Advancing equity in challenging times: A qualitative study of telehealth expansion and changing patient–provider relationships in primary care settings during the COVID-19 pandemic

Objective The patient–provider relationship is critical for achieving high-quality care and better health outcomes. During the COVID-19 pandemic, primary care practices rapidly transitioned to telehealth. While telehealth provided critical access to services for many, not all patients could optimally utilize it, raising concerns about its potential to exacerbate inequities in patient–provider relationships. We investigated technical and workforce-related barriers to accessing telehealth and the impacts on patient–provider relationships for vulnerable populations. Methods Qualitative, semi-structured interviews from May 2021 to August 2021 with 31 individuals (medical directors, physicians, and medical assistants) working at 20 primary care practices in Massachusetts, North Carolina, and Texas. Thematic analysis to better understand how barriers to using telehealth complicated patient–provider relationships. Results Interviewees shared challenges for providers and patients that had a negative effect on patient–provider relationships, particularly for vulnerable patients, including older adults, lower socio-economic status patients, and those with limited English proficiency. Providers faced logistical challenges and disruptions in team-based care, reducing care coordination. Patients experienced technological challenges that made accessing and engaging in telehealth difficult. Interviewees shared challenges for patient–provider relationships as commonly used telephone-only telehealth reduced channels for non-verbal communication. Conclusion This study indicates that barriers to virtual interaction with patients compared to in-person care likely led to weaker personal relationships that may have longer-term effects on engagement with and trust in the healthcare system, particularly among vulnerable patient groups. Additional support and resources should be available to primary care providers to optimize telehealth utilization

EFFECT OF FOLIAR APPLICATION OF UREA ON DIFFERENT GROWTH STAGES OF WHEAT

The experiment was conducted at Student Farm, Department of Agronomy, Sindh Agriculture University, Tandojam during the year 2012-13, to evaluate the effect of foliar dose of urea on different growth stages of wheat variety TJ-83 with 3 replications, experimental design Randomized Block Design with two factors A foliar nitrogen concentration of urea with treatments control (non -treated plots), 0.5% and 1.0%however in factor B include two growth stages i.e. Tillering stage, Anthesis stage. Wheat variety TJ-83 was cultivated at net plot size 4x4= (16 m2). The results revealed that germination (%) showed non-significant response to foliar nitrogen concentrations, growth stages and their interaction whereas all other wheat traits significantly affected by different foliar fertilizers, growth stages and their interaction.The mean maximum plant height (cm), grains spike-1 and seed index (1000 grain weight g) were recorded at 0.5% urea nitrogen concentrations whereas other wheat traits tillers plant-1, spike length (cm), spikelets spike-1 and grain yield kg ha-1 were foundThe experiment was conducted at Student Farm, Department of Agronomy, Sindh Agriculture University, Tandojam during the year 2012-13, to evaluate the effect of foliar dose of urea on different growth stages of wheat variety TJ-83 with 3 replications, experimental design Randomized Block Design with two factors A foliar nitrogen concentration of urea with treatments control (non -treated plots), 0.5% and 1.0%however in factor B include two growth stages i.e. Tillering stage, Anthesis stage. Wheat variety TJ-83 was cultivated at net plot size 4x4= (16 m2). The results revealed that germination (%) showed non-significant response to foliar nitrogen concentrations, growth stages and their interaction whereas all other wheat traits significantly affected by different foliar fertilizers, growth stages and their interaction.The mean maximum plant height (cm), grains spike-1 and seed index (1000 grain weight g) were recorded at 0.5% urea nitrogen concentrations whereas other wheat traits tillers plant-1, spike length (cm), spikelets spike-1 and grain yield kg ha-1 were found superior at 0.5% and 1.0% foliar nitrogen concentrations.Maximum mean for growth stages was observed at plant height (cm), tillers plan-1,spike length (cm), spikelets spike-1, seed index (1000 grain weight g) and grain yield were recorded at tiilering stages whereas higher value of grains spike-1 was recorded at anthesis growth stage of wheat. The interactive results indicated that the maximum plant height (cm) was recorded at interaction of 1.0% foliar nitrogen concentration x tillering stage, however higher values of tillers plan-1, spike length (cm) spikelets spike-1, seed index (1000 grain weight g) and grain yield kg ha-1 were observed at interaction of 0.5% and 1.0% foliar nitrogen concentrations x tillering stages. Further results indicated that the foliar nitrogen concentrations, growth stages and their interaction showed enhanced values as compared to control plots where no any fertilizer was applied.&nbsp

Immunohistochemical Estrogen receptor determination in human Breast carcinoma: correlation with histologic differentiation and age of the patients

An immunohistochemical assay for the measurement of estrogen receptor (ER) has been evaluated on 290 consecutive human breast biopsy and mastectomy specimens in the year 1992 at The Aga Khan University Hospital laboratories. Immunohistochemical localization of estrogen receptor on frozen/paraffin section was scored in a semi-quantitative fashion incorporating both the intensity and the distribution of specific staining. Histologic grading of the tumour was performed according to Bloom’s method. In this study, 21% of the tumours were estrogen receptor negative, 15% were weak positive, 25% intermediate positive and 39% strong positive. Fifty percent of the well differentiated tumours showed strong ER positivity against 27% of the poorly differentiated tumours. Seventy eight percent of all negative estrogen receptors were in patients younger than 50 years of age (pre-menopausal group), while 52% of strong estrogen receptor positivity was observed in patients older than 50 years (post- menopausal). This study demonstrates the value of immunohistochemical method to determine the ER status in patients with advanced breast cancer

Does the Clinical Frailty Scale at Triage Predict Outcomes From Emergency Care for Older People?

