bluuebunny/crossref_metadata_2025 huggingface dataset:
Tax complexity and individual tax compliance costs of the personal income tax in Canada, 1985-2023: a synthesis
Authors: Vaillancourt François
Published: December 2024

This paper presents evidence on the evolution of both the complexity of the personal income tax system and the compliance costs incurred by personal income tax filers(PIT) in Canada. The complexity is measured using three indicators: ;length of federal income tax code(1971-2018), number of federal PIT expenditures(1981-2014) and length of PIT forms (2000-2015) .All three indicators show an increase in complexity. The compliance costs of the PIT are calculated using survey information gathered from individual canadians on time expanded and amount spent the following year for the 1985, 2007, 2018 and 2022 tax filing /calendar years. Our results show a decrease in the PIT compliance costs in hours, in total value and as share of GDP and revenues collected. This drop compliance costs is most likely due to the increasing use of software by tax filers to prepare their tax returns; this allows them, amongst other things, to download information from the Revenue agencies. A tax pain index combining complexity and compliance costs is put forward ; its small growth over time may well explain why increasing tax complexity of the PIT in Canada is apparently well tolerated.
PENYULUHAN SISTEM RUJUKAN PELAYANAN KESEHATAN
Authors: Purnamasari Devi , Salim Agus , Azzari Widya , Bagiana Rizka
Published: December 2024

Sistem  Rujukan  pelayanan  kesehatan  merupakan  penyelenggaraan  pelayanan kesehatan  yang  mengatur  pelimpahan  tugas  dan  tanggung  jawab  pelayanan kesehatan  secara timbal balik baik vertikal maupun horizontal. Sistem  rujukan diwajibkan  bagi  pasien  yang  merupakan  peserta  jaminan  kesehatan  atau  asuransi  kesehatan  sosial  dan  pemberi  pelayanan kesehatan. Pada Artikel ini penulis menguraikan kegiatan pengabdian masyarakat yang telah dilakukan untuk meningkatkan pemahaman masyarakat tentang Sistem rujukan pelayanan kesehatan. Kegiatan pengabdian masyarakat yang dilakukan di daerah Kulim, Kecamatan Kulim menggunakan metode ceramah, diskusi dan tanya jawab. Adapun hasil dari kegiatan masyarakat ini, masyarakat telah mampu memahami tentang system rujukan pelayanan kesehatan. Kegiatan ini juga dapat meningkatkan antusias atau kesadaran masyarakat dalam pengecekan kesehatan serta meningkatkan kesadaran masyarakat terhadap hidup sehat
PENGENALAN TENTANG PUSKESMAS TENAYAN RAYA SEBAGAI FASILITAS KESEHATAN TINGKAT I DI KEL. KULIM KEC. KULIM KOTA PEKANBARU
Authors: Zaky Abdul , Nurulisah Annisa , Indryani Filda , Yoshandi T. Mohd
Published: December 2024

Seiring dengan adanya pandemi COVID-19, masyarakat Indonesia mulai mengalami berbagai dampak. Salah satu dampak negatifnya yaitu menurunnya tingkat kunjungan ke fasilitas kesehatan, karena ketakutan untuk berobat. Pada artikel ini penulis menguraikan kegiatan pengabdian masyarakat yang telah dilakukan untuk meningkatkan pemahaman masyarakat tentang Puskesmas Tenayan Raya sebagai Fasilitas Kesehatan Tingkat I di Kel. Kulim Kec. Kulim Kota Pekanbaru. Kegiatan pengabdian masyarakat yang dilaksanakan di Posyandu Cempaka Indah di RW 001 Kel. Kulim menggunakan metode ceramah dan diskusi tanya jawab. Adapun hasil dari pengabdian masyarakat ini adalah untuk meningkatkan pengetahuan masyarakat RW 001 Kel. Kulim tentang fasilitas kesehatan yang ada di Kelurahan Kulim sehingga masyarakat dapat menggunakan BPJS Kesehatannya sesuai sistem rujukan berjenjangnya.
Transformation towards Organic Cassava Production in Yasothon Province, Thailand
Authors: Kumsueb Benjamas , Kitchaicharoen Jirawan , Jintrawet Attachai , Limnirunkul Budsara , Kono Yasuyuki
Published: December 2024

With the marked increase in consumer and commercial demand for organic foods and products, organic cassava production has become a viable alternative for small growers because it can lead to the sustainability of the agriculture and food production system. However, few studies have been conducted to enable a more comprehensive understanding of the factors that contribute to the transformation from chemical into organic cassava production systems. This study quantitatively aimed to identify socioeconomic, cassava profitability, and institutional factors that influence the cultural practice transformation towards organic cassava production in a district of Yasothon province, Thailand. We used a structured interview schedule to collect data from 283 sampled cassava growers comprising 236 chemical cassava growers and 47 organic cassava growers in the district during the period from August 2020 to November 2020. Quantitatively, we used the binary logistic regression method to identify the positive and negative factors contributing to the transformation of cassava production systems including growers’ motivations for the transformation. The study findings indicated that income from organic cassava was taken as the main motivation for growers’ decisions to transform (40.3%). We found that organic cassava farm gate price, access to formal credit, labor used and membership in growers’ organizations were positive significant factors that affected the cultural practice transformation. Finally, small cassava growers as well as stakeholders should systemically be considered by policymakers and in strategic intervention through relevant institutions.
Optimizing Energy Efficiency of Adiabatic Frequency Conversion in an Add-Drop Resonator
Authors: Pattanasiri Busara , Lipar Werachai , Pithakwongsaporn Santhad
Published: December 2024

