bluuebunny/crossref_metadata_2025 huggingface dataset:
Does healthcare inequity reflect variations in peoples’ abilities to access healthcare? Results from a multi-jurisdictional interventional study in two high-income countries
Authors: Haggerty Jeannie , Levesque Jean-Frederic , Harris Mark , Scott Catherine , Dahrouge Simone , Lewis Virginia , Dionne Emilie , Stocks Nigel , Russell Grant
Published: September 2020

Background

Primary healthcare services must respond to the healthcare-seeking needs of persons with a wide range of personal and social characteristics. In this study, examined whether socially vulnerable persons exhibit lower abilities to access healthcare. First, we examined how personal and social characteristics are associated with the abilities to access healthcare described in the patient-centered accessibility framework and with the likelihood of reporting problematic access. We then examined whether higher abilities to access healthcare are protective against problematic access. Finally, we explored whether social vulnerabilities predict problematic access after accounting for abilities to access healthcare.

Methods

This is an exploratory analysis of pooled data collected in the Innovative Models Promoting Access-To-Care Transformation (IMPACT) study, a Canadian-Australian research program that aimed to improve access to primary healthcare for vulnerable populations. This specific analysis is based on 284 participants in four study regions who completed a baseline access survey. Hierarchical linear regression models were used to explore the effects of personal or social characteristics on the abilities to access care; logistic regression models, to determine the increased or decreased likelihood of problematic access.

Results

The likelihood of problematic access varies by personal and social characteristics. Those reporting at least two social vulnerabilities are more likely to experience all indicators of problematic access except hospitalizations. Perceived financial status and accumulated vulnerabilities were also associated with lower abilities to access care. Higher scores on abilities to access healthcare are protective against most indicators of problematic access except hospitalizations. Logistic regression models showed that ability to access is more predictive of problematic access than social vulnerability.

Conclusions

We showed that those at higher risk of social vulnerability are more likely to report problematic access and also have low scores on ability to seek, reach, pay, and engage with healthcare. Equity-oriented healthcare interventions should pay particular attention to enhancing people’s abilities to access care in addition to modifying organizational processes and structures that reinforce social systems of discrimination or exclusion.
Evaluating the impact of a small number of areas on spatial estimation
Authors: Aswi Aswi , Cramb Susanna , Duncan Earl , Mengersen Kerrie
Published: September 2020

Background

There is an expanding literature on different representations of spatial random effects for different types of spatial correlation structure within the conditional autoregressive class of priors for Bayesian spatial models. However, little is known about the impact of these different priors when the number of areas is small. This paper aimed to investigate this problem both in the context of a case study of spatial analysis of dengue fever and more generally through a simulation study.

Methods

Both the simulation study and the case study considered count data aggregated to a small area level in a region. Five different conditional autoregressive priors for a simple Bayesian Poisson model were considered: independent, Besag-York-Mollié, Leroux, and two variants of a localised clustering model. Data were simulated with eight different sizes of areal grids, ranging from 4 to 2500 areas, and two different levels of both spatial autocorrelation and disease counts. Model goodness-of-fit measures and model estimates were compared. A case study involving dengue fever cases in 14 local areas in Makassar, Indonesia, was also considered.

Results

The simulation study showed that model performance varied under different scenarios. When areas had low autocorrelation and high counts, and the number of areas was at most 25, the BYM, Leroux and localised$$G = 2$$G=2models performed similarly and better than the independent and localised$$G = 3$$G=3models. However, when the number of areas were at least 100, all models performed differently, and the Leroux model performed the best. Overall, the Leroux model performed the best for every scenario especially when there were at least 16 areas. Based on the case study, the comparative performance of spatial models may also vary for a small number of areas, especially when the data have a relatively large mean and variance over areas. In this case, the localised model withG = 3 was a better choice.

Conclusion

Detecting spatial patterns can be difficult when there are very few areas. Understanding the characteristics of the data and the relative influence of alternative conditional autoregressive priors is essential in selecting an appropriate Bayesian spatial model.
Mitochondrial donation in translational medicine; from imagination to reality
Authors: Bagheri Hesam Saghaei , Bani Farhad , Tasoglu Savas , Zarebkohan Amir , Rahbarghazi Reza , Sokullu Emel
Published: September 2020

