Non-invasive prenatal screening provides a risk assessment for aneuploidies by utilizing cell-free DNA (cfDNA). It is recommended that cell-free DNA screening (cfDNA screening) be offered to all ...pregnant people regardless of a priori risk for aneuploidy. In the absence of an increased risk, alternative motives for electing cfDNA screening and different levels of informed decision making may arise. Therefore, our study aimed to characterize low-risk patients' motivations for cfDNA screening election, determine how often informed decisions are being made, and compare motivations between informed and uninformed decision makers. A survey that included a modified, validated measure of informed choice (MMIC) and questions to assess patients' motivations for cfDNA screening was offered at four MFM clinics following genetic counseling. It was found that 44% of participants (n = 100) made an uninformed decision about testing. Participants with private insurers were 4.25 times more likely to make an informed decision (95% CI = 1.10-16.37). Informed decision makers scored avoiding invasive procedures higher (p = 0.007) and ranked doing what family/friends desire lower (p = 0.005) than uninformed decision makers. While most participants scored receiving information about genetic conditions highest, 12% of participants reported fetal sex disclosure as a priority. However, this was not found to be associated with uninformed decision making. This study ultimately established that following genetic counseling, a low-risk population shared motivations with high-risk populations which highlights the importance of complete pre-test counseling for all. Future research should investigate the effect of modifying variables, such as socioeconomic status, on the performance of informed choice measures and critically evaluate the parameters that determine informed choice.
Guidelines advocate that patients being considered for thoracic surgery should undergo a comprehensive preoperative risk assessment. Multiple risk prediction models to estimate the risk of mortality ...after thoracic surgery have been developed, but their quality and performance has not been reviewed in a systematic way. The objective was to systematically review these models and critically appraise their performance.
The Cochrane Library and the MEDLINE database were searched for articles published between 1990 and 2019. Studies that developed or validated a model predicting perioperative mortality after thoracic surgery were included. Data were extracted based on the checklist for critical appraisal and data extraction for systematic reviews of prediction modelling studies.
A total of 31 studies describing 22 different risk prediction models were identified. There were 20 models developed specifically for thoracic surgery with two developed in other surgical specialties. A total of 57 different predictors were included across the identified models. Age, sex and pneumonectomy were the most frequently included predictors in 19, 13 and 11 models, respectively. Model performance based on either discrimination or calibration was inadequate for all externally validated models. The most recent data included in validation studies were from 2018. Risk of bias (assessed using Prediction model Risk Of Bias ASsessment Tool) was high for all except two models.
Despite multiple risk prediction models being developed to predict perioperative mortality after thoracic surgery, none could be described as appropriate for contemporary thoracic surgery. Contemporary validation of available models or new model development is required to ensure that appropriate estimates of operative risk are available for contemporary thoracic surgical practice.
Brucellosis is an important zoonotic disease of animals and humans caused by bacteria of the genus
. Brucellae are Gram-negative intracellular bacteria which infect a wide variety of animals ...including goats, sheep, buffaloes, cows, pigs, and wildlife. The objectives of this study were to determine the seroprevalence and spatial distribution of brucellosis in Central Punjab, Pakistan. A total of 1083 blood samples of goats, sheep, buffaloes, and cows were collected from 38 villages of four districts (Kasur, Faisalabad, Lahore, and Okara) of Punjab, Pakistan, and screened for brucellosis by Rose Bengal Plate test (RBPT) and PCR confirmed. Epidemiological, demographic data and GPS coordinates for every sample were collected. By using interpolation of the Aeronautical Reconnaissance Coverage Geographic Information System (Arc GIS), a surface plot was generated applying inverse distance weight (IDW). It was found that 35 (3.23%) serum samples were positive for brucellosis. In eight (61.5%), six (75%), seven (87.5%), and eight (89%) villages, positive goats, sheep, buffaloes, and cattle were detected, respectively. In general, older animals are more often positive for brucellosis. In goats bucks were more often RBPT positive than females while in sheep, buffaloes, and cattle more females were positive. The spatial distribution of brucellosis shows that it is widely distributed in the western region of the study area in goats and in the South-West region in sheep. Similarly, for buffaloes it is restricted to the south-east and north-west regions, and in cattle brucellosis is present in western region of study area only. Reflected by this study, brucellosis poses a risk for livestock in developing countries due to lack of awareness by officials, owners, and consumers, and control measures are missing. A risk map of brucellosis was generated to develop effective strategies for awareness rising and to improve the quality of control programs in Pakistan.