Adiabatic frequency conversion (AFC) in add-drop resonators holds promise for enhancing energy efficiency in photonic applications. This theoretical study investigates the conditions for optimizing the energy efficiency of the drop port within an add-drop resonator configuration. The analysis considers both fixed input pulse shapes and continuous wave inputs, taking into account AFC's relative timescales. Specifically, the critical coupling regime is explored, and it is observed that the extrinsic decay rates into the drop port and through port converge to nearly equal values, thereby maximizing drop port efficiency. Moreover, when a global parameter is swept, it is demonstrated that the maximal efficiency of the drop port is achieved when the extrinsic decay rates of both ports are equal. This optimization strategy extends to scenarios involving continuous wave inputs as well. These findings provide valuable insights for designing high-performance add-drop resonators and advancing the practical implementation of AFC in photonic systems.
Data Cataloging as a Catalyst for Effective Data Governance and Improved Decision-Making
Authors: Garg Varun
Published: December 2024

Data governance is a foundational component for organizations managing data as a strategic asset in today’s data-
driven environments. Effective data governance ensures data quality, security, accessibility, and regulatory compliance,

all of which are crucial for maintaining organizational integrity and competitive advantage. This paper explores how
data cataloging, as a core tool within data governance frameworks, facilitates metadata management, data lineage
tracking, and role-based access control (RBAC). We analyze the technical mechanisms through which data cataloging
contributes to governance objectives, such as maintaining data quality and enabling regulatory compliance.
Additionally, this study examines the impact of data cataloging on decision-making within organizations, highlighting
improvements in decision accuracy, speed, and accountability. By drawing from examples in sectors such as finance
and healthcare, this paper outlines the challenges associated with data cataloging implementation, including integration
complexity and scalability issues. The paper concludes with future directions, focusing on artificial intelligence (AI)-
enabled metadata tagging and cloud-native cataloging solutions, which promise to enhance data cataloging capabilities
and make governance frameworks more agile and scalable.
Keywords
Data Governance, Data Cataloging, Metadata Management, Data Quality, Data Lineage, Role-Based Access Control
(RBAC), Compliance, AI-Driven Cataloging, Cloud-Native Solutions, Data-Driven Decision-Making.
System identification-based tuning of PID algorithm parameters by using PSO and genetic algorithms
Authors: Bejad Al-Harbi  , Bounsiar Abdenour , Algosaibi Abdulelah
Published: December 2024

The PID control algorithm is the most used industrial control method. This is due to its simplicity, ease of use, and because it yields stable results. PID parameters vary for each controller; therefore, finding the optimal parameters is crucial for obtaining good results. However, tuning PID parameters for complex systems is not a trivial task and is also somewhat difficult as conventional techniques rely on time and effort manual tuning or rely on simplified statistical estimation techniques of the system’s model yielding sub- optimal results. In this project, we propose to use machine learning for PID parameter tuning on proprietary historical time series operating process control data. The data is processed with the help of computational and machine-learning techniques to better identify the process model and predict the optimal PID parameters. The research methodology consists of three main steps. First, process-model identification is done by using a Radial Basis Function (RBF) neural network. Secondly, Particle Swarm Optimization (PSO) hybrid with Genetic Algorithms (GA) is used for finding the optimal PID parameters. The PID values predicted by PSO, will be fed to GA optimization process as an initial starting point. The final step consists of integrating the identified process model with the PID optimization algorithm in a computer-based simulation environment (Simulink). The experimental simulations are done for various study cases. Results showed that the predicted PID parameters error rate and standard deviation for PID control and process are decreased, which enhances the process controlling and stability.
Applying artificial intelligence in predicting educational excellence in higher education institutions: A case study in Jordanian universities
Authors: Najdawi Mohamed Hadi Al , Shwedeh Fanar , Abdelmoghies Mahmoud Mokhtar , Kitana Abdelkarim , Ali Ahmed
Published: December 2024

Monitoring the responsible application of Artificial Intelligence (AI) in higher education requires the establishment of robust regulatory frameworks and thorough policy guidelines. The study concentrates on important elements that could impede the excellence of education, including issues with data security, privacy, and policies as well as legal frameworks. By examining these variables, the study aims to address the particular opportunities and difficulties encountered in this setting and to gain a deeper knowledge of how AI deployment affects educational excellence in Jordanian higher education institutions. A survey research methodology has been chosen. Institutions in Jordan that have started implementing AI or metaverse technology were given a pre-made questionnaire. The population of students in Jordanian higher education institutions, including both local and foreign students at different educational levels, is the main subject of this study. During the three-month data collection phase, the sample size was cautiously raised to more than 457 individuals in order to boost the research's robustness. The results show that the AI adoption, trust in technology (by data privacy and security), and policy & regulations in Jordanian higher institutions have significant impacts on educational excellence. Our results highlight the urgent need for policymakers to reevaluate and explain current regulatory frameworks in order to safeguard educational excellence, while also confirming the transformative possible of AI implementation in improving instructive resources and services. This study demonstrates the possible benefits of integrating AI technologies into educational backgrounds by confirming the strong correlation between AI adoption and educational excellence. In order to increase the effectiveness, usability, and caliber of educational resources and services, schools ought to think about implementing AI-driven tools and platforms.
Grit and workplace spirituality on psychological well-being among faculties of higher education institutions
Authors: Ali Amjad , Kumari Shalu , Ali Nasir , Sayeeduzzafar Sayeeduzzafar , Jeet Vikram
Published: December 2024

