Digital Commons Network^™

Evolution Of Respiratory Therapist Training In Taiwan: A 17-Year Journey From Legislation To Competency-Based Education, Wei-Jhen Wang, Cheng-Heng Liu, Yun-Ting Tseng, Yi-Ting Hung, Hui-Jiuan Chen, Yao-Wen Kuo, Huey-Ling Chen

Journal of Medical Education

Respiratory therapist (RT) training in Taiwan has evolved over two decades, progressing from legislative foundation to a competency-based education framework. The Respiratory Therapists Act, promulgated in 2002, formalized the profession and mandated national licensure. Subsequently, university-level programs emerged, replacing hospital-based training. To bridge the gap between academic preparation and clinical demands, a nationwide two-year post-graduate year (PGY) training program was implemented in 2007, currently delivered across 13 accredited training institutions. Through the institutional experience of National Taiwan University Hospital (NTUH), presented as an illustrative case study, we describe a 17-year, feedback-driven process of continuous improvement encompassing 16 curriculum revisions. Recent …

Sexuality-Related Lexical (In)Visibility In Asian Englishes: A Corpus-Based Study Using The International Corpus Of English (Ice), Jess V. Mendoza, April N. Salvador, Teri An Joy G. Magpale

Journal of English and Applied Linguistics

This study examines the visibility and invisibility of sexuality-related terms in four Asian Englishes using data from the International Corpus of English (ICE). Drawing on Wilkinson’s (2022) sexuality-related lexical set and informed by scholarship on heteronormativity, the study analyzes the proportional visibility of 19 target lexemes across Englishes in Hong Kong, the Philippines, Singapore, and India. The findings show that only a small subset of terms (gay, lesbian, same sex, sexual preference, bisexual, and sexual orientation) appear in the corpora, and even these occur at low frequencies. Among these, gay emerges as the most recurrent. The remaining terms are not …

Syarat Usia Presiden Dan Wakil Presiden Dalam Perspektif Konstitusi Dan Konstitusionalisme: Makna Dan Kriteria, Ardhes Blandhivay Leuanan, Mei Susanto

Jurnal Konstitusi & Demokrasi

In order to investigate the inconsistent interpretations of the Constitutional Court regarding the age requirements for presidential and vice-presidential candidates, this study will analyze the dynamics of determining age requirements from the perspective of the 1945 Constitution and the principles of constitutionalism. A socio-legal approach is used in the normative research method to analyze the Constitutional Court's decisions in light of the social and political factors that shaped them. According to the results, Constitutional Court Ruling No. 90/PUU-XXI/2023 marks a turning point in the evolution of Indonesian constitutional law. Initially, there was no strict interpretation of the age limits for …

Reorientasi Kebijakan Pelindungan Anak Terhadap Adiksi Internet Dalam Perspektif Pemenuhan Hak Konstitusional Di Indonesia, I Kadek Agus Aditya Firmantara, Bagus Hermanto

Jurnal Konstitusi & Demokrasi

This article examines the paradigm shift in child protection policy in the digital environment through Government Regulation Number 17 of 2025 concerning the Governance of Electronic System Providers for Child Protection (PP TUNAS) from the perspective of fulfilling children's constitutional rights in Indonesia. The study is motivated by the increasing use of the internet by children, which not only exposes them to risks such as harmful content, sexual exploitation, and misuse of personal data, but also creates the risk of internet addiction that may adversely affect children's health, education, and overall development. Despite these concerns, internet addiction has not been …

Intimate Partner Violence And Adverse Pregnancy Outcomes Among Women Accessing Postnatal Care In A Tertiary Hospital In North-Central Nigeria: A Cross-Sectional Study, Paul E. Agbo, Lucky L. Changkat, Mary C. Momoh, Salihu O. Mohammed, Dogara B. Bawa, Adeola Olabamiji, Rashida Musa, Steve C. Okoro, Ene F. Agbo, Lawal A. Abdulmumuni

Preventia: The Indonesian Journal of Public Health

Intimate partner violence (IPV) during pregnancy is a major public health concern associated with adverse maternal and neonatal outcomes, particularly in low- and middle-income countries. Despite increasing recognition, evidence linking specific forms of IPV to pregnancy outcomes in Nigeria remains limited. This study was conducted to determine the prevalence of intimate partner violence and examine its association with adverse pregnancy outcomes among women attending postnatal care in a tertiary hospital in North-Central Nigeria. A hospital-based cross-sectional analytic study was conducted among 381 women attending postnatal care. Data were collected using a structured, interviewer-administered questionnaire that incorporated the Abuse Assessment Screen. …