Mushrooms have been an indispensable element of the human culture since antiquity and are cherished all over the globe for their nutritive and therapeutic benefits. Being acknowledged as “the new ...superfood” of the future, they are a cardinal component of human diet for boosting health status and well being. Mushrooms are endowed with antioxidant, antimicrobial, anticancer, prebiotic, antidiabetic, and anti-inflammatory activities, upholding a great therapeutic potential and a huge spectrum of clinical applications. The wide ranges of bioactive compounds including polysaccharides, polysaccharides protein complexes, peptides and proteins, terpenoids and phenolic compounds have been reported from diverse groups of mushroom. Laden with a wealth of nutrients and innumerable biomolecules of therapeutic worth, they are internationally appreciated and envisaged as world's largest untapped resources of dietary supplements. In the recent years, owing to significant healthier lifestyle changes, dietary practices of people and consumers opting for immunity enhancing supplements especially during the COVID-19 pandemic, the yearning for mushroom based nutraceuticals and functional foods is on rise. This review gives comprehensive details on the biodiversity of mushrooms, its nutritional and medicinal importance, secondary metabolites especially of nutraceuticals and pharmaceutical potential, and their role as bioactive agents and application in preparing mushroom based value-added products.
Using evolutionary perspective of gossip and knowledge-based view, the study proposes knowledge sharing behaviour as the underlying mechanism that helps in establishing the relationship between ...positive workplace gossip and success of IT projects. The study used multi-source and multi-layered data collection technique; data were collected from 304 employees working in information technology (IT) projects within Pakistan. The study used peer reports for knowledge sharing behaviour, while gossip and project success were self-reported. Results of the study show that positive workplace gossip has a positive relation with project success. The study also found support of partial mediation of knowledge sharing behaviour between positive workplace gossip and project success. These results have crucial implications for policy makers and project managers of IT projects. The findings reveal the importance of informal social networks of project team members towards project success. Managers shall device such mechanisms that allow for propagation of informal networks and knowledge sharing. Keywords Critical Success Factors, Information Technology Projects, Knowledge Sharing Behaviour, Positive Workplace Gossip, Project Success.
To estimate the out-of-pocket payment on routine management of type 2 diabetes in patients attending a public-sector facility.
The cross-sectional study was conducted from December 2016 to May 2017 ...at Jinnah Postgraduate Medical Centre, Karachi, and comprised of persons with type 2 diabeties. A pretested questionnaire was administered to collect data from the patients. Comparisons of average out-of-pocket expenditure were done across different groups on the basis of gender, education, monthly income and duration of disease. SPSS 20 was used for data analysis.
Of the 336 subjects, 178(53%) were males and 158(47%) were females. Overall mean age was 52.20+/-12.64 years, and 170(50.6%) were illiterate. The monthly mean cost on diabetes care was PKR2227}2217.70. People with academic level matriculation or higher spent more on the disease (p<0.001). Expenditure increased with the increase in number of years of disease (p<0.001). Participants with income of less than PKR15000 spent higher percentage of their income compared to the participants earning more (p<0.001).
High out-of-pocket expenditure was incurred by people with diabeties. The coverage of social security nets and individual insurance should be broadened to help improve diabetes management.