The existence of active crosstalk between cells in a paracrine and juxtacrine manner dictates specific activity under physiological and pathological conditions. Upon juxtacrine interaction between the cells, various types of signaling molecules and organelles are regularly transmitted in response to changes in the microenvironment. To date, it has been well-established that numerous parallel cellular mechanisms participate in the mitochondrial transfer to modulate metabolic needs in the target cells. Since the conception of stem cells activity in the restoration of tissues’ function, it has been elucidated that these cells possess a unique capacity to deliver the mitochondrial package to the juxtaposed cells. The existence of mitochondrial donation potentiates the capacity of modulation in the distinct cells to achieve better therapeutic effects. This review article aims to scrutinize the current knowledge regarding the stem cell’s mitochondrial transfer capacity and their regenerative potential.
Implications for post critical illness trial design: sub-phenotyping trajectories of functional recovery among sepsis survivors
Authors: Puthucheary Zudin A. , Gensichen Jochen S. , Cakiroglu Aylin S. , Cashmore Richard , Edbrooke Lara , Heintze Christoph , Neumann Konrad , Wollersheim Tobias , Denehy Linda , Schmidt Konrad F. R.
Published: September 2020

Background

Patients who survive critical illness suffer from a significant physical disability. The impact of rehabilitation strategies on health-related quality of life is inconsistent, with population heterogeneity cited as one potential confounder. This secondary analysis aimed to (1) examine trajectories of functional recovery in critically ill patients to delineate sub-phenotypes and (2) to assess differences between these cohorts in both clinical characteristics and clinimetric properties of physical function assessment tools.

Methods

Two hundred ninety-one adult sepsis survivors were followed-up for 24 months by telephone interviews. Physical function was assessed using the Physical Component Score (PCS) of the Short Form-36 Questionnaire (SF-36) and Activities of Daily Living and the Extra Short Musculoskeletal Function Assessment (XSFMA-F/B). Longitudinal trajectories were clustered by factor analysis. Logistical regression analyses were applied to patient characteristics potentially determining cluster allocation. Responsiveness, floor and ceiling effects and concurrent validity were assessed within clusters.

Results

One hundred fifty-nine patients completed 24 months of follow-up, presenting overall low PCS scores. Two distinct sub-cohorts were identified, exhibiting complete recovery or persistent impairment. A third sub-cohort could not be classified into either trajectory. Age, education level and number of co-morbidities were independent determinants of poor recovery (AUROC 0.743 ((95%CI 0.659–0.826), p < 0.001). Those with complete recovery trajectories demonstrated high levels of ceiling effects in physical function (PF) (15%), role physical (RP) (45%) and body pain (BP) (57%) domains of the SF-36. Those with persistent impairment demonstrated high levels of floor effects in the same domains: PF (21%), RP (71%) and BP (12%). The PF domain demonstrated high responsiveness between ICU discharge and at 6 months and was predictive of a persistent impairment trajectory (AUROC 0.859 (95%CI 0.804–0.914), p < 0.001).

Conclusions

Within sepsis survivors, two distinct recovery trajectories of physical recovery were demonstrated. Older patients with more co-morbidities and lower educational achievements were more likely to have a persistent physical impairment trajectory.

In regard to trajectory prediction, the PF score of the SF-36 was more responsive than the PCS and could be considered for primary outcomes. Future trials should consider adaptive trial designs that can deal with non-responders or sub-cohort specific outcome measures more effectively.
Do we still need breast cancer screening in the era of targeted therapies and precision medicine?
Authors: Trimboli Rubina Manuela , Giorgi Rossi Paolo , Battisti Nicolò Matteo Luca , Cozzi Andrea , Magni Veronica , Zanardo Moreno , Sardanelli Francesco
Published: September 2020

Breast cancer (BC) is the most common female cancer and the second cause of death among women worldwide. The 5-year relative survival rate recently improved up to 90% due to increased population coverage and women’s attendance to organised mammography screening as well as to advances in therapies, especially systemic treatments. Screening attendance is associated with a mortality reduction of at least 30% and a 40% lower risk of advanced disease. The stage at diagnosis remains the strongest predictor of recurrences. Systemic treatments evolved dramatically over the last 20 years: aromatase inhibitors improved the treatment of early-stage luminal BC; targeted monoclonal antibodies changed the natural history of anti-human epidermal growth factor receptor 2-positive (HER2) disease; immunotherapy is currently investigated in patients with triple-negative BC; gene expression profiling is now used with the aim of personalising systemic treatments. In the era of precision medicine, it is a challenging task to define the relative contribution of early diagnosis by screening mammography and systemic treatments in determining BC survival. Estimated contributions before 2000 were 46% for screening and 54% for treatment advances and after 2000, 37% and 63%, respectively. A model showed that the 10-year recurrence rate would be 30% and 25% using respectively chemotherapy or novel treatments in the absence of screening, but would drop to 19% and 15% respectively if associated with mammography screening. Early detection per se has not a curative intent and systemic treatment has limited benefit on advanced stages. Both screening mammography and systemic therapies continue to positively contribute to BC prognosis.
Video-based interviewing in medicine: protocol for a scoping review
Authors: Selvam Rajajee , Hu Richard , Musselman Reilly , Raiche Isabelle , Moloo Husein
Published: September 2020

Background

Careers in healthcare involve an extensive interview process as transitions are made from one level of training to the next. For physicians, interviews mark the gateway from entrance into medical school, acceptance into residency, fellowships, and subsequent job opportunities. Previous literature outlining the costs associated with face-to-face interviews and concerns regarding the climate crisis has triggered an interest in video-based interviews. Barriers to transitioning away from in-person interviews include concerns regarding lack of rapport between applicants and interviewers, and applicants being less able to represent themselves. In a new era ushered in by COVID where many of us have utilized virtual meetings more than any prior time both personally and for work, we wanted to consolidate the current literature on the use of video-based interviews in healthcare and summarize the findings.