The present research investigates the complex connection between grit, workplace spirituality, and psychological well-being among faculty members in higher education institutions. The study was focused on faculty members of public state universities in India (Bihar). The data was gathered through surveys and then examined using multiple regression analysis. Findings offer valuable insights into the factors that influence psychological well-being among faculty members. Precisely results indicate that grit and workplace spirituality are strong predictors of various aspects of psychological well-being. The study also revealed an interesting facet of workplace spirituality as the workplace spirituality was positively associated with psychological well-being, but a further analysis of its components showed a more complex relationship. The spiritual orientation dimension, representing an individual's adherence to their spiritual ideals at work, was discovered to adversely affect psychological well-being. This contradictory discovery indicates that an overemphasis on spiritual orientation in higher education could result in a contradiction between personal values and professional requirements, ultimately reducing psychological well-being. It emphasizes the importance of a balanced approach to workplace spirituality that enables individuals to incorporate their spiritual beliefs into their work without facing excessive stress or conflict. The results provide significant information for enhancing the welfare of educational professionals and may have wider significance for the education sector and occupational psychology.
Enhancing students’ comprehension of metaphoric terms in physics
Authors: Kuqali Margarita , Plaku Megi
Published: December 2024

This paper aims to dwell on students’ perceptions and attitudes towards metaphoric terms and some approaches that contribute to the comprehension and acquisition of basic physics metaphoric terminology for 1st-year undergraduate engineering students. Physics English terminology comprehension and acquisition is of great importance when it comes to these students. Being the lingua franca of today, mastering the basic terminology of the respective field of interest in English is demanding for everyone who aspires to have a deep understanding of their field of interest and a prosperous career in the future. To have an effective input and output in the teaching/learning process a collaboration among professionals of STEM (science, technology, engineering, and mathematics) and ESP (English for Specific Purposes) is necessitated. Physics is fundamentally dependent on abstract notions that frequently lack tangible counterparts, such as in these metaphoric terms "tunneling effect" or "black hole".  Concepts expressed through such metaphoric terms assist students to envision, conceive, and acquire the latter, but can also hinder their understanding of concepts. To conduct this research, a semi–structured questionnaire was handed to 100 students of Polytechnic University of Tirana to investigate their beliefs towards these terms and to determine different approaches that will contribute to their understanding of the above-mentioned terms. The results concluded that students face challenges in comprehending a metaphoric unknown term. Nevertheless, the results indicated that the most used and preferred approaches to learning these terms are related to the professor’s assistance with explanation, analogy with everyday experiences, and visual aids, videos mainly. This study highlights the importance of collaboration between STEM and ESP in combining the linguistic-semantic nature of terms and their practical application in the function of students’ terminology acquisition.
The Challenging Dynamics of Democracy, Authoritarianism and Populism in the Southern Caucasus
Authors:   European Center for Populism Studies (ECPS), Koskina Stavroula
Published: December 2024

The 16th session of the Mapping Global Populism (MGP) Panel Series, hosted by the ECPS, critically examined the interplay of populism, democracy, and authoritarianism in the Southern Caucasus. Featuring six distinguished scholars, the discussion focused on Armenia, Azerbaijan, and Georgia, analyzing how populism drives democratic backsliding and institutional fragility in hybrid regimes. Common themes included the erosion of liberal norms and the entanglement of political and economic power among elites. Panelists also examined the influence of global power dynamics, particularly Russia’s invasion of Ukraine, on regional politics, highlighting how external pressures shape domestic strategies and policy orientations.
Teacher’s belief of metacognitive reading strategies and awareness in reading classrooms
Authors: Mofreh Samah Ali Mohsen , Salem Sultan , Wei Teoh Yi
Published: December 2024

While studies on students' application of reading strategies have gained prominence, there is a paucity of research on teachers. The study aims to investigate how teachers’ beliefs about metacognitive reading strategies impact their metacognitive awareness in reading classrooms. The samples involved 82 teachers from public secondary schools. This study used a quantitative research design. Research findings demonstrated that teachers significantly believed in and used metacognitive reading strategies, whereas a small number of teachers believed in them but did not implement them. The result of this study indicated that teachers possessed high metacognitive awareness levels while teaching reading comprehension. Analysis underscored the significance of implementing metacognitive reading strategies through a series of implications and suggestions. While some teachers believed in metacognitive reading strategies but did not use them, this study found that teachers believed in and employed them. Additionally, the study indicated that teachers exhibited high levels of metacognitive awareness during reading comprehension instruction, suggesting a strong understanding of their cognitive processes. Based on these results, the study suggests that reading classrooms should gradually use metacognitive reading strategies while taking into account the Malaysian English as a Second Language (ESL) context and traditional teaching methods. The implications of this research underscore the importance of fostering teachers' metacognitive awareness and strategically applying reading strategies to enhance student learning outcomes.
Case study of the identification of gifted students in an independent school in Sydney’s western suburbs: What is working, what needs improvement, and what could change look like
Authors: Madden Alix , Townend Geraldine
Published: December 2024

