The Economic Impact of Lower Extremity Amputations in Diabetics. a Retrospective Study From a Tertiary Care Hospital of Faisalabad, Pakistan

Background: Among the various complications of diabetes, lower-extremity amputation due to diabetic foot is a common problem. In Pakistan, 6-7% of patients with diabetes suffer from diabetic foot ulceration. Objectives: Our primary objective was to explore the frequency of diabetic foot amputations, and the secondary objective was to calculate the economic burden of these preventable surgeries on the health budget of the provincial government. Materials & Methods: It was a retrospective cross-sectional observational study conducted after obtaining approval from the Ethical Review Committee of Allied hospital, Faisalabad Medical University. The data of diabetic foot patients who underwent amputations between July 2017 and December 2017 were retrieved from three Surgical Units (I, II & III), using a purposive sampling technique. All amputations carried out for reasons other than diabetic foot were excluded. The direct medical cost of one diabetic foot amputation was calculated via a local survey of the various private hospitals of Faisalabad. The indirect costs in terms of loss of productivity and disability costs, transport costs, rehabilitation costs were not included in this study. The data were evaluated by using SPSS Version 23. Results: A total of 85 patients were included in our study. The male to female ratio was 2.7 to 1. The mean direct treatment cost for minor amputation was PKR 46926.00 ± 11730.90 ($382.35 ± 95.58), and the mean direct treatment cost for major amputation was PKR 53720.00 ± 12401.24 ($437.71 ± 101.40). Out of 85 amputations, 63 (74%) were major amputations, and the remaining 22 (26%) were minor amputations. The total cost for 63 major amputations was PKR 3,384,360 ($27568.91) and for 22 minor amputation was PKR 1,032,372 ($8409.67). The net cost came out to be PKR 4,416,732 ($35978.59) for all the 85 cases being reported in a tertiary care hospital of Faisalabad for six months. Conclusion: Diabetic foot, a preventable complication of long-term diabetes mellitus, has an economic burden on the hospital budget, which, if adequately addressed via primary prevention programme, can yield not just economical but medical benefits as well

Omani camel calves in a traditional management system

Le dromadaire Omani est une race particulière de la région du Golfe persique. C'est un animal à usages multiples et, depuis récemment, très demandé pour ses qualités de coureur. La population cameline à Oman était de 98 500 têtes en 1994 avec un taux de croissance annuel de 3,7 p. 100. Cette enquête a été réalisée entre 1992 et 1997. La reproduction a lieu en hiver (de novembre à mars). Vingt femelles adultes sur 364 ont été mises à la reproduction chaque année. En moyenne, 12 chamelons sont nés chaque année (taux de mise bas de 60 p. 100). Le taux moyen de conception a été de 4,5 p. 100, indiquant un sérieux problème dans le système d'élevage traditionnel. La plupart des chamelons (71,6 p. 100) sont nés de chamelles du groupe d'âge 11-20 ans. Les plus jeunes animaux en âge de se reproduire étaient utilisés pour la selle ou la course. Le rapport des chamelons femelles/mâles était de 1,14. Pour 53 gestations répertoriées, la durée moyenne de gestation a été de 384 jours (12,6 mois). Le taux de mortalité annuel a été de 2,66 p. 100. Tous les cas ont été répertoriés au cours du premier mois post-partum. Les causes de mortalité du chamelon comprenaient la pneumonie, les diarrhées et la sous-nutrition. Le système traditionnel d'élevage n'était pas adapté à une préparation adéquate de la mère pour l'allaitement post-partum. Trois chamelles ont mis bas deux fois avec des intervalles entre les mises bas de 3,3, 2,87 et 2,6 ans. Sept mâles reproducteurs étaient gardés séparément des femelles. Au cours des cinq années d'observation, 273 saillies ont été effectuées, conduisant à 60 naissances. Deux des mâles ont sailli 59 fois chacun, et chacun d'eux a participé à 11 conceptions. La gestion de la reproduction n'a pas permis une évaluation de la fertilité mâle ou femelle. (Résumé d'auteur

Desperately seeking fixedness: practitioners accounts of 'becoming doctoral researchers

We draw upon the concept of liminality to explore the experiences of practitioners enrolled on a UK Doctor of Business Administration (DBA) programme. We analyse twenty practitioners’ reflective journals to detail how the DBA liminal space was negotiated. More specifically, we describe how practitioners deal with their struggles of identity incoherence or ‘monsters of doubt’ which are amplified in the DBA context owing to the complex nature of the separation phase of liminality. We identify three broad methods deployed in this endeavour: ‘scaffolding’; ‘putting the past to work’ and ‘bracketing’- which evidence practitioners ‘desperately seeking fixedness’. We make three contributions – first, we provide empirical insights into the experiences of the increasingly significant, but still under researched, DBA student. Second, we develop our understandings of monsters of doubt through illustrating how these are negotiated for learning to progress. Finally, we contribute to wider discussions of ‘becoming’ to demonstrate the simultaneous and paradoxical importance of movement and fixedness in order to learn and become

Cellular Imaging Of The Tapetal-like Reflex In Carriers Of RPGR-associated Retinopathy