As one of the most important intervals in Earth life evolution, the latest Permian to earliest Triassic witnessed the greatest mass extinction and most profound recovery of marine biotas. In this ...period, gondolellid conodonts went through a major faunal turnover and morphologic change marked by platform reduction during the late Griesbachian to Dienerian. However, the details of this morphologic change process remain poorly known. The resultant Dienerian segminate conodonts also display remarkable morphologic variations related to growth, which has caused a great deal of confusion in taxonomy. Ontogenetic and phylogenetic studies are believed to be essential in understanding the developmental process and evolution of organisms and thus will be helpful for improving taxonomic definitions and revealing temporal changes of morphology. Here, based on abundant and well-preserved specimens from the Salt Range and Surghar Range of northwestern Pakistan, we described in detail the morphologic variants and reconstructed the ontogenetic series for seven stratigraphically important Griesbachian-Dienerian conodonts belonging to Clarkina, Neoclarkina, Neospathodus, and Sweetospathodus. A further Dienerian key species Eurygnathodus costatus is also included in discussion based on the work of Lyu et al. (2020). The phylogenetic relationships among these taxa were reconstructed by means of cladistic approach. Some important evolutionary trends were recognized. Morphometric data including element length, platform width and denticle number were collected based on global occurrences and were plotted to illustrate the ontogenetic trajectory. Comparisons of ontogenetic trajectories revealed complex heterochronic patterns for platform growth. The reduction of platform may result from progenesis and neoteny in late Griesbachian Neoclarkina species and further from postdisplacement of the flange in Dienerian segminate conodonts. The Dienerian Neospathodus lineage may represent a paedomorphosis of the flange, whereas the lineage of Sw. kummeli–Eu. costatus was probably characterized by a peramorphosis of the platform through acceleration.
•Taxonomic definitions are improved based on reconstructed ontogenesis for Griesbachian-Dienerian key conodonts•Phylogenetic relationships are proposed for these key conodonts based on cladistic approach•Globally integrated morphometric data provide quantitative constraints on conodont development and heterochronic patterns
The demand for water escalated over the years and led to water shortage in many parts of the world. This situation further intensified due to water pollution. This research involves the analysis of ...groundwater from selected locations along River Ravi, the estimation of economic value of water for intended uses and mapping of threat zones regarding poor quality groundwater consumed by the people or the residents of the selected areas. Questionnaire survey was used as a tool for economic valuation and laboratory analysis was performed for quality testing. The quality of water was found to be average in terms of chemical and bacteriological parameters. Whereas physical parameters were found within acceptable limits. Total dissolved solids (TDS), Turbidity and Electrical conductivity (EC) results were found to be within the permissible limits given by World Health Organization (WHO). However, pH of the water samples of few areas violated the permissible limit of WHO (6.5–8.5). Among chemical parameters, nickle (0.07 mg/l) chromium (1.0 mg/l), cobalt (0.02 mg/l) and arsenic (10 ppb) exceeded their respective permissible limit. Contingent valuation method (CVM) was used for determining Willingness to pay (WTP) for drinking water quality which was found to be low (
Rs. 3.848)
. This was due to the low-literacy level as residents were not aware of the consequences of the contaminated water. The economic value of water for irrigation purpose determined through Residual valuation method (RVM), was found to be
37.46
Wheat >
28.41
Sugarcane >
23.05
Rice. This implicates that wheat has the highest ratio for productivity and residual value as compared to rice and sugarcane. Farmers should be encouraged to grow more of wheat crops as compared to sugarcane and rice. Threat areas for deteriorated water quality were mapped for better understanding of general public regarding drinking water quality in their vicinity.
Genetic counselors have a unique role in healthcare that requires a balance between being a patient educator and patient advocate when discussing disability. This study aimed to determine genetic ...counselors’ implicit attitudes toward disability, and identify what factors affect these implicit attitudes. Case scenarios involving disability were used to examine hypothetical estimates of time spent on different topics within a genetic counseling session. Implicit attitudes were measured using the validated Disability Attitudes Implicit Association Test (DA‐IAT), and personal/professional experiences with disability were assessed. Analysis of 382 respondents of the electronic survey revealed that personal experience with individuals with disabilities was not significantly associated with implicit attitudes scores. In addition, results demonstrated that genetic counselors have a stronger bias toward ability (Dmean = 0.62, Dstd = ±0.45) compared to previous participants of the DA‐IAT (p < .005). Practice specialty, length of time in the genetic counseling field, or whether the participant was a practicing counselor or genetic counseling student were not associated with implicit attitudes scores. The bias toward ability observed across practice specialties may be due to shared factors that influence interest in this field, but may also potentially reflect the inability of the DA‐IAT to capture the complexity of genetic counselors’ relationship to individuals with disability. This study emphasizes the importance of incorporating patients’ individual definitions of disability into genetic counseling sessions and building an environment of patient advocacy and education around their personal perspectives and needs.
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