This case study presents a report of the identification processes for gifted students at an independent school in western Sydney. This study aims to provide some insights into the efficacy of the current identification methods and the perceived support for the identification of gifted students across the school leadership. The findings are informed by the analysis of students’ ability and achievement tests over several years and semi-structured interviews with key stakeholders in the school’s leadership team. This methodology underpins the data collection appropriate for this research. Key findings highlight the challenges of providing and maintaining a consistent, robust policy that allows for rigorous identification and the reliance on ad hoc recommendations and limited data points. It was also noted that although there was a paucity of ability testing, empirical data did inform student allocation to academic classes associated with high academic performance. It was also found that the attitudes among the school leadership were positive, and they acknowledged a need for change. The report recommends that the school expand its procedures for identifying gifted students and support this with a formalized, clear, and accessible policy. This would ensure a more systematic and reliable approach to recognizing and nurturing gifted students, ultimately enhancing their educational experience.
Directed Motivational Currents Under DST: A Critical Review
Authors: Liu Songwei
Published: December 2024

"Directed motivational currents" (DMCs) represent a novel construct within L2 motivation theory, extensively utilized in the domain of second language acquisition research. Initially introduced by Dörnyei (2013), DMCs describe a state of complete immersion in a task, aligning with the dynamic systems theory (DST), particularly during the socio-dynamic phase of L2 motivation. At the outset, Dörnyei was inspired by the 'flow experience' introduced by Csikszentmihalyi in 1975. This review centers on the construct of 'directed motivational currents' in accordance with the complex dynamic systems theory (DST). Consequently, the four significant periods in second language (L2) motivation, the complex dynamic systems theory, as well as the characteristics and dimensions of DMCs will be expounded. Additionally, this article begins with presenting its origin and reflecting on how the research of DMCs has evolved over time. This can be categorized into its validity, its application in teaching, the triggers and mediating forces involved, and its relationship with other concepts. Critiques regarding it will also be provided.
The Effects of Understanding Community Child Center Policies on Policy Trust and the Mediating Effect of Trust in Government
Authors:   Hyupsung Institute for Liberal Arts Studies, Cho Sunghui
Published: December 2024

This study aims to examine the effects of understanding policies related to Community Child Centers and trust in government on policy trust, and to verify the mediating effect of trust in government in the relationship between policy understanding and policy trust. For this purpose, data from 642 institutions that participated in a safety-related survey conducted by the National Council of Community Child Centers were analyzed using a structural equation model. The analysis confirmed that understanding policies related to Community Child Centers and trust in government positively affect policy trust. Moreover, the mediating effect of trust in government in the relationship between policy understanding and policy trust was statistically significant. Based on the study results, strategies were proposed to enhance policy understanding and trust in government to improve policy trust related to Community Child Centers.
Non-alcoholic Steatohepatitis Diagnosis and Treatment – Current Concepts
Authors:   Dr Carol Davila Central Military University Emergency Hospital, Bucharest, Romania
Research Metabolism Center, Bucharest, Romania, Ijacu Ana M. , Gagiu Laura G. ,   Dr Carol Davila Central Military University Emergency Hospital, Bucharest, Romania
Research Metabolism Center, Bucharest, Romania, Staicu Iulia M. ,   Dr Carol Davila Central Military University Emergency Hospital, Bucharest, Romania
Research Metabolism Center, Bucharest, Romania, Zugravu Corina ,   Carol Davila University of Pharmacy and Medicine, Dept of Food Hygiene and Nutrition, Bucharest, Romania, Constantin Ciprian ,   Dr Carol Davila Central Military University Emergency Hospital, Bucharest, Romania
Research Metabolism Center, Bucharest, Romania
Medicine Faculty, Dept of Diabetes and Nutrition, Titu Maiorescu University, Bucharest, Romania
Published: December 2024

NAFLD (Non-alcoholic fatty liver disease) is a condition of high importance due to its increased prevalence, estimated at 24% of the global population, and its potential progression to advanced liver disease, cirrhosis, and hepatocellular carcinoma. One-quarter of NAFLD patients have NASH (non-alcoholic steatohepatitis), which is histologically described as liver steatosis, inflammation, fibrosis, hepatocyte injury, and death. Metabolic disruptions, such as obesity, diabetes, and dyslipidemia, are considered to have a great impact on the development of NASH. Patients may have NAFLD for a long time before progressing into NASH, which highlights the necessity of periodic imaging and biochemical evaluation of the liver, and also presents an optimal window of therapeutic intervention. The challenge in developing treatment for NASH stems from the slow progression of the disease and the reliance on sequential biopsies as the diagnostic and staging tools. Several non-invasive tests have been developed as potential future alternatives to the current invasive gold standard. This review aims to assess the current available methods of diagnosis and treatment targeting inflammation.
Navigating Cancer: Mental Adjustment as Predictor of Somatic Symptoms in Romanian Patients- A Cross-Sectional Study
Authors:   Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Licu Monica , Popescu Dragos M. ,   University of Medicine and Pharmacy, Craiova, Romania, Ionescu Claudiu G. ,   Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Voinea Oana ,   Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Stoica Lidia ,   Chronic Diseases Patients Association „Restart to Life”, Bucharest, Romania, Cotel Adriana ,   Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Published: December 2024