Association Of Lifestyle, Nutritional Status, And Eating Habits With Academic Performance Among Adolescents, Lulu'ul Badriyah, Farah Paramita, Rachmy Rosyida Ro'is, Shanica Yohana Veronica, Alifia Meida Indrayati, Randy Gustawan

Preventia: The Indonesian Journal of Public Health

Health is an important factor in determining academic performance. This study aims to analyze the relationships between lifestyle, nutritional status, eating habits, and academic achievement among high school students. The study used a cross-sectional design with a sample of 131 students from four schools in Malang City, Malang Regency, Batu City, and Pasuruan Regency. Data were collected through interviews, anthropometric measurements, and the SQ-FFQ and IPAQ questionnaires. Analysis was performed using the Chi-Square test. The results showed that most respondents slept less than 8 hours (58.8%), used smartphones for ≥ 8 hours per day (50.4%), had moderate physical activity (52.7%), …

Respectful Maternity Care: A Narrative Review Of Current Evidence And Clinical Implications, Hadeel Rasheed Seger, Nada Abd Ali Mohammed, Khalid Alyodawi

Preventia: The Indonesian Journal of Public Health

Respectful Maternity Care (RMC) is key to improving quality maternity care and has also been recognized as a foundational approach to quality maternity services. The framework has been developed around respect and promotion of dignified care, confidentiality and privacy, and autonomy of a woman, along with her right to freedom from neglect, discrimination, physical and verbal abuse, during pregnancy and childbirth. Despite worldwide acknowledgment and promotion of RMC, disrespect and abuse during childbirth have been observed among women in maternity settings, especially in low- and middle-income countries. This narrative review summarizes the current evidence and clinical implications of RMC. The …

Investigating The Effects Of Ai-Mediated Language Instruction On Linguistic, Affective, And Autonomy-Related Outcomes Among English Language Learners, Raniah Hassen Kabooha

Journal of King Abdulaziz University: Computing and Information Technology Sciences

Artificial intelligence (AI) has increasingly been integrated into language education; however, empirical evidence regarding its effects on both linguistic and affective outcomes among English as a foreign language (EFL) learners remains limited, particularly in higher education contexts. This study investigated the impact of AI-mediated instruction on English language proficiency, language motivation, language anxiety, and learner autonomy among university-level EFL students. An explanatory sequential mixed-methods design was employed involving sixty first-year female EFL students in Saudi Arabia who were assigned to either an experimental group receiving AI-assisted instruction or a control group receiving traditional instruction over a ten-week period. Quantitative data …

Integrating Interdisciplinary Approaches To Enhance Creativity In Higher Education, Yuan Shuang Ma, Gulmira Karabalaeva, Sultan Karabalaev, Guldana Akieva, Nurisa Tynystanova

Higher Learning Research Communications

Objectives:The aim of this study was to identify specific conditions that promote creativity and innovation among students.

Methods:Through a comprehensive methodology that includes questionnaires, creative thinking tests, and qualitative interviews, the study assessed students’ perceptions of factors influencing creativity.

Results:Key findings highlight the importance of a dynamic, interdisciplinary curriculum that encourages a holistic understanding of real-world challenges. The study emphasized the significance of student-centered learning environments, where active participation, autonomy, and exploration of personal interests foster creativity. The research also demonstrates that innovative teaching methods, such as problem-based learning and the use of modern technology (e.g., multimedia …

Effect Of Androgen Receptor Polymorphism On Hypogonadism Severity And Efficacy Of Testosterone Replacement Therapy, Nelson W Mills, Beatriz S Hernandez, Peyton J Coady, Arnaav Walia, Gal Saffati, Daniela Orozco Rendon, Dalia Khera, Nadia Khera, Weitao Song, Mohit Khera

Faculty, Staff and Students Publications

Background: The preferred treatment for hypogonadism, testosterone replacement therapy (TRT), has a varying efficacy that is currently not fully understood. This observation may be explained by polymorphism of the androgen receptor (AR), a ligand-binding transcription factor whose polyglutamine tract length affects various health conditions and androgen sensitivity. It has been theorized that this polymorphism may also affect the severity of hypogonadism. This study sought to determine a correlation between hypogonadism severity, TRT efficacy, and number of CAG trinucleotide repeats in the AR gene.