Study objective: We determine whether the Clinical Frailty Scale applied at emergency department (ED) triage is associated with important service- and patient-related outcomes. Methods: We undertook a single-center, retrospective cohort study examining hospital-related outcomes and their associations with frailty scores assessed at ED triage. Participants were aged 65 years or older, registered on their first ED presentation during the study period at a single, centralized ED in the United Kingdom. Baseline data included age, sex, Clinical Frailty Scale score, National Early Warning Score–2 and the Charlson Comorbidity Index score; outcomes included length of stay, readmissions (any future admissions), and mortality (inhospital or out of hospital) up to 2 years after ED presentation. Survival analysis methods (standard and competing risks) were applied to assess associations between ED triage frailty scores and outcomes. Unadjusted incidence curves and adjusted hazard ratios are presented. Results: A total of 52,562 individuals representing 138,328 ED attendances were included; participants’ mean age was 78.0 years, and 55% were women. Initial admission rates generally increased with frailty. Mean length of stay after 30- or 180-day follow-up was relatively low; all Clinical Frailty Scale categories included patients who experienced zero days’ length of stay (ie, ambulatory care) and patients with relatively high numbers of inhospital days. Overall, 46% of study participants were readmitted by the 2-year follow-up. Readmissions increased with Clinical Frailty Scale score up until a score of 6 and then attenuated. Mortality rates increased with increasing frailty; the adjusted hazard ratio was 3.6 for Clinical Frailty Scale score 7 to 8 compared with score 1 to 3. Conclusion: Frailty assessed at ED triage (with the Clinical Frailty Scale) is associated with adverse outcomes in older people. Its use in ED triage might aid immediate clinical decisionmaking and service configuration

There Is Selective Increase in Pro-thrombotic Circulating Extracellular Vesicles in Acute Ischemic Stroke and Transient Ischemic Attack: A Study of Patients From the Middle East and Southeast Asia.

Stroke attacks were found to be present at a younger age in patients from Southeast Asia (SE) and the Middle East (ME) resident in the state of Qatar. Extracellular vesicles (EVs), which are small membrane vesicles with pro-thrombotic properties, may contribute to the high risk of stroke in this population. Thus, total and cell-specific medium size EVs were counted by flow cytometry in platelet-free plasma from healthy volunteers and patients with transient ischemic attacks (TIA) and acute ischemic stroke (AIS) from SE and ME. Acutely, within 48 h of attacks, there was an increase in total endothelial EVs in TIA (6.73 ± 1.77; = 0.0156; = 21) and AIS (11.23 ± 1.95; = 0.0007; = 66) patients compared to controls (2.04 ± 0.78; = 24). Similar increases were also evident in EVs originating from platelets, erythrocytes, granulocytes, and leukocytes. Compared to controls, there was also an increase in EVs derived from activated endothelial cells, platelets, granulocytes, leukocytes, and pro-coagulant EVs (Annexin V) at 5 and 30-days following the acute events, while a decrease was observed in erythrocyte-derived EVs. This is the first study characterizing EVs in TIA and AIS patients from ME and SE showing an increase in EVs associated with endothelial and platelet cell activation, which may contribute to the elevated risk of stroke at a younger age in this population.Qatar University high collaborative grant (QUCG-CPH-2018\2019-2

Reduction of the ATPase inhibitory factor 1 (IF1) leads to visual impairment in vertebrates

In vertebrates, mitochondria are tightly preserved energy producing organelles, which sustain nervous system development and function. The understanding of proteins that regulate their homoeostasis in complex animals is therefore critical and doing so via means of systemic analysis pivotal to inform pathophysiological conditions associated with mitochondrial deficiency. With the goal to decipher the role of the ATPase inhibitory factor 1 (IF1) in brain development, we employed the zebrafish as elected model reporting that the Atpif1a−/− zebrafish mutant, pinotage (pnttq209), which lacks one of the two IF1 paralogous, exhibits visual impairment alongside increased apoptotic bodies and neuroinflammation in both brain and retina. This associates with increased processing of the dynamin-like GTPase optic atrophy 1 (OPA1), whose ablation is a direct cause of inherited optic atrophy. Defects in vision associated with the processing of OPA1 are specular in Atpif1−/− mice thus confirming a regulatory axis, which interlinks IF1 and OPA1 in the definition of mitochondrial fitness and specialised brain functions. This study unveils a functional relay between IF1 and OPA1 in central nervous system besides representing an example of how the zebrafish model could be harnessed to infer the activity of mitochondrial proteins during development