Objective: This study aimed to examine the relationship between mental adjustment mechanisms and somatic symptoms in cancer survivors, a topic with limited research in Psycho-oncology. Methods: In this exploratory cross-sectional study, 88 cancer patients were surveyed using the Somatic Symptoms Scale (SSS-8), the Somatic Symptom Disorder Scale (SSD-12), and the Mini-Mental Adjustment to Cancer Scale (MINI-MAC). Additional questions were asked regarding cancer stage, treatment, and illness relapses. Data collection occurred over one month at a local oncology unit. Results: Several significant correlations were observed between the scales and subscales of the instruments applied during this study. The most important results showed that maladaptive adjustment mechanisms were significantly associated with somatic symptoms, while adaptive mechanisms were not. However, "fighting spirit," an adaptive mechanism, acted as a moderator between somatic symptoms and their psychological impact (effect size t = 0.157, p 0.05). Lower "fighting spirit" scores correlated with higher SSS-8 and SSD-12 scores, indicating its potential protective role. Conclusion: A more specific assessment of somatic symptoms and their link to mental adaptation to cancer is needed. Psycho-oncological interventions should address both adaptive and maladaptive adjustment mechanisms due to their significant influence on patient outcomes.
AI-Enhanced Strategies for COVID-19 Vaccination and Booster Prioritization: A Comprehensive Framework
Authors: AlShaya Sara , Gopakumar Aji , Raghupathy Rahul , Mukherjee Badshah , Abou Elias Bachir , Jamal Mohideen Sheik , Mathur Vibhor , Kurakula Sudheer
Published: December 2024

Background: Distributing vaccines efficiently during the COVID-19 pandemic presented significant logistical challenges. To address the need for identifying populations at risk of breakthrough infections and those requiring booster shots, Emirates Health Services (EHS) developed a framework utilizing AI-driven digital solutions. Objective: To develop a machine learning (ML) model to identify individuals at risk of breakthrough infections and in need of booster doses, aiming to prioritize booster administration and reduce repeated infections among fully vaccinated individuals in the Northern Emirates of the UAE.
Methods: A monitoring dashboard was developed using the EHS Intelligence (PaCE) platform. The study, conducted in three phases, created models to predict infection risk, COVID-19 severity in ICU patients and breakthrough infection risk, using data from the Wareed EMR system.
Results: The AI models accurately identified high-risk individuals and predicted ICU mortality, achieving AUCs of 75% and 74% for infection risk, 94% and 91% for ICU mortality in training and validation datasets, observed 79% AUC with 85% accuracy for identifying high-risk groups for booster vaccination.
Conclusion: The integration of AI in vaccination prioritization demonstrated its potential to enhance public health initiatives and improve pandemic management in the UAE.
IMMUNOHISTOCHEMICAL EXPRESSION OF MATRIX METALLOPROTEINASE-1 (MMP-1) IN DIFFERENT TYPES OF BREAST CARCINOMA AND ITS COMPARISON WITH ER/PER AND HER2/neu
Authors: Farwa Batool Shamsi  , Ammara Anwar  , Raees Abbas Lail  , Mulazim Hussain Bukhari  , Nadia Naseem  , Abdul Hannan Nagi
Published: December 2024

Background: Breast cancer is a complex disease that comprises of various biological sub-types with different natural history. Matrix metalloproteinase-1(MMP-1) expression has been reported to inversely correlate with the survival. The current study was conducted to classify breast cancer into four subtypes based on IHC, to assess the immunohistochemical expression of MMP-1 in primary breast carcinoma, to compare its expression with ER/PR and HER2/neu. Methods: A descriptive study was conducted on 100 mastectomy specimens of breast carcinoma after being fixed in 10% formalin at Department of Histopathology, University of Health Sciences Lahore. Sections were taken on frosted slides for H&E and on lysine coated slides for immunohistochemistry (IHC). Haematoxylin and eosin (H&E) and IHC for oestrogen receptor/progesterone receptor (ER/PR), HER2/neu and Matrix metalloproteinase (MMP-1) were performed according to protocol. Results: The mean age was 48.44±11.79 Years (ranging 25 to 90 years). 97 cases were of Invasive ductal carcinoma (IDC) type, two showed the features of invasive lobular carcinoma and only one case was found to be of mucinous type, 19 cases were found to be in grade I, 74 in grade II and seven cases were in grade III. Breast cancer has been classified into four major groups based on IHC profile ER/PR and HER2/neu expression. The groups were: Triple positive, ER/PR+, HER2-, ER/PR-, HER2/neu+ and triple negative) cases. Among 100 cases of breast cancer, 9 were of triple positive type, (ER/PR +, HER2/neu+), 28 cases were of ER/PR +, HER2- type, 19 were ER/PR-, HER2/neu +ve and 44 cases were of triple negative type (ER/PR-, HER2/neu-ve). 13 cases were of score 1 MMP-1out of which 7 (25.0%) were ER/PR+, HER2-, 1 (5.3%) case was ER/PR-, HER2/neu +ve and 5 (11.4%) cases were triple negative. Among 30 cases of MMP-1 score 4, 5(55.6%) cases were of triple positive type, 3 (10.7%) cases were of ER/PR +, HER 2/neu-ve type, 12(63.2%) cases were of ER/PR-, HER 2/neu+ve type, and 10 (22.7%) cases were of triple negative type. A significant p-value of <0.05 was obtained. Conclusions: Among four IHC based subtypes, most frequent were triple negative breast cancers which showed high IHC score of MMP-I which is reported to be an important marker for metastatic potential in breast carcinoma.
VISUAL OUTCOME OF PAEDIATRIC TRAUMATIC CATARACT IN PAEDIATRIC OPHTHALMOLOGY DEPARTMENT OF A TERTIARY CARE HOSPITAL
Authors: Chaudhry Rabia Khawar , Rehman Aziz ur , Muhammad Nasar Qamar Khan  , Dad Mehboob , Kazi Ghulam Qadir
Published: December 2024