Methods

A scoping review will be conducted to explore the benefits and limitations of video-based interviews for both applicants and interviewers within healthcare fields, as well as the perceived barriers associated with transitioning away from face-to-face interviews. The scoping review methodology outlined by Arksey and O’Malley will be implemented. The search strategy developed by the authors in collaboration with an academic health sciences librarian will be conducted across four electronic databases (Embase, MEDLINE, Cochrane Central, and PsycInfo) and supplemented by a review of the grey literature and reference lists of included studies. The study selection process will be documented using the PRISMA flow diagram, and reasons for exclusion following full-text review will be recorded. The extracted data will be analyzed using quantitative and qualitative analysis.

Discussion

Despite previous literature on the costs associated with face-to-face interviews, there has been hesitancy with transitioning to video-based interviews due to concerns of lack of rapport between applicants and interviewers, and applicants being less able to represent themselves. While these limitations have been explored in previous studies, a succinct review of the current literature to guide the effective restructuring of the interview process is lacking. With our scoping review, we hope to fill this gap in the literature to better understand barriers to transitioning from face-to-face interviews and directions for future research.
Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review
Authors: Rios Patricia , Radhakrishnan Amruta , Williams Chantal , Ramkissoon Naveeta , Pham Ba’ , Cormack Gordon V. , Grossman Maura R. , Muller Matthew P. , Straus Sharon E. , Tricco Andrea C.
Published: September 2020

Background

The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF).

Methods

EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning® (CAL®). All search results were processed using CAL® to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second.

Results

Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff.

Conclusions

Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors.

Systematic review registration

PROSPERO CRD42020181993
On the fractional partial integro-differential equations of mixed type with non-instantaneous impulses
Authors: Zhu Bo , Han Baoyan , Liu Lishan , Yu Wenguang
Published: September 2020

In this paper, we consider the initial boundary value problem for a class of nonlinear fractional partial integro-differential equations of mixed type with non-instantaneous impulses in Banach spaces. Sufficient conditions of existence and uniqueness of PC-mild solutions for the equations are obtained via general Banach contraction mapping principle, Krasnoselskii’s fixed point theorem, andα-order solution operator.
A numerical solution by alternative Legendre polynomials on a model for novel coronavirus (COVID-19)
Authors: Hashemizadeh Elham , Ebadi Mohammad Ali
Published: September 2020

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. This paper provides a numerical solution for the mathematical model of the novel coronavirus by the application of alternative Legendre polynomials to find the transmissibility of COVID-19. The mathematical model of the present problem is a system of differential equations. The goal is to convert this system to an algebraic system by use of the useful property of alternative Legendre polynomials and collocation method that can be solved easily. We compare the results of this method with those of the Runge–Kutta method to show the efficiency of the proposed method.
Spatiotemporal variability and trends in rainfall and temperature in Alwero watershed, western Ethiopia
Authors: Alemayehu Arragaw , Maru Molla , Bewket Woldeamlak , Assen Mohammed
Published: September 2020

Climate analysis at relevant time scales is important for water resources management, agricultural planning, flood risk assessment, ecological modeling and climate change adaptation. This study analyses spatiotemporal variability and trends in rainfall and temperature in Alwero watershed, western Ethiopia. Our analysis is focused on describing spatial and temporal variability of rainfall in the study area including detection of trends, with no attempt at providing meteorological explanations to any of the patterns or trends. The study is based on gridded monthly rainfall and maximum and minimum temperature data series at a resolution of 4 × 4 km which were obtained from the National Meteorological Agency of Ethiopia for the period 1983–2016. The study area is represented by 558 points (each point representing 4 × 4 km area). Mean annual rainfall of the watershed is > 1600 mm. Annual, June–September (Kiremt), March–May (Belg) rainfall totals exhibit low inter-annual variability. Annual and October-February (Bega) rainfalls show statistically significant increasing trends at p = 0.01 level. May and November rainfall show statistically significant increasing trends at p = 0.01 level. March shows statistically significant decreasing trend at p = 0.1 level. The mean annual temperature of the watershed is 25 °C with standard deviation of 0.31 °C and coefficient of variation of 0.01 °C. Mean annual minimum and maximum temperatures show statistically non-significant decreasing trends. Bega season experienced statistically significant deceasing trend in the maximum temperature at p = 0.01 level. The year-to-year variability in the mean annual minimum and maximum temperatures showed that the 2000s is cooler than the preceding decades. Unlike our expectations, annual and seasonal rainfall totals showed increasing trends while maximum and minimum temperatures showed decreasing trends. Our results suggest that local level investigations such as this one are important in developing context-specific climate change adaptation and agricultural planning, instead of coarse-scale national level analysis guiding local level decisions.
Ramp lesions: a systematic review of MRI diagnostic accuracy and treatment efficacy
Authors: Moreira José , Almeida Margarida , Lunet Nuno , Gutierres Manuel
Published: September 2020

