP/FD. Survey-weighted negative binomial regression was applied. Results: From April to July 2019, 8,912 individuals participated in the KSAWHS 2019 individual questionnaire, of whom …

Patient Experiences And Safety Concerns Regarding Glp-1 Receptor Agonists For Obesity: A Cross-Sectional Survey In Jeddah, Saudi Arabia, Mansour A Tobaiqy, Sulafa T. Alqutub, Mohammed A. Alzahrani, Renad H. Alazwari, Faisal A. Asiri

Saudi Medical Journal

Objective: To evaluate the perceptions, experiences, and safety concerns of patients regarding the glucagon-like peptide-1 (GLP-1) receptor agonists. Obesity is a significant public health issue. The newer anti-obesity medications: GLP-1 receptor agonists, with an increase in therapeutic options. However, little is known about the perceived benefits, safety, cost, and accessibility. Methods: Cross-sectional survey included adults who previously used at least 1 anti-obesity medication and conducted in 3 general hospitals in Jeddah, Kingdom of Saudi Arabia (KSA) during June 2025 to February 2026. The questionnaire was created after reviewing the current evidence and validated the contents. It included questions on demographic …

Patient Safety Culture Among Healthcare Professionals In Jeddah First Health Cluster: A Multi-Professional Cross-Sectional Study, Saad S. Alyazidi, Salah S. Alshagrawi

Saudi Medical Journal

Objective: Patient safety culture (PSC) is essential to improve healthcare quality and reduce preventable harm. Despite ongoing healthcare transformation in Saudi Arabia, there is limited evidence on healthcare professionals' (HCPs) perceptions of PSC in newly established health clusters. Methods: We conducted a cross-sectional study among HCPs in 6 government hospitals within the Jeddah First Health Cluster, Saudi Arabia. Data were gathered utilizing the Hospital Survey on PSC (HSOPSC). Descriptive measurement sand multiple linear regression analyses were used to evaluate perceptions of PSC and associated factors. Results: A total of 256 HCPs participated in the study. Overall, PSC was perceived as …

The Al-Bahah Paradox: Divergent Patterns Of Increased And Decreased Infectious Disease Incidence Relative To National Saudi Rates Over 12 Years Of Surveillance, Mohammed A. A. Alqumber

Saudi Medical Journal

Objective: To identify statistically significant deviations in notifiable infectious disease incidence between Al-Bahah region and national Saudi averages, and to generate hypotheses that may inform future epidemiological, microbiological, and public health investigations. Methods: In April 2026, a 12-year retrospective ecological study (2013–2024) was conducted using surveillance data from the Saudi Ministry of Health for 37 notifiable infectious diseases across 20 health regions. Cumulative incidence rates, standardized morbidity ratios (SMRs), and Z-tests compared observed cases in Al-Bahah against national estimates. Results: Overall incidence was 15.8% lower in Al-Bahah than nationally (86.42 versus 102.68; incidence rate ratios = 0.842; p …

Preoperative Urine Albumin-To-Creatinine Ratio Predicts Acute Kidney Injury After Coronary Artery Bypass Grafting, Ahmed M. Alkhunaizi, Jumana A. Al Naser, Khaled D. Algarni, Suhaib M. Ahmed, Amro M. Moubarak, Haralabos D. Parissis

Saudi Medical Journal

Objective: To prospectively evaluate whether baseline urine albumin-to-creatinine ratio (uACR) predicts acute kidney injury (AKI) and postoperative decline in kidney function in elective, isolated coronary artery bypass grafting (CABG) patients and explore the magnitude of effect across clinically relevant uACR strata. Preoperative uACR is a marker of glomerular endothelial dysfunction and systemic microvascular injury that may identify patients at increased risk for AKI after CABG. Methods: In this single-center prospective cohort study, 111 adults undergoing elective, isolated CABG between January 2020 and December 2024 were stratified by baseline uACR (< 30, 30–300, > 300 milligram/gram[mg/g]). The primary outcome was AKI defined by Kidney …

The Role Of F-18 Fdg Pet/Ct In The Evaluation Of Solitary Pulmonary Nodules, Erdal Cetinkaya, Fatih Guzel, Sadiye Altun Tuzcu, Ilbey Erkin Cetin, Ibrahim Ibiloglu, Esref Argin, Feray Altun Cetin, Bekir Tasdemir