Background: Paediatric traumatic cataract is one of leading treatable cause of childhood blindness. The purpose of this study is to analyse number of avoidable blindness in children and to access final visual outcomes, causative factors, strategies for the prevention and management. Methods: One hundred and twenty patients of ocular traumatic cataract age between 2 months to 14 years were treated in Department of Paediatric Ophthalmology from April 2019 till April 2020wasprospectivelyreviewed. Data included age, gender, time of presentation, type of injury, anterior segment with fundus examination, time and type of surgery, visual outcome at presentation and final visual outcome. Visual acuity was assessed by fixation and following, Snellen's chart according to patient's age. Some patients underwent for lens aspiration and rest underwent for lens aspiration, posterior capsulotomy and anterior vitrectomy followed by intraocular lens implantation under general anaesthesia. Patients who lost follow ups for two months were not included in study. Analysis of data was done using SPSS for window version 24.0. Results: One hundred and twenty eyes operated for traumatic cataract among which 64 (53.34%) patients were males and 56 (46.66%) were females. The average age of patients was 7.8 years with traumatic cataract. Initial Uncorrected visual out come at the time of presentation ranged from 6/60 to light perception. 15 %of children with traumatic cataract had post-operative final visual outcome of better than 6/18. Conclusion: The commonest cause of ocular injuries in our pediatric ophthalmology department was domestic, mostly in 5-9 years of age with greater number in males. In traumatic cataract extraction final visual outcome depends on initial visual outcome, source and type of injury, duration of presentation, duration of surgery and complications.
EPIDEMIOLOGICAL ASPECTS OF ALLERGIC CONJUNCTIVITIS: A CROSS SECTIONAL STUDY
Authors: Ayisha Kausar  , Nadia Akhtar  , Nighat Akbar
Published: December 2024

Background: Allergic conjunctivitis is a common ocular disease which not only affects vision but can also compromise the quality of life of patients to a greater extent. If it is not properly managed it can lead to decreased vision due to corneal complications. This study was conducted to evaluate the epidemiological aspects of allergic conjunctivitis. Methods: This cross-sectional study was carried out in the Ophthalmology department of Federal General Hospital, from June 2018 to June 2020. We enrolled 236 patients of allergic conjunctivitis. Data collection form consisted of a structured questionnaire, records of ocular findings using slit lamp biomicroscope and skin prick test results. Data analysis was done using SPSS version 23.0. Results: The mean age (±SD) of study population was 22.71±13.11 years, 60.2% were females. Most common type of conjunctivitis was vernal keratoconjunctivitis (VKC) 46.2%, followed by perennial (27.1%), seasonal (17.4%) and atopic (9.3%). There was significant association of type of conjunctivitis with the age, p-value<0.001. VKC was prevalent in patients of age <20 years. There was a significant association of gender with type of conjunctivitis, p-value =0.000. Perennial variety was more prevalent in females while VKC was common in males. Collateral atopy was present in 52.1% patients. Corneal involvement was seen in 17.8% patients. There was a significant association between corneal involvement and interference with daily visual activities, p-value 0.034. SPT was positive in 79.7% patients. Conclusion: Ocular allergies/ conjunctivitis was more prevalent in female population. VKC is the most common type of allergic conjunctivitis, prevalent in males of age <20 yrs. Allergic rhinitis was the most common co-morbidity followed by dermatitis.
INTRAVITREAL BEVACIZUMAB ALONE VERSUS INTRAVITREAL BEVACIZUMAB IN COMBINATION WITH FOCAL MACULAR PHOTOCOAGULATION IN DIABETIC MACULAR OEDEMA
Authors: Jatoi Asadullah , Shaikh Noman Ahmed , Narsani Ashok Kumar , Asma Jatoi
Published: December 2024