Methods: One hundred sixty-two males presenting to a single institution with symptoms of hypogonadism were recruited for …

Leading Healthcare Improvement: An Implementation Strategy, Kelley Arredondo, Anthony Ecker, Lindsay Vaclavik, Jacquelene Shahin, Ashley Thompson, Molly Horstman, David Ramsey, Kyler M Godwin

Faculty, Staff and Students Publications

Introduction: Healthcare professionals often implement quality improvement (QI) initiatives but lack training to implement and sustain QI initiatives. Leading Healthcare Improvement (LHI) is a course that combines principles from change management, team science, and leadership effectiveness into an implementation strategy to enable clinicians to lead sustainable change.

Methods: LHI is a 6-session, 4-month interactive training. Learners work on an active QI project throughout the course. A Wilcoxon signed-rank test was conducted to evaluate pre- and post-course changes in learners' self-reported confidence across five QI competencies.

Results: Veterans Healthcare Administration clinicians and fellows completed the LHI pre- (n = 111) and …

Psoriasis Effects On Psychological And Daily Activities In Patients Attending To Outpatient Clinics In Aldiwaniyah Teaching Hospital, Saja Abbas Musa, Hassan Raji Jallab, Akeel Hamid Jabur

Al-Qadisiyah Medical Journal

Background: Psoriasis is a chronic immune-related skin disorder affecting 2–3% globally, linked to heart disease, joint issues, metabolic syndrome, and psychological disorders. It also impacts social life, mental health, and work productivity, with added challenges in Middle Eastern patients due to stigma and limited healthcare access. Aim: To assess the psychological and functional impact of psoriasis on patients attending Al-Diwaniyah Teaching Hospital. It focuses on anxiety, depression, social disengagement, and effects on daily activities like work, exercise, sleep, and hygiene. The study also explores the relationship between disease severity and impairment levels. Material and Methods: The study was conducted at …

The Development Of An In Silico Vaccine Design-Based E-Module To Improve Students' Biological Literacy, Qairinasherin Qwine Ferendi, Rusdi Rusdi, Hanum Isfaeni

Jurnal Pendidikan Sains

Low levels of biological literacy among students, particularly in biotechnology, highlight the need for innovative digital learning media that facilitate meaningful and contextual learning experiences. This study aimed to develop and evaluate an interactive biotechnology e-module based on in silico vaccine design to improve students’ biological literacy. The study employed Educational Design Research (EDR) using the Hannafin and Peck model, which consists of three phases: needs assessment, development, and implementation. The participants included 73 tenth-grade science students and one biology teacher from SMAN 68 Jakarta, Indonesia. The e-module was developed using Canva and Heyzine to create an interactive flipbook integrating …

The Effect Of Emotional Intelligence And Logical-Mathematical Intelligence On Students’ Mathematical Problem-Solving Ability, Zulkyfli Siduppa, Sutji Rochaminah, Muh Hasbi, Dasa Ismaimuza

Jurnal Pendidikan Sains

Mathematical problem-solving ability is an essential competency in mathematics education because it supports students’ reasoning, critical thinking, and decision-making skills. This study aimed to examine the influence of emotional intelligence and logical-mathematical intelligence on the mathematical problem-solving ability of Grade XII students at SMA Negeri 1 Tolitoli. The study employed a quantitative survey design involving 143 students from the Mathematics and Natural Sciences (MIPA) program during the 2023/2024 academic year. Data were collected using an emotional intelligence questionnaire, a logical-mathematical intelligence questionnaire, and a mathematical problem-solving test on algebraic function limits. All instruments were validated and demonstrated satisfactory reliability, with …

Community-Based Exercise Programs Dalam Mengurangi Fear Of Falling Dan Meningkatkan Quality Of Life Pada Lansia: A Systematic Literature Review, Amirah Hasna Rafifah -, Hanif Maulana, Saffanah