PURPOSE: To examine the features of the tapetal-like reflex (TLR) in female carriers of RPGR-associated retinopathy by means of adaptive optics scanning light ophthalmoscopy (AOSLO) and spectral domain optical coherence tomography. METHODS: Nine molecularly confirmed RPGR carriers and three healthy controls underwent ocular examination and the following retinal imaging modalities: color photography, near-infrared reflectance, fundus autofluorescence, spectral domain optical coherence tomography, and AOSLO. After identifying TLR areas across all imaging modalities, normalized local contrast of outer retinal bands on spectral domain optical coherence tomography was calculated and AOSLO-acquired photoreceptor mosaic analysis was performed. RESULTS: Seven carriers had TLR areas, which colocalized with increased rod photoreceptor reflectivity on confocal AOSLO and reduced cone photoreceptor densities. Parafoveal TLR areas also exhibited reduced local contrast (i.e., increased reflectivity) of the outer retinal bands on spectral domain optical coherence tomography (inner segment ellipsoid zone and outer segment interdigitation zone). Healthy controls did not show TLR. CONCLUSION: The cellular resolution provided by AOSLO affords the characterization of the photoreceptor mosaic in RPGR carriers with a TLR. Features revealed include reduced cone densities, increased cone inner segment diameters, and increased rod outer segment reflectivity

Clinical and molecular characterization of HER2 amplified-pancreatic cancer

<p>Background: Pancreatic cancer is one of the most lethal and molecularly diverse malignancies. Repurposing of therapeutics that target specific molecular mechanisms in different disease types offers potential for rapid improvements in outcome. Although HER2 amplification occurs in pancreatic cancer, it is inadequately characterized to exploit the potential of anti-HER2 therapies.</p> <p>Methods: HER2 amplification was detected and further analyzed using multiple genomic sequencing approaches. Standardized reference laboratory assays defined HER2 amplification in a large cohort of patients (n = 469) with pancreatic ductal adenocarcinoma (PDAC).</p> <p>Results: An amplified inversion event (1 MB) was identified at the HER2 locus in a patient with PDAC. Using standardized laboratory assays, we established diagnostic criteria for HER2 amplification in PDAC, and observed a prevalence of 2%. Clinically, HER2- amplified PDAC was characterized by a lack of liver metastases, and a preponderance of lung and brain metastases. Excluding breast and gastric cancer, the incidence of HER2-amplified cancers in the USA is >22,000 per annum.</p> <p>Conclusions: HER2 amplification occurs in 2% of PDAC, and has distinct features with implications for clinical practice. The molecular heterogeneity of PDAC implies that even an incidence of 2% represents an attractive target for anti-HER2 therapies, as options for PDAC are limited. Recruiting patients based on HER2 amplification, rather than organ of origin, could make trials of anti-HER2 therapies feasible in less common cancer types.</p&gt

Vicious walkers, friendly walkers and Young tableaux II: With a wall

We derive new results for the number of star and watermelon configurations of vicious walkers in the presence of an impenetrable wall by showing that these follow from standard results in the theory of Young tableaux, and combinatorial descriptions of symmetric functions. For the problem of $n$-friendly walkers, we derive exact asymptotics for the number of stars and watermelons both in the absence of a wall and in the presence of a wall.Comment: 35 pages, AmS-LaTeX; Definitions of n-friendly walkers clarified; the statement of Theorem 4 and its proof were correcte

Mapping Children's Discussions of Evidence in Science to Assess Collaboration and Argumentation

The research reported in this paper concerns the development of children's skills of interpreting and evaluating evidence in science. Previous studies have shown that school teaching often places limited emphasis on the development of these skills, which are necessary for children to engage in scientific debate and decision-making. The research, undertaken in the UK, involved four collaborative decision-making activities to stimulate group discussion, each was carried out with five groups of four children (10-11 years old). The research shows how the children evaluated evidence for possible choices and judged whether their evidence was sufficient to support a particular conclusion or the rejection of alternative conclusions. A mapping technique was developed to analyse the discussions and identify different "levels" of argumentation. The authors conclude that suitable collaborative activities that focus on the discussion of evidence can be developed to exercise children's ability to argue effectively in making decisions

Processes, contexts, and rationale for disinvestment: a protocol for a critical interpretive synthesis

Background: Practical solutions are needed to support the appropriate use of available health system resources as countries are continually pressured to ‘do more with less’ in health care. Increasingly, health systems and organizations are exploring the reassessment of possibly obsolete, inefficient, or ineffective health system resources and potentially redirecting funds to those that are more effective and efficient. Such processes are often referred to as ‘disinvestment’. Our objective is to gain further understanding about: 1) whether how and under what conditions health systems decide to pursue disinvestment; 2) how health systems have chosen to undertake disinvestment; and 3) how health systems have implemented their disinvestment approach. Methods/Design We will use a critical interpretive synthesis (CIS) approach, to develop a theoretical framework based on insights drawn from a range of relevant sources. We will conduct systematic searches of databases as well as purposive searches to identify literature to fill conceptual gaps that may emerge during our inductive process of synthesis and analysis. Two independent reviewers will assess search results for relevance and conceptually map included references. We will include all empirical and non-empirical articles that focus on disinvestment at a system level. We will then extract key findings from a purposive sample of articles using frameworks related to government agendas, policy development and implementation, and health system contextual factors and then synthesize and integrate the findings to develop a framework about our core areas of interest. Lastly, we will convene a stakeholder dialogue with Canadian and international policymakers and other stakeholders to solicit targeted feedback about the framework (e.g., by identifying any gaps in the literature that we may want to revisit before finalizing it) and deliberating about barriers for developing and implementing approaches to disinvestment, strategies to address these barriers and about next steps that could be taken by different constituencies. Discussion Disinvestment is an emerging field and there is a need for evidence to inform the prioritization, development, and implementation of strategies in different contexts. Our CIS and the framework developed through it will support the actions of those involved in the prioritization, development, and implementation of disinvestment initiatives. Systematic review registration PROSPERO CRD42014013204 Electronic supplementary material The online version of this article (doi:10.1186/2046-4053-3-143) contains supplementary material, which is available to authorized users