Background: To compare the mean best corrected visual acuity (BCVA) between intravitreal bevacizumab (IVB) and combination treatment bevacizumab and Focal Macular Photocoagulation (FMP) for diabetic macular oedema (DME). Method: It is a randomized control trial conducted at Department of ophthalmology at Institute of Ophthalmology, Liaquat University of medical and health sciences, Jamshoro from 1st November 2019 to 31st October 2020, in which 260 Patients between the ages of 40 to 75 years, with DME were included. While patients with macular oedema secondary to other causes than diabetic retinopathy, presence of vitreomacular traction, aphakic patients, history of glaucoma or who had received pan-retinal photocoagulation, IVB, triamcinolone within 12 months, patients with history of stroke or cardiac disease, patients with media opacities such as corneal opacities were also excluded from the study. Two hundred sixty (260) patients were divided in two groups. Group A has 130 patients and they were treated with IVB alone. Group B also included 130, and they were treated with combination of IVB+FMP. The patients were followed-up monthly for 3 months and BCVA was checked at the end of 3 months. Results: Patients in group B showed superior visual outcome, when they were treated with IVB+FMC as compared to patients in group A who received IVB alone. Conclusion: Combination treatment OF IVB+FMP is an effective treatment option for diabetic macular oedema as compared to IVB alone with better mean visual outcome.
EXPLORING THE BARRIERS OF AND RECOMMENDATIONS FOR ONLINE TEACHING AND LEARNING IN UNDERGRADUATE MEDICAL EDUCATION: A DESCRIPTIVE PHENOMENOLOGICAL STUDY
Authors: Muhammad Junaid Khan  , Ahsan Sethi
Published: December 2024

Background: The advancement in science and technology has forced educational institutions worldwide to shift to online teaching and learning (T&L), including medical colleges in Pakistan. This qualitative study explores the barriers and recommendations for online classes among undergraduate medical students in Khyber Pakhtunkhwa, Pakistan. Method: The study included students from six medical colleges who were actively engaged in online T&L with a descriptive phenomenological approach. Result: The study resulted in a multitude of barriers hampering the overall quality of effectiveness of online T&L, including internet connectivity issues, communication gaps, health concerns due to prolonged screen time, challenges in joint family settings, and limited time for self-study. The lack of interactivity in online classes was a significant concern, as students felt they had limited opportunities to engage with their peers and instructors. The recommendation mainly targeted the fair and transparent assessment, and feedback mechanism with continuous monitoring that potentiate student engagement, training and improving resources that can increase the effectiveness and readiness of online medical education well for the transition to distance learning. Conclusion: It is important to modify and adopt meticulous methodical approaches like fair and transparent assessment methods, robust feedback mechanisms, improved resources, rigorous supervision, and thorough faculty development programs that will counterbalance similar barriers for a more effective and inclusive online learning environment.
IMPACT OF COVID-19: FACULTY SUGGESTIONS REGARDING ONLINE MEDICAL TEACHING
Authors: Sabqat Mashaal , Anbreen Aziz  , Tayyeba Iftikhar Mirza  , Bushra Adeel
Published: December 2024

Background: As a result of the SARS-CoV-2 related government lockdown, academic institutions in Pakistan, including medical and dental colleges and universities, had to forgo on-site classes and make an emergency shift to online teaching. This study explores the perspective of the faculty, as a key stakeholder, on ways to increase the effectiveness of online teaching and learning at these medical and dental colleges and universities. Methods: A descriptive cross-sectional qualitative survey was conducted in April-July 2020 in 32 medical and dental colleges of Pakistan. The sample size was not pre-determined and the participants included teaching faculty of both clinical and basic sciences. Data were iteratively collected and analyzed till data and time saturation were achieved. Thematic analysis of data was done by running two coding cycles. All authors ensured analytical triangulation by analyzing the data independently before developing consensus on the subthemes and themes. Results: One hundred and thirty-two medical teachers responded. Data analysis revealed three themes regarding suggestions to improve teaching methods improve assessment and increase the effectiveness of online teaching and learning. The participants suggested supplementing real-time classes with recorded lectures, providing broadband internet services, using assignment-based and active learning strategies, continuous formative assessment, faculty training, and standardization of online teaching by higher authorities. Conclusion: The current study offers actionable steps to decision makers at medical colleges and universities to make online teaching and learning more efficient and valuable, based on the suggestions from their faculty.
HYDATID CYST IN A RARE SITE; THE LEFT VENTRICLE
Authors: Nadeem Ijaz  , Huma Hanif  , Zahid Rehman  , Niaz Ali  , Tahir Iqbal  , Imtiaz ur Rehman
Published: December 2024

Echinococcosis is a disease that has been affecting human beings since decades and is primarily a zoonotic disease. The larvae of genus Echinococcus causes this disease. The most common sites for these cysts are the lungs and liver. Cardiac hydatidosis is a rare phenomenon and the incidence of such cases is about 1.3%. The case presented is of a 15-year-old boy who would have shortness of breath on exertion and acute right leg pain. To diagnose cardiac variant of the cystic disease, computed topography (CT) and echocardiography were done. Doppler studies confirmed acute limb ischemia. The treatment modality was an open-heart surgery and bilateral embolectomy of the popliteal artery. The patient was discharged to home with albendazole chemotherapy. The study gives an insight into an unusual presentation and successful treatment of cardiac hydatid cyst as well as the associated complications that can be encountered.
HOW TO TEACH '˜LISTENING FOR LEARNING' IN A CLINICAL CONTEXT?
Authors: Junaid Syed Muhammad , Usman Mahboob  , Natasha Nadeem  , Nayab lqbal  , Ali Maqbool Khuwaja  , Madeeha Bangash
Published: December 2024