Jurnal Fisioterapi Terapan Indonesia

The global increase in the elderly population presents significant challenges in maintaining independence and quality of life among older adults. One of the most common problems experienced by the elderly is fear of falling, which negatively affects physical activity, balance, and psychological well-being. Community-based exercise programs represent an approach that not only improves physical function but also strengthens social interaction and self-confidence among older adults. This study aims to review community-based exercise programs in reducing fear of falling and improving quality of life among the elderly through a Systematic Literature Review (SLR) using the PRISMA 2020 guidelines. The literature …

Analisis Pengaruh Artificial Intelligence Terhadap Efisiensi Pengambilan Keputusan Dan Implikasinya Pada Manajemen Sumber Daya Manusia Di Indonesia: Studi Literatur Sistematis, Andi Wulan, Agung Wirabrata, Dwija Ardya Pradipta

Jurnal Manajemen dan Usahawan Indonesia

Artificial Intelligence (AI) is reshaping organizational decision-making and Human Resource Management (HRM), yet empirical insights remain fragmented. This study examines the effect of AI adoption on decision-making efficiency and its implications for HRM through a Systematic Literature Review (SLR) guided by PRISMA 2020. The dataset exclusively comprises scholarly articles uploaded by the researcher. The identification stage yielded 87 records, reduced to 72 after duplicate removal; screening produced 34 articles for full-text assessment, and 15 studies met the inclusion criteria. These 15 articles were analyzed using thematic synthesis to map recurring patterns and conceptual linkages. The findings indicate that AI significantly …

Hybrid Working Untuk Ibu Bekerja: Perspektif Self Determination Theory, Paulina Sri Trifina Hariyati, Nayunda Andhika Sari

Jurnal Manajemen dan Usahawan Indonesia

The phenomenon of hybrid working, which combines working from home and from the office, offers flexibility that has the potential to enhance work-life balance for employees. This is believed to be particularly significant for working mothers who carry high domestic responsibilities, providing them with the space to manage their time between work and family. Utilizing the Self-Determination Theory framework, this study aims to understand the meanings and strategies employed by working mothers navigating hybrid work. This research adopts a qualitative approach through interviews with 13 working mothers at a life insurance company in Jakarta. The findings indicate that for working …

Examining The Effects Of Interdependent Group Contingencies As A Classwide Intervention To Reduce Unsafe Behavior On The Playground, Elizabeth K. Linton

LSU Doctoral Dissertations

The purpose of this study was to evaluate the effects of different class wide interdependent group contingencies on unsafe playground behavior and student preferences for each intervention. In Experiment 1, we assessed the effects of the Good Behavior Game (GBG) on unsafe behavior across three third-grade classes. The GBG effectively reduced unsafe playground behavior relative to baseline, though student-choice data indicated that students did not prefer the intervention. This finding prompted Experiment 2, in which we evaluated synchronous schedule of reinforcement (SSR) as a classwide interdependent group contingency and compared its effectiveness and preference to the GBG. Participants in Experiment …

Activities Of Daily Living Limitations In Middle-Aged And Older Adults With Joint Disorders And Osteoporosis: Indonesia Longitudinal Aging Survey 2023, Desfalina Aryani, Mufti As Siddiq As Siddiq M. Irzal, Agustina Sianipar

Jurnal Epidemiologi Kesehatan Indonesia

Population ageing is associated with an increasing prevalence of limitations in activities of daily living. Joint disorders and osteoporosis are common health problems among older adults and may begin to emerge during middle age, potentially accelerating functional decline. However, studies examining the association between these conditions and limitations in activities of daily living in Indonesia remain limited. This study aimed to analyse the association between joint disorders and osteoporosis and limitations in activities of daily living among middle-aged and older adults in Indonesia. This study employed a cross-sectional design using data from the Indonesia Longitudinal Aging Survey (ILAS) 2023. The …

Comparing The Effects Of Project-Based Learning, Inquiry Learning, And Conventional Instruction On Students' Learning Motivation In Biology, Yeyen Angraini, Irwandi Irwandi, Jayanti Syahfitri

Jurnal Pendidikan Sains

Learning motivation is an important factor influencing students’ engagement, persistence, and success in Biology learning. However, classroom instruction at the senior high school level is often dominated by teacher-centered approaches, which may limit students’ active participation and motivational development. This study aimed to compare students’ learning motivation across Project-Based Learning (PjBL), Inquiry Learning, and conventional instructional approaches in Biology learning. The study employed a quantitative quasi-experimental design with a pretest–posttest approach involving three groups. Participants consisted of 85 Grade XI students from SMA Negeri 1 Talang Padang, South Sumatra, distributed across three classes: PjBL (n = 28), Inquiry (n = …

