Evaluation of the gulf of aqaba coastal water, Jordan

© 2020 by the authors. (1) Background: The Gulf of Aqaba (GoA) supports unique and diverse marine ecosystems. It is one of the highest anthropogenically impacted coasts in the Middle East region, where rapid human activities are likely to degrade these naturally diverse but stressed ecosystems. (2) Methods: Various water quality parameters were measured to assess the current status and conditions of GoA seawater including pH, total dissolved solids (TDS), total alkalinity (TA), Cl-, NO3-, SO42-, PO43-, NH4+, Ca2+, Mg2+, Na+, K+, Sr, Cd, Co, Cr, Cu, Fe, Mn, Pb, and Zn. (3) Results: The pH values indicated basic coastal waters. The elevated levels of TDS with an average of about 42 g/L indicated highly saline conditions. Relatively low levels of inorganic nutrients were observed consistent with the prevalence of oligotrophic conditions in GoA seawater. The concentrations of Ca2+, Mg2+, Na+, K+, Sr, Cl-, and SO42- in surface layer varied spatially from about 423-487, 2246-2356, 9542-12,647, 513-713, 9.2-10.4, 22,173-25,992, and 317-407 mg/L, respectively. The average levels of Cd, Co, Cr, Cu, Fe, Mn, Pb and Zn ranged from 0.51, 0.38, 1.44, 1.29, 0.88, 0.38, and 6.05 μg/L, respectively. (4) Conclusions: The prevailing saline conditions of high temperatures, high evaporation rates, the water stratification and intense dust storms are major contributing factors to the observed seawater chemistry. The surface distribution of water quality variables showed spatial variations with no specific patterns, except for metal contents which exhibited southward increasing trends, closed to the industrial complex. The vast majority of these quality parameters showed relatively higher values compared to those of other regions

Comparison of Patient-Reported Experience of Patients Receiving Radiotherapy Measured by Two Validated Surveys

Patient-reported experience is associated with improved patient safety and clinical outcomes. Quality improvement programs rely on validated patient-reported experience measures (PREMs) to design projects. This descriptive study compares the experience of cancer patients treated with radiation as recorded through the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) or as recorded through Your Voice Matters (YVM) between February and August 2019. Six questions were compared (“overall experience with care”, “discussion of worries”, “involvement in decisions”, “trusting providers with confidential information”, “providing family with information”, and “knowing who to contact”). Positive experience scores were calculated by cohort and by tumor groups. Multivariable logistic regression models evaluated factors associated with positive experience. Two cohorts (220 and 200 patients) met the eligibility criteria for the AOPSS and YVM, respectively. Positive experience was reported similarly between the two PREMs for “overall experience with care”, “discussion of worries”, and “trusting providers with confidential information” with a score difference of 1–4% at the cohort level. Positive experience score difference ranged from 5% to 44% across questions at the tumor group level. Different experience gaps were identified with the two measures, mainly at the tumor group level. Programs interested in using these PREMS might consider this when designing projects

Evaluation of the Gulf of Aqaba Coastal Water, Jordan

(1) Background: The Gulf of Aqaba (GoA) supports unique and diverse marine ecosystems. It is one of the highest anthropogenically impacted coasts in the Middle East region, where rapid human activities are likely to degrade these naturally diverse but stressed ecosystems. (2) Methods: Various water quality parameters were measured to assess the current status and conditions of GoA seawater including pH, total dissolved solids (TDS), total alkalinity (TA), Cl−, NO3−, SO42−, PO43−, NH4+, Ca2+, Mg2+, Na+, K+, Sr, Cd, Co, Cr, Cu, Fe, Mn, Pb, and Zn. (3) Results: The pH values indicated basic coastal waters. The elevated levels of TDS with an average of about 42 g/L indicated highly saline conditions. Relatively low levels of inorganic nutrients were observed consistent with the prevalence of oligotrophic conditions in GoA seawater. The concentrations of Ca2+, Mg2+, Na+, K+, Sr, Cl−, and SO42− in surface layer varied spatially from about 423–487, 2246–2356, 9542–12,647, 513–713, 9.2–10.4, 22,173–25,992, and 317–407 mg/L, respectively. The average levels of Cd, Co, Cr, Cu, Fe, Mn, Pb and Zn ranged from 0.51, 0.38, 1.44, 1.29, 0.88, 0.38, and 6.05 µg/L, respectively. (4) Conclusions: The prevailing saline conditions of high temperatures, high evaporation rates, the water stratification and intense dust storms are major contributing factors to the observed seawater chemistry. The surface distribution of water quality variables showed spatial variations with no specific patterns, except for metal contents which exhibited southward increasing trends, closed to the industrial complex. The vast majority of these quality parameters showed relatively higher values compared to those of other regions