Purpose

We conducted a systematic review of the published literature to assess the accuracy of Magnetic Resonance Imaging (MRI) in establishing the presence of ramp lesions (RLs) in Anterior Cruciate Ligament (ACL) deficient knees and the clinical efficacy of the surgical repair of RLs.

Methods

A comprehensive search of the MEDLINE, Web of Science and Scopus databases was performed according to PRISMA guidelines. Studies assessing MRI diagnostic accuracy for RLs or the clinical effect of RL repair in participants with ACL injuries were included. Diagnostic accuracy measures were pooled and plotted in forest plots. Preoperative and at last follow-up treatment efficacy outcome measures were extracted and plotted in forest plots, for graphical comprehension.

Results

Sixteen studies met the criteria and were included. The diagnostic analysis showed a pooled sensitivity, specificity, positive and negative likelihood ratios of 65.1% (95% CI, 59.73 to 70.42), 91.6% (95% CI, 89.14 to 94.05), 2.91 (95% CI, 2.38–3.55) and 0.53 (95% CI, 0.44–0.64), respectively, with high heterogeneity (I2 above 80%) for all measures. Treatment analysis showed improved Lysholm Knee Score, IKDC score and laxity difference between the knees in all studies after meniscal suture repair. A separate analysis showed no differences between repair of smaller, stable, RLs with meniscal sutures and repair with abrasion and trephination only.

Conclusion

Although the results present considerable heterogeneity, MRI seems to demonstrate moderate accuracy in the diagnosis of RLs in patients with ACL tear and the surgical repair of RLs can be associated with improved overall outcomes.
Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant
Authors: Goldsmith Ira , Evans Peter Llewelyn , Goodrum Heather , Warbrick-Smith James , Bragg Thomas
Published: September 2020

Background

Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant.

Method

To design the implant manual bone threshold segmentation was performed to create a 3-D virtual model of the patient’s chest and the tumor from sub-millimeter slice computed tomography (CT) scan data. We estimated the extent of resection needed to ensure tumor-free margins by growing the tumor by two cm all around.. We designed the implant using an anatomical image of the ribs and right hemi-sternum and then fabricated a 3D model of them in titanium metal using TiMG 1 powder bed fusion technology. At surgery the implant was slotted into the defect and sutured to the ribs laterally and hemi-sternum medially.

Results

Histology confirmed clear all around microscopic margins. Following surgery and at 18 month follow up the patient was asymptomatic with preserved quality of life and described no pain, localized tenderness or breathlessness. There was no displacement or paradoxical movement of the implant.

Conclusion

Our techniques of CT segmentation, editing, computer aided design of the implant and fabrication using laser printing of a custom-made anatomical titanium alloy chest wall ribs and hemi-sternum for reconstruction is feasible, safe and provides a satisfactory result. Hence, a patient specific 3-D printed titanium chest wall implant is another useful adjunct to the surgical approach for reconstructing large chest wall defects whilst preserving the anatomical shape, structure and function of the thorax.
Contagion of the World
Authors: Prigozhin Aleksandr
Published: September 2020

This essay demonstrates the centrality of impersonal intimacy to Virginia Woolf’s modernist poetics. In contrast to the major forms of intimacy—marriage, friendship, and family—the “minor” intimacies to which Woolf attends generate a sense of significant relation with a proximate other without the backing of intersubjectivity or of established social form. Focusing on The Voyage Out (1915), “An Unwritten Novel” (1917), and “Mr. Bennett and Mrs. Brown” (1924), the essay highlights minor intimacy as an alternative to the given forms both of intimacy itself and of realistic fiction. Drawing on contemporary critiques of intimacy by Lauren Berlant and Leo Bersani, I argue that sociality in Woolf’s writing is an unhealing scar, a problem of subject-world relation that necessarily persists, but that in doing so, stimulates Woolf’s formal inventiveness. Registering impersonal affective transmission through innovative literary form, Woolf frees her narratives to propose alternative modes of relation.
Zebrafish Nedd8 facilitates ovarian development and the maintenance of female secondary sexual characteristics via suppression of androgen receptor activity
Authors: Yu Guangqing , Liu Xing , Zhang Dawei , Wang Jing , Ouyang Gang , Chen Zhu , Xiao Wuhan
Published: September 2020