Effective Leadership Styles In Enhancing School Happiness Among Teachers Of General Education Schools In Hafr Al-Batin Governorate (Qualitative Study Using Grounded Theory), Abdullah Bin Mohammed Al-Ameri

University of Tabuk Journal for Humanities and Social Sciences

The study aimed to identify effective leadership styles that enhance school happiness among male and female teachers in general education schools in Hafr Al-Batin Governorate, adopting a qualitative approach based on grounded theory. Data were collected through semi-structured interviews with a purposive sample of 45 teachers, ensuring diversity in educational stage and years of experience, during the first semester of the academic year 1447/2025. The data were analyzed using MAXQDA software following the procedures of open, axial, and selective coding. The findings identified six leadership styles positively associated with school happiness: fair leadership, communicative leadership, motivational leadership, empowering leadership, social …

The Inflammatory Link Between Obesity, Quality Of Life, And Female Sexual Dysfunction: The Role Of Interleukin-6, Amelia Putri Ariyani, Lilik Herawati, Zidni Imanurrohmah Lubis, Alifia Syafira Putri, Adhiratih Ken Sari

Folia Medica Indonesiana

Female sexual dysfunction (FSD) is a common condition that impairs women's quality of life and is frequently associated with obesity. Beyond hormonal and vascular mechanisms, chronic low-grade inflammation, particularly elevated interleukin-6 (IL-6), has been proposed as a biological mediator of this association. This systematic review, registered in PROSPERO (CRD420251046082), aimed to evaluate the role of IL-6 in mediating the association between obesity and FSD. A comprehensive search of PubMed, Scopus, Embase, and Web of Science was conducted for studies published between 2018 and 2025, focusing on obese women, quantitative IL-6 measurements, and validated assessments of sexual function such as the …

Roots Or Resources?: Understanding Latino Student Leadership In Higher Education, Kelly Parra

Honors Theses

For the purpose of this study, Latino/a refers to individuals who are from Latin America or of Latin American descent. The term Latino/a is used because it captures individuals from a variety of Latino American cultural backgrounds and is not limited to a single national origin or ethnic subgroup (Pratt Institute Libraries, n.d).

Student leadership development is often fostered with involvement in student organizations, leadership programs, mentorship opportunities, and other institutional resources provided through higher education (Lebrón et al., 2017). However, for many students’ Latino/a leadership-related skills may begin developing long before entering college through family responsibilities, cultural experiences, and …

Quality Of Life Indicators In Historic Urban Spaces: A Case Study Of Al-Mustansiriya Madrasa, Baghdad / Iraq, Israa H. Karam Ali, Shireen I. Khazaal

Al-Esraa University College Journal for Engineering Sciences

Historic urban spaces play a central role in shaping social interaction, environmental comfort, and collective identity in cities with deep cultural heritage. Despite this importance, empirical assessments of their performance in terms of Quality of Life (QoL) from the perspective of contemporary users remain limited, particularly in the context of Baghdad. This study examines Quality of Life indicators within a historic urban space through a case study of Al-Mustansiriya Madrasa, one of Baghdad's most prominent historic educational complexes. A descriptive–analytical approach was adopted, integrating a structured questionnaire survey, systematic on-site observation, and spatial analysis based on Space Syntax techniques. The …

Interaction Design In Museum Architecture: A Contemporary Developmental Vision For The Iraqi Museum, Afaf Abdel Sahib Mohammed, Enas Salim Abdulahaad

Al-Esraa University College Journal for Engineering Sciences

The Iraqi Museum's remaining architectural form and traditional display techniques do not allow for enough interaction between visitors and the items, despite the museum's great heritage and cultural value. This between visitors and the exhibits. Additionally, the museum does not include interactive technologies and contemporary architecture, which are now essential components of modern museums around the world.This invites the question of how to optimize the Iraqi Museum's visitor experience by applying the principles of interaction design in museum architecture within a contemporary developmental vision. In order to revive the architectural spaces within the Iraqi Museum, the research aims to generate …