Identifying the structure of Zn-N-2 active sites and structural activation

Identification of active sites is one of the main obstacles to rational design of catalysts for diverse applications. Fundamental insight into the identification of the structure of active sites and structural contributions for catalytic performance are still lacking. Recently, X-ray absorption spectroscopy (XAS) and density functional theory (DFT) provide important tools to disclose the electronic, geometric and catalytic natures of active sites. Herein, we demonstrate the structural identification of Zn-N-2 active sites with both experimental/theoretical X-ray absorption near edge structure (XANES) and extended X-ray absorption fine structure (EXAFS) spectra. Further DFT calculations reveal that the oxygen species activation on Zn-N-2 active sites is significantly enhanced, which can accelerate the reduction of oxygen with high selectivity, according well with the experimental results. This work highlights the identification and investigation of Zn-N-2 active sites, providing a regular principle to obtain deep insight into the nature of catalysts for various catalytic applications

Scheduling M2M traffic over LTE uplink of a dense small cell network

We present an approach to schedule Long Term Evolution (LTE) uplink (UL) Machine-to-Machine (M2M) traffic in a densely deployed heterogeneous network, over the street lights of a big boulevard for smart city applications. The small cells operate with frequency reuse 1, and inter-cell interference (ICI) is a critical issue to manage. We consider a 3rd Generation Partnership Project (3GPP) compliant scenario, where single-carrier frequency-division multiple access (SC-FDMA) is selected as the multiple access scheme, which requires that all resource blocks (RBs) allocated to a single user have to be contiguous in the frequency within each time slot. This adjacency constraint limits the flexibility of the frequency-domain packet scheduling (FDPS) and inter-cell interference coordination (ICIC), when trying to maximize the scheduling objectives, and this makes the problem NP-hard. We aim to solve a multi-objective optimization problem, to maximize the overall throughput, maximize the radio resource usage and minimize the ICI. This can be modelled through a mixed-integer linear programming (MILP) and solved through a heuristic implementable in the standards. We propose two models. The first one allocates resources based on the three optimization criteria, while the second model is more compact and is demonstrated through numerical evaluation in CPLEX, to be equivalent in the complexity, while it performs better and executes faster. We present simulation results in a 3GPP compliant network simulator, implementing the overall protocol stack, which support the effectiveness of our algorithm, for different M2M applications, with respect to the state-of-the-art approaches

Psychiatric rating scales in Urdu: a systematic review

<p>Abstract</p> <p>Background</p> <p>Researchers setting out to conduct research employing questionnaires in non-English speaking populations need instruments that have been validated in the indigenous languages. In this study we have tried to review the literature on the status of cross-cultural and/or criterion validity of all the questionnaires measuring psychiatric symptoms available in Urdu language.</p> <p>Methods</p> <p>A search of Medline, Embase, PsycINFO and <url>http://www.pakmedinet.com</url> was conducted using the search terms; Urdu psychiatric rating scale, and Urdu and Psychiatry. References of retrieved articles were searched. Only studies describing either cross-cultural or criterion validation of a questionnaire in Urdu measuring psychiatric symptoms were included.</p> <p>Results</p> <p>Thirty two studies describing validation of 19 questionnaires were identified. Six of these questionnaires were developed indigenously in Urdu while thirteen had been translated from English. Of the six indigenous questionnaires five had had their criterion validity examined. Of the thirteen translated questionnaires only four had had both their cross-cultural and criterion validity assessed.</p> <p>Conclusion</p> <p>There is a paucity of validated questionnaires assessing psychiatric symptoms in Urdu. The BSI, SRQ and AKUADS are the questionnaires that have been most thoroughly evaluated in Urdu.</p

Genetic regulation of pituitary gland development in human and mouse

Normal hypothalamopituitary development is closely related to that of the forebrain and is dependent upon a complex genetic cascade of transcription factors and signaling molecules that may be either intrinsic or extrinsic to the developing Rathke’s pouch. These factors dictate organ commitment, cell differentiation, and cell proliferation within the anterior pituitary. Abnormalities in these processes are associated with congenital hypopituitarism, a spectrum of disorders that includes syndromic disorders such as septo-optic dysplasia, combined pituitary hormone deficiencies, and isolated hormone deficiencies, of which the commonest is GH deficiency. The highly variable clinical phenotypes can now in part be explained due to research performed over the last 20 yr, based mainly on naturally occurring and transgenic animal models. Mutations in genes encoding both signaling molecules and transcription factors have been implicated in the etiology of hypopituitarism, with or without other syndromic features, in mice and humans. To date, mutations in known genes account for a small proportion of cases of hypopituitarism in humans. However, these mutations have led to a greater understanding of the genetic interactions that lead to normal pituitary development. This review attempts to describe the complexity of pituitary development in the rodent, with particular emphasis on those factors that, when mutated, are associated with hypopituitarism in humans