Nedd8 is a ubiquitin-like protein that covalently conjugates to target proteins through neddylation. In addition to cullin-RING ligases, neddylation also modifies non-cullin proteins to regulate protein activity, stability and localization. However, the roles of NEDD8 remain largely unknown in vivo. Here, we found that loss of nedd8 in female zebrafish led to defects in oogenesis, disrupted oocyte maturation and stimulated growth of the breeding tubercles (BTs) on the pectoral fins. The BTs are normally present in males, not females. However, the loss of one copy of ar can partially rescue the phenotypes displayed by nedd8-null female zebrafish. Further assays indicated that Nedd8 conjugates to Ar and Ar is neddylated at lysine 475 and lysine 862. Moreover, Nedd8 conjugation efficiently suppressed Ar transcriptional activity. Lysine 862 (K862) of Ar is the key site modified by neddylation to modulate Ar transcriptional activity. Thus, our results not only demonstrated that Nedd8 modulates ovarian maturation and the maintenance of female secondary sexual characteristics of female zebrafish in vivo, but also indicated that androgen signaling is strictly regulated by nedd8.
Do small precocial birds enter torpor to conserve energy during development?
Authors: Aharon-Rotman Yaara , Körtner Gerhard , Wacker Chris B. , Geiser Fritz
Published: September 2020

Precocial birds hatch feathered and mobile, but when they become fully endothermic soon after hatching, their heat loss is high and they may become energy-depleted. These chicks could benefit from using energy-conserving torpor, which is characterised by controlled reductions of metabolism and body temperature (Tb). We investigated at what age the precocial king quail Cortunix chinensis can defend a high Tb under a mild thermal challenge and whether they can express torpor soon after achieving endothermy to overcome energetic and thermal challenges. Measurements of surface temperature (Ts) using an infrared thermometer showed that king quail chicks are partially endothermic at 2–10 days, but can defend high Tb at a body mass of ∼13 g. Two chicks expressed shallow nocturnal torpor at 14 and 17 days for 4 to 5 hours with a reduction of metabolism by>40% and one approached torpor threshold. Although chicks were able to rewarm endogenously from the first torpor bout, metabolism and Ts decreased again by the end of the night, but they rewarmed passively when removed from the chamber. The total metabolic rate increased with body mass. All chicks measured showed a greater reduction of nocturnal metabolism than previously reported in quails. Our data show that shallow torpor can be expressed during the early postnatal phase of quails, when thermoregulatory efficiency is still developing, but heat loss is high. We suggest that torpor may be a common strategy for overcoming challenging conditions during the development in small precocial and not only altricial birds.
Prostaglandin catabolism in Spodoptera exigua, a lepidopteran insect
Authors: Ahmed Shabbir , Kim Yonggyun
Published: September 2020

Several prostaglandins (PGs) and PG-synthesizing enzymes have been identified from insects. PGs mediate cellular and humoral immune responses. However, uncontrolled and prolonged immune responses might have adverse effects on survival. PG catabolism in insects has not been reported. Here, using a transcriptomic analysis, we predicted two PG-degrading enzymes, PG dehydrogenase (SePGDH) and PG reductase (SePGR), in Spodoptera exigua, a lepidopteran insect. SePGDH and SePGR expression levels were upregulated after immune challenge. However, their expression peaks occurred after those of PG biosynthesis genes such as PGE2 synthase or PGD2 synthase. SePGDH and SePGR expression levels were upregulated after injection with PGE2 or PGD2. In contrast, such upregulated expression was not detected after injection with leukotriene B4, an eicosanoid inflammatory mediator. RNA interference (RNAi) using double-stranded RNAs specific to SePGDH or SePGR suppressed their expression levels. The RNAi treatment resulted in an excessive and fatal melanization of larvae even after a non-pathogenic bacterial infection. Phenoloxidase (PO) activity mediating the melanization in larval plasma was induced by bacterial challenge or PGE2 injection. Although the induced PO activity decreased after 8 h in control, larvae treated with dsRNAs specific to PG-degrading enzyme genes kept the high PO activities for a longer period compared to control larvae. These results suggest that SePGDH and SePGR are responsible for PG degradation at a late phase of immune responses.
Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
Authors: Ren Ming-Han , Qi Xing-Si , Chu Yu-Ning , Yu Ya-Nan , Chen Yun-Qing , Zhang Peng , Mao Tao , Tian Zi-Bin
Published: September 2020

Background

When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration.

Patients and Methods

We retrospectively reviewed data from 691 patients who underwent gastrectomy for EGC with ulceration. Subsequently, a stratification system for lesions was created based on the expanded ESD criteria, and the associations between the subgroups and the rate of LNM were analyzed.