Saudi Medical Journal

Objective: Fluorine-18 fluorodeoxyglucose positronemissiontomography/computedtomography (F-18 FDG PET/CT) is commonly used in the evaluation of solitary pulmonary nodules (SPNs). This study aimed to investigate the predictive value of maximum standardized uptake value (SUVmax) and its ratios to liver and mediastinal blood pool SUVmax values for malignancy in SPNs, using histopathological findings as the reference standard. Methods: The study included 130 patients who underwent F-18 FDG PET/CT and had either histopathological confirmation or at least two years of radiological follow-up. Demographic data (age and sex), nodule size, location, contour characteristics, nodule SUVmax, nodule-to-liver SUVmax ratio (NLR), and nodule-to-mediastinal blood pool SUVmax ratio …

The Case For Gulf Region-Specific Peripheral Artery Disease Trials: A Comprehensive Literature Review, Hosaam H. Nasr, Faisal A. Almudaiheem

Saudi Medical Journal

Peripheral artery disease (PAD) research is globally underrepresented, with landmark trials like Best Endovascular Surgical Therapy for Patients with Critical Limb Ischemia and Bypass versus Angioplasty in Severe Ischemia of the Leg predominantly featuring white, Western populations. These studies fail to account for the unique clinical landscape of the Gulf region, where PAD prevalence reaches up to 13.7%. Gulf patients present at younger ages and face a disproportionately high diabetes burden, with regional prevalence near 18%, nearly double that of Europe. Beyond metabolic factors, the Gulf population exhibits distinct genetic architectures, including high rates of consanguinity and familial hypercholesterolemia. Because …

The Role Of Chimeric Antigen Receptor Regulatory T Cells In Promoting Immune Tolerance In Solid Organ Transplantation: Mechanisms And Therapeutic Potential, Maher S. Alwethaynani

Saudi Medical Journal

Solid organ transplantation (SOT) is a life-saving procedure for patients with end-stage organ failure; however, lifelong immunosuppressant use is needed to prevent allograft rejection. These drugs increase the risk of non-Hodgkin lymphoma, liver, kidney, and lung cancers, and heighten susceptibility to oncogenic viruses, including hepatitis B and Epstein-Barr virus. The usage of chimeric antigen receptor (CAR) regulatory T (Treg) cells is a promising approach to induce transplant tolerance while minimizing dependence on immunosuppressants. The CAR Tregs offer the potential to enhance graft survival and quality of life by reducing immunosuppressant-related morbidity and mortality. Despite remarkable progress in transplantation tolerance, challenges …

Meta-Analysis On The Effect Of Tai Chi Chuan On Human Biomechanics And Health From (2021–2025), Bijad S. Alqahtani, Husam A. Almalki

Saudi Medical Journal

Objective: Prior reviews emphasize overall health outcomes of Tai Chi Chuan (TCC) but rarely resolve the biomechanical intermediates (such as Center of Mass (CoM)–Center of Pressure (CoP) control, joint loading) that link practice to clinical function—knowledge that matters for balance, fall risk, and osteoarthritic knee load management. This systematic review and meta-analysis aim to test the null hypothesis that TCC produces no improvement versus comparators in (i) biomechanical stability indices (mediolateral/anterior–posterior CoM–CoP separation; COP Root Mean Square RMS) and (ii) related clinical functions (such as Time up and go (TUG), Berg balance scale (BBS), Western Ontario and McMaster Universities Osteoarthritis …

Developmental Dysplasia Of The Hip In Saudi Arabia And The Gulf Countries: A Genetic Systematic Review Study, Naif Z. Alrashdi, Ahmed M. Almansour, Azfar Jamal

Saudi Medical Journal

Objective: To describe the available research on genetic determinants with special emphasis on the developmental dysplasia of the hip (DDH), in Saudi Arabia and Gulf nations, with reference to the genetic variants, family trend, and environmental factors. Methods: The literature search was conducted in PubMed, Embase, Scopus, Web of Science, and the Saudi Digital Library and Google Scholar through a broad literature search since the beginning of the databases until 2023. Studies that conducted in Saudi Arabia or Gulf countries which evaluated the relationships of genetic factors in DDH were included. Case reports, conference abstracts, and studies that did not …

Exploring Translational Medical Research Progress In G20 Countries: 5-Year Study, Hana A. Alhumud, Fars K. Alanazi, Edward B. Devol

Saudi Medical Journal

Objectives: Biomedical research is crucial for advancing medical knowledge and improving public health. However, the research process is often disjointed and lacks seamless progression, leading to delays and missed opportunities. To address this, the concept of translational research has emerged, focusing on the smooth transition of research results to the next stage of inquiry. Methods: This study analyzed approximately 40,000 research publications from the Web of Science database to identify research activities associated with translational research. Publications from Group of 20 (G20) countries over the past 5 years were examined to explore patterns of research focus and progress in this …