Patient reported experience in a radiation oncology department

Understanding patient experience is essential to providing high quality, person-centered care. A real-time baseline cross-sectional study was completed to identify gaps in patient experience that can be targeted for quality improvement (QI). This study is part of PROSE (Person-centered Radiation Oncology Service Enhancement), a QI initiative developed to improve patient experience at a tertiary cancer centre Radiation Oncology (RO) Department. Data was collected using the Your Voice Matters (YVM) questionnaire. The YVM captures information on the patient’s last visit, and questions are organized based on dimensions of person-centered care. Recruitment occurred between May and August 2019 in the radiation department. Consecutive patients during the study period were approached to complete the YVM either in reference to their initial consultation or previous treatment appointment. Percent positive scores were calculated for quantitative data and a content analysis was completed for open-text data. Of 512 patients approached, a total of 400 patients participated across tumors groups. Overall, patients highly endorsed positive experiences with feeling respected by their healthcare provider. Contacting the clinic, emotional support and wait times were rated as the least positive components of experience across appointment types and tumors groups. The Lung tumour group demonstrated worse experiences across all domains during treatments compared to all other tumour groups. Gaps and differences in patient experience were demonstrated across appointment types and tumour groups. This study provides direction to effectively develop and implement QI work aimed at improving patient experience. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

The challenges of managing glioblastoma multiforme in developing countries: a trade-off between cost and quality of care

BACKGROUND AND OBJECTIVES: The management of glioblastoma multiforme (GBM) in developing countries is hindered by the paucity of clear protocols due in part to growing economic constraints and the lack of availability of expensive chemotherapeutic agents. We evaluated the deliverable treatment protocols and achievable outcomes for patients with GBM in a low-income country prior and subsequent to the worldwide adoption of temozolomide. DESIGN AND SETTING: Retrospective case series. PATIENTS AND METHODS: Charts of consecutive patients with a pathologic diagnosis of high-grade glioma diagnosed between January 2003 and December 2008 were retrospectively reviewed. RESULTS: We identified 146 adult patients, including 105 males and 41 females between 19 and 81 years of age (median age, 51 years), with histologically confirmed high-grade glioma. All patients underwent craniotomy. Eighty-two patients were treated with radiotherapy and temozolomide, of whom 42 patients received temozolomide concurrent with radiation followed by adjuvant temozolomide; 40 patients received irradiation followed sequentially by 6 cycles of temozolomide. In 40 patients irradiation was utilized as a single modality treatment adjuvant to surgery. The follow-up ranged from 1 to 56 months (median, 9.4 months). The median survival for the whole cohort was 10.2 months. The median survival for the radiotherapy-alone group was 5.3 months and for combined radiotherapy/temozolomide was 14.8 months. Survival was similar in both concurrent and sequential groups. Temozolomide conferred a statistically significant survival benefit of 9 months compared with standard therapeutic modalities. CONCLUSIONS: The results compare favorably to those reported in developed nations. Current management of GBM in developing countries should include maximal surgical resection followed by radiotherapy/temozolomide whenever medically and/or financially feasible. Outcomes comparable to those obtained within the context of randomized trials can be expected in low-income settings if healthcare delivery is carefully planned. Our results indicate that concurrent and sequential regimens are equally effective in these patients