Results

LNM was confirmed in 16.5% (114/691) of patients. Univariate analysis demonstrated that age, sex, tumor size, macroscopic features, depth of invasion, tumor differentiation, Lauren type, lymphovascular invasion (LVI), and perineural invasion were associated with LNM. Multivariate analysis showed that LVI [odds ratio (OR) = 16.761, P < 0.001], SM1 invasion (OR = 2.159, P = 0.028), and SM2 invasion (OR = 3.230, P < 0.001) were independent risk factors for LNM. LNM occurred in undifferentiated mucosal tumors, with ulceration being 1.7% (2/116) when the lesion was smaller than 20 mm. Further stratification revealed that among lesions < 30 mm in size, undifferentiated tumors with SM1 invasion had a higher rate of LNM and a lower disease-free survival rate than differentiated tumors with SM1 invasion and tumors limited to the mucosal layer.

Conclusions

Depth of invasion and LVI were strongly associated with LNM in ulcerative EGC. Endoscopic resection may be applicable for undifferentiated mucosal ulcerative EGC < 30 mm in size, and additional investigation is needed to evaluate its safety.
Budesonide/Fomoterol in combination with Montelukast in the treatment of Bronchial Asthma
Authors: Dai Xiaoxia , Feng Tao , Zhang Xuejuan , Li Kaishu
Published: September 2020

Objective: To analyze the clinical effect of budesonide/fomoterol combined with montelukast in the treatment of chronic persistent asthma.

Methods: Ninety-four patients with asthma who came to our hospital for treatment from April 2017 to April 2019 were randomly divided into control group and observation group, with 47 patients in each group. The control group was treated with budesonide/formoterol, and the observation group was treated with montelukast on the basis of the control group. The treatment effect of the two groups was observed and compared.

Results: The total efficacy rate of the observation group was significantly higher than that of the control group (P<0.05); the daytime symptom score and nighttime symptom score of the observation group were significantly higher than those of the control group (P<0.05). The pulmonary function indexes of the two groups after treatment were significantly higher than that before treatment, and the improvement of the observation group was more significant (P<0.05); the FeNO and EO levels of the observation group after treatment were superior to those of the control group, and the difference was statistically significant (P<0.05).

Conclusion: Budesonide/formoterol powder inhalation combined with montelukast can effectively improve the lung function, reduce the level of inflammatory factors, and accelerate the regression of symptoms in the treatment of chronic persistent asthma. It is worth clinical application.

doi: https://doi.org/10.12669/pjms.36.7.2018

How to cite this:Dai X, Feng T, Zhang X, Li K. Budesonide/Fomoterol in combination with Montelukast in the treatment of Bronchial Asthma. Pak J Med Sci. 2020;36(7):1688-1692. doi: https://doi.org/10.12669/pjms.36.7.2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
An epidemiological study of prevalence and comorbidity of non-clinical Dyslexia, Dysgraphia and Dyscalculia symptoms in Public and Private Schools of Pakistan
Authors: Ashraf Farzana , Najam Najma
Published: September 2020

Objective: Dealing with Dyslexia, Dysgraphia and Dyscalculia symptoms is a major challenge for teachers and school psychologists while addressing students’ issues. The present study was designed to examine the prevalence and comorbidity of specific learning disabilities (SLD) symptoms such as dyslexia, dysgraphia and dyscalculia in public and private schools of Lahore, Pakistan.

Methods: This cross-sectional study was conducted in four schools of Lahore from June, 2019 to December 2019. We examined 666 participants (boys= 384, girls= 282) from two public (n=409) and two private (n=257) schools of Lahore with a mean age of 13 years (SD±1.44). Participants were assessed on Learning Disabilities Checklist (LDC) along with a demographic sheet. The data were analyzed by using descriptive statistics (frequencies and percentages) and inferential analyses of Chi Square test of association and Cohen’s Kappa by using SPSS version 24.

Results: Findings indicated that 39% participants showed SLD symptoms, 33% dyslexia, 48% dysgraphia and 45% dyscalculia symptoms. Significant co-morbidities were seen, such as 30% for dyslexia and dysgraphia symptoms, dyslexia and dyscalculia 26% and dysgraphia and dyscalculia as 36%. Variations in SLD, dyslexia, dysgraphia and dyscalculia symptoms were also seen across gender and schools with significant higher prevalence in public schools.