Prevalence And Determinants Of Perceived Occupational Stress Among Healthcare Workers At Al-Imam Al-Sadiq Hospital, Maha Flaih Abdzaid, Saad Saleem Raheem

Al-Nisour Journal for Medical Sciences

Occupational stress in healthcare workers is an increasing global issue that affects employee mental health and quality of care. To formulate adequately the intervention, it is crucial to identify the specific stressors within an institution. Thus, this study attempts to assess the prevalence and predictors of perceived occupational stress among health professionals at Al-Imam Al-Sadiq Hospital. This was a descriptive cross-sectional study that employed convenience sampling and determined sample-size at Al-Imam Al-Sadiq Hospital comprising 220 HCWs. Data will gather using a structured questionnaire that has 3 sections. Statistical Analysis: For categorical variables, descriptive and Inferential statistics were employed. Majority of …

Evaluation Of Air Quality And Respiratory Health Among Wastewater Treatment Workers Across Different Exposure Levels: A Cross-Sectional Study In Al-Diwaniyah City, Zahraa R. Mizher, Luma H. Alazawii, Israa J Mohammad

Al-Nisour Journal for Medical Sciences

Wastewater treatment facilities are important sources of occupational exposure to dangerous air pollutants, such as particulate matter and toxic gases, which can have a detrimental effect on employees' respiratory health. Lung function may be compromised by prolonged exposure, especially in uncontrolled settings. However, there isn't much information about these dangers in Iraq. The purpose of this study was to evaluate the quality of the air and compare lung function-based diagnoses and related risk factors across workers who were heavily and slightly exposed. A cross-sectional analytical study was conducted on 108 employees of Al-Diwaniyah's sewer networks and wastewater treatment facilities participated. …

Laboratory Evaluation Of Traditional Diagnostic Methods For The Detection Of Enterobius Vermicularis Infection In Al-Kut City, Ayman Riyadh Ismael, G. Aqeele, Haider Nadhim Abdaljabbar

Al-Nisour Journal for Medical Sciences

Enterobiasis (pinworm infection), caused by Enterobius vermicularis, is one of the most prevalent intestinal helminthic illnesses, particularly among children. Our investigation included 100 morning stool samples evaluated using wet mount, Lugol's iodine smear, and fecal flotation technique. In addition, only 60 subjects contributed perianal samples for the Scotch tape test. The results indicated that 11% of samples were positive by both wet mount and iodine preparation, however the flotation approach detected a higher positivity rate of 14%. Despite the smaller number of collected samples, the Scotch tape test revealed the highest positivity rate (15%; 9/60), emphasizing its potential diagnostic …

Methotrexate Adherence In Rheumatoid Arthritis Patients Using The Cqr-19 Scale And Its Relationship With Behavioral Factors At Marjan Teaching Hospital, Fatima Abbas Abed, Ali Hussein Al-Hafidh, Adnan Hussein Mahmoud

Al-Nisour Journal for Medical Sciences

Background: Methotrexate (MTX) and other disease-modifying antirheumatic medications are necessary for the long-term management of rheumatoid arthritis (RA), a chronic autoimmune illness. Nonetheless, a significant obstacle in the treatment of RA continues to be non-adherence to MTX. Comprehending the behavioral elements linked to adherence could potentially enhance therapy results.
Objective: To assess MTX adherence using the CQR-19 and examine its association with behavioral factors among RA patients at Marjan Teaching Hospital.
Methods: A cross-sectional study was conducted in the Rheumatology Unit of Marjan Teaching Hospital, Babylon, Iraq, from December 18, 2025, to April 18, 2026. A total of 220 RA …

Oxidative Stress And Recurrent Miscarriage: Exploring The Underlying Mechanisms, Hawraa Hazim, Alaa Al-Qaisi, Muataz Ali

Al-Nisour Journal for Medical Sciences

Despite a significant number of anatomical, genetic and chromosomal studies, the problem of recurrent miscarriage (RM) is still one of the challenges in reproductive medicine, as in almost 50% of the cases no clear cause is found. These are unexplained cases that are frequently called idiopathic RM and indicate that there might be an underlying molecular and biochemical mechanism that is not routinely checked during clinical practice. This review focuses on the key role of oxidative stress and redox imbalance in the pathogenesis of idiopathic RM. A special focus is placed on mitochondrial dysfunction, which results in increased electron leakage …