Active listening skills are an important factor in communication skill set. And for budding doctors they need to be incorporated in the undergraduate medical programs. Studies have shown that patients, prefer the doctors who can listen to them instead of just looking at their signs and symptoms. Listening is related to empathy when strictly talking from patient's perspective. Having better listening skills can also lead to less prescription errors and help the doctor to identify some missing points from the history that can help in the diagnosis. Listening skills can be taught in different ways. Role plays are a safe way to teach them however, while teaching them in a clinical setting, we need to approach it in a different way like bedside teaching, Chairside Dental OPD etc.
MEDIASTINAL LYMPHADENOPATHY AS A PREDICTOR OF WORSE OUTCOME IN SEVERE COVID-19 CASES
Authors: Qayyum Uzma , Naghmana Akhtar  , Mudassir Iqbal  , Amina Noor  , Danish Hassan Khan  , Salman Saleem  , Shazia Nisar
Published: December 2024

Background: This cross-sectional study is aimed at evaluating the association of mediastinal lymphadenopathy with COVID-19 prognosis in severe cases. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Pakistan, from June to July 2020. Methods: One hundred and fifty (150) laboratory-confirmed SARS CoV-2 infected, severe cases in Intensive Care Unit/ High Dependency Unit were included. These cases were divided into two categories, i.e., with and without mediastinal lymphadenopathy on High Resolution Computed Tomography chest. The two categories were compared on the basis of data obtained including age, gender, comorbid, White Blood Cell count, lymphocyte count, median days of hospitalization, need for invasive ventilation, Intensive Care Unit admission, clinical outcome and High-Resolution Computed Tomography chest findings. The data was compiled on a questionnaire and analysed on SPSS 24. Result: Total 155 severe COVID-19 patients were reviewed, out of which 36 (23.2%) had mediastinal lymphadenopathy (category 1) and 119 (76.8%) had no mediastinal lymphadenopathy (category 2). Laboratory findings including median of white blood cells and lymphocyte percentage had no significant change in both categories. Intensive care unit admissions were 12 (33.3%) and 56 (47.1%) in category 1 and 2 respectively. Median days of hospitalization (8 days) and mortality rate (16%) were almost the same in both categories. Conclusion: Our study concludes that presence of mediastinal lymphadenopathy in severe COVID-19 cases is not associated with worse outcome. However, overall prevalence of mediastinal lymphadenopathy in severe cases is high (23.2%).
CORRELATION OF CAREGIVERS' STRAIN WITH PATIENTS' DISABILITY IN STROKE
Authors: Adan Sardar  , Khurram Shahzad  , Abdul Rehman Arshad  , Khawar Shabbir  , Syed Hassan Raza
Published: December 2024

Background: Stroke results in serious long-term disability in fifty percent of the survivors, making them dependent on others for activities of daily living. Our study aims to study the effect of this dependence on care-givers. Cross sectional study. Methods: It was a cross sectional study conducted at Combined Military Hospital Peshawar from September 2020 to November 2020. Self-administered questionnaires were used to interview 96 patients with stroke and their caregivers selected through convenience sampling technique. Barthel Index was used to measure disability among patients, whereas Modified Caregivers Strain Index (M-CSI) was used for the caregivers. An association between the two scores was analyzed through Pearson's coefficient of correlation (r) and linear regression. Results: Mean ages of the patients and their caregivers were 66.13±11.32 and 36.32±13.71 years respectively. Median score of Barthel index was 1.00 (interquartile range 0.00- 9.75). Mean M-CSI score was 17.31±5.04. There was significant negative correlation between Barthel Index and M-CSI (R=0.542, p<0.001). No significant association was found between duration of stroke and history of recurrent stroke with Barthel Index (p=0.399 and p=0.527 respectively). Conclusion: Greater the dependence of patients for activities of daily living on their caregivers, higher is the level of strain among the latter. There is dire requirement of social support and rehabilitation centers to address the physical and mental needs of both the patients and their care providers.
THE SHAPE AND SIZE OF SELLA TURCICA IN SKELETAL CLASS I, II, AND III MALOCCLUSIONS
Authors: Gulalai Jan  , Shahab Adil  , Kainat Zeb  , Omaima Alam  , Ghazala Wazir  , Ullah Wahid
Published: December 2024

Background: The Sella point, located near the center of the Sella Turcica and providing cover for the pituitary gland in the skull, is one of the most frequently used cranial cephalometric landmarks for radiograph tracing. The research aimed to quantify the dimensions and delineate the anatomy of the sella turcica across various skeletal shapes. Methods: 180 subjects, aged 9 to 27 years, including 91 men and 89 females, had lateral cephalometric radiographs. These subjects were divided into three skeleton classes: Class I, II, and III, with 60 subjects in each group. Measurements of the length, depth, and anteroposterior diameter were made, and the shape was examined using linear dimensions. The difference in linear dimensions was determined using a student t-test, and the link between sella turcica size and skeletal types was examined using a one-way analysis of variance (ANOVA). When comparing the age groups, the older group's linear dimensions were bigger than the younger group's (p < 0.01). Male and female length differences were found to be significantly different (p <0.05). The length and diameter of the skeletons differed significantly from the sella size when compared. Sixty-one percent of the individuals had normal-appearing sella turcica. Further research addressing the sella turcica in the South Indian population can use the current study's linear dimensions and form as reference standards.