Conclusion: High prevalence of SLD symptoms and comorbidity in students was found which is alarming, particularly in public sector schools in Pakistan. SLD and dyslexia were higher for boys, whereas girls scored high on dysgraphia and dyscalculia. Therefore, there is great need of introducing screening measure of assessment of SLD and management strategies to deal with these issues.

doi: https://doi.org/10.12669/pjms.36.7.2486

How to cite this:Ashraf F, Najam N. An epidemiological study of prevalence and comorbidity of non-clinical Dyslexia, Dysgraphia and Dyscalculia symptoms in Public and Private Schools of Pakistan. Pak J Med Sci. 2020;36(7):1659-1663. doi: https://doi.org/10.12669/pjms.36.7.2486

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Subjective quality of multiple choice questions used in undergraduate courses in orthopedics and other specialties
Authors: Husnain Amina , Khan Asif , Khan Mohammad Umer , Hussain Faisal Nazeer
Published: September 2020

Background and Objective: Multiple Choice Questions (MCQs) can sample broad domains of knowledge efficiently and reliably. The MCQs of lower order C1(Cognitive Level1=Recall of knowledge) do not fulfill this purpose and those of higher cognitive order C2 (Cognitive Level2=Interpret) &C3(Cognitive Level3=Analyze) are better at assessing the problem solving capabilities of the student. Every good educational activity must be supported by quality examination to complete the objectives of a curriculum. The objective of the study was to evaluate MCQs presently being used in internal examinations of medical colleges in Lahore.

Methods: Papers consisting of MCQs from Orthopedics other specialties were collected in June 2019 from different medical colleges of Lahore and reviewed by a senior medical teacher without blinding and without his knowing the scores the students had been awarded before. Question statement, clinical scenarios, options and other mistakes were assessed in each item on predetermined criteria. Cognitive level of the item was determined if it was asking for a recall/identify/ analyze response. The results were tabulated and compared in two groups i.e. Miscellaneous and Orthopedics.

Results: Most of the items(total=589) in both groups were of C1 cognitive level though Orthopedics (229) were slightly better (χ2 = 49.882 P-Value = 0.000 (Statistically Significant). Miscellaneous group (360) was better in quality in making clinical scenarios (χ2 = 29.952 P-Value = 0.000 (Statistically Significant) and writing a question statement without confusion. Options were better written in both groups. A good percentage of items needed to be corrected for mistakes in spellings, grammar and segregation into under graduate level.

Conclusions: The cognitive level of assessment tool s MCQs is quiet low in both groups especially clinical scenario construction can be improved. Mistakes in spellings, grammar and conceptual mediocrity is common in both groups.

doi: https://doi.org/10.12669/pjms.36.7.2864

How to cite this:Husnain A, Khan A, Khan MU, Hussain FN. Subjective quality of multiple choice questions used in undergraduate courses in orthopedics and other specialties. Pak J Med Sci. 2020;36(7):1618-1622. doi: https://doi.org/10.12669/pjms.36.7.2864

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Assessment of episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age
Authors: Bham Shireen Qassim , Saeed Farhan , Khan Muhammad Athar , Khan Rashid Naseem
Published: September 2020

Objective: To assess the episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age.

Methods: This descriptive cross-sectional study was carried out at Darul Sehat Hospital and SESSI, Karachi in the Department of Pediatrics from 1st November 2018 to 3rd February 2019. An interview based questionnaire was administered and selection of participants was done by convenience sampling. Total of 196 participants were selected for interview.

Results: Total 196 participants were interviewed which included mothers of children between the age group of 1- 60 months. The questions were entered on the questionnaire after taking consent from the mothers. Among them, males were 98 (52.7%) and females were 88(47.3%). One hundred seventy two (88.7%) children were vaccinated for pneumococcal and rotavirus whereas unvaccinated children were 22(11.3%). There was an incidence of 66(63.5%) for loose watery diarrhea. In vaccinated children, grading of diarrhea was found to be severe cases as 30 (34.9%), moderate cases as 27 (31.4%) and mild cases as 29(33.7%). For unvaccinated children, severe cases were 12 (66.7%) and for mild and moderate cases were (11.1%) and 04(22.2%) respectively with p value of 0.035. As compared to their unvaccinated counterparts, the frequency of severe pneumonia was far less than cough and cold in vaccinated children (p<0.001)

Conclusion: There is significant reduction in cases of severe pneumonia in children receiving pneumococcal vaccine as compared to children receiving Rota vaccine there is moderate reduction in cases of severe diarrhea. The overall coverage of Pneumococcal and Rota vaccines was higher in our sample population. Efforts should be made to increase the awareness of Rotavirus vaccination in order to have better coverage in future.

doi: https://doi.org/10.12669/pjms.36.7.2996

How to cite this:Bham SQ, Saeed F, Khan MA, Khan RN. Assessment of episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age. Pak J Med Sci. 2020;36(7):1596-1600. doi: https://doi.org/10.12669/pjms.36.7.2996

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Pakistani Student Nurses’ perceptions of their hospital’s health professionals’ attitudes and suggested ways to improve patient care – An untainted view
Authors: Safdar Sachal Aqeel , Zafar Humaira , Ahmad Jawwad , Qayyum Rashid , Nasim Sajid , Safdar Chaudhry Aqeel
Published: September 2020

Background & Objectives: Feedback brings a fresh perspective and improvement in any organization. Health professionals (HPs) lose insight of the gaps in medical care. The views of student nurses can help improve systems. The objective of this study was to assess the views of our student nurses and how they perceive the way the doctors and HPs work in our hospital and comment on training, attitudes, care pathways, teamwork, and what needed to be improved.

Methods: A proforma based qualitative study was carried out at the Nurses’ Training Centre of PAF Hospital and Fazaia Medical College, Islamabad, from January to March 2020. After approval, a semi-structured proforma with open and closed ended questions was administered, in English and Urdu. The results were analyzed by comparative numbers and percentages for each question and descriptive responses were grouped in recurring themes and analyzed for content and their constructive value.

Results: Out of 85 nursing cadets, the proforma could be administered to 61(M=38(62.3%) and F=23(37.7%). Most were FSc with 26% graduates. Majority of the female students’ main reason for joining was to serve humanity, unlike most males. According to gender many responses were interestingly different. Majority of females thought male doctors were better (86%). Only 36% said the doctors were sincere in care of patients. Most thought that we needed to improve patient counseling. Most thought the seniors treated them unfairly, but bullying was negligible. They wanted the senior HPs to improve their attitudes and ensure adequate equipment in the wards. They were worried about personal security from patients and relatives. Dedicated mental health services to deal with stress of witnessing every day misery and death was suggested.

Conclusions: Doctors need to improve their counseling skills and should talk more to the patients and their relatives. They should acknowledge the nursing students and improve teamwork. Belittling them in front of others harms their self-efficacy. Simple corrections like punctuality, ownership of their patients and improvement of equipment and systems can improve patient care.

doi: https://doi.org/10.12669/pjms.36.7.3110

How to cite this:Safdar SA, Zafar H, Ahmad J, Qayyum R, Naseem S, Safdar CA. Pakistani Student Nurses’ perceptions of their hospital’s health professionals’ attitudes and suggested ways to improve patient care – An untainted view. Pak J Med Sci. 2020;36(7):1671-1677.  doi: https://doi.org/10.12669/pjms.36.7.3110

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Prevalence & features of inner ear malformations among children with congenital sensorineural hearing loss: A Public Cochlear Implant Centre Experience
Authors: Ahmed Jawwad , Saqulain Ghulam , Khan Muhammad Iqbal javed , Kausar Mobeen
Published: September 2020

Objective: To determine the prevalence and features of inner ear anomalies in children with congenital profound hearing loss who presented at our cochlear implant center based on imaging studies.

Methods: This retrospective study reviewed charts of children with congenital SNHL, who presented to Department of Otolaryngology & Auditory Implant Centre, Capital Hospital Islamabad over a period of 2 years from 1st May 2017 to 30th April 2019. These included 481 cases of both genders aged between 1 to 12 years. After gathering demographic data, audiological data, computed tomography findings of the temporal bone were analyzed. Data was analyzed using SPSS 22.

Results: The Inner Ear Malformations were identified in 48(10%) children including 28 (58.33%) males and 20 (41.67%) female. Most 20(41.67%) presented at >3-5 years of age followed by 19(39.58%) at 2-3 years. However, no significant association of gender (p=0.57, p=0.076) and age of presentation (p=0.344, p=0.697) for right and left ears was noted with inner ear malformations. The most common anomaly noted were CLA, CH-III and CH-II in decreasing order of frequency in both ears.

Conclusion: The prevalence of IEM’s was found to be 48(10%). Commonest anomalies noted were CLA, CH-III and CH-II. No significant association of gender and age of presentation was noted with type of anomaly in both ears.

doi: https://doi.org/10.12669/pjms.36.7.3134

How to cite this:Ahmed J, Saqulain G, Khan MIJ, Kausar M. Prevalence & features of inner ear malformations among children with congenital sensorineural hearing loss: A Public Cochlear Implant Centre Experience . Pak J Med Sci. 2020;36(7):1511-1516.  doi: https://doi.org/10.12669/pjms.36.7.3134

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Another generalization of the bivariate FGM distribution with two-dimensional extensions
Authors: Cuadras Carles M. , Díaz Walter
Published: September 2020

The Farlie–Gumbel–Morgenstern family of bivariate distributions with given marginals is frequently used in theory and applications and has been generalized in many ways. With the help of two auxiliary distributions, we propose another generalization and study its properties. After defining the dimension of a distribution as the cardinal of the set of canonical correlations, we prove that some well-known distributions are practically two-dimensional. Then we introduce an extended FGM family in two dimensions and study how to approximate any distribution to this family.
Sharp theorems on multipliers in harmonic function spaces in higher dimension
Authors: Arsenović Miloš , Shamoyan Romi F.
Published: September 2020

Abstract is available in the PDF file.