A Three Tiered Evaluation Framework for Effective Writing Instruction in English for Academic Purposes Course

Academic writing is becoming a matter of concern for the developing countries where English serves as a second or foreign language because of the significant role it plays in the academic as well as professional life of an individual. Excellence in academic writing and communication is among the top ranked expectations from graduates of all disciplines, Pakistani Higher education Commission has listed Technical and Academic communication as second significant competence (2017). Therefore, there is a dire need of a writing instruction framework that could inculcate communicative competence among Pakistani graduates. A framework that will suppress all challenges and ensure success. The consciously chosen methodology meant to determine the effectiveness of 3-Tiered Evaluation Framework in enhancing students’ engagement in writing classes; ensuring their academic success. The study established that the 3-tiered evaluation framework assisted teachers and language learners alike in dealing with language related problems including; large class size, writing in second/foreign language, absence of corrective feedback, students’ passivity and high dependence on easily available notes. The 3-TEF ensured active involvement of students in writing tasks facilitated through collaboration and systematic critical reflection, which ultimately improved students’ writing engagement and achievements. Besides, interpersonal skills, negotiation, critical thinking, autonomous learning, team work, collaboration, and confidence development, surfaced as by-products of the 3-TEF

Diagnostic Accuracy of Ultrasound in Detecting Hepatocellular Carcinoma Keeping Histopathology as Gold Standard

Objective: To determine the diagnostic accuracy of USG in detecting hepatocellular carcinoma. Methodology: A total of 70 patients with liver cirrhosis with mass and age 18-60 years of either gender were included. Nodular lesion <3 cm in size, non-specific vascular profile, poor visualization and FNA / biopsy can cause complications were excluded. All the patients were then underwent first ultrasound and then histopathology. The ultrasonography findings were recorded presence or absence of HCC and correlated with CT scan findings. Results: In USG positive patients, 31(44.28%) (88.8%)True Negative had no hepatocellular carcinoma on histopathology (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasound in detecting hepatocellular carcinoma keeping histopathology as gold standard was 88.57%, 91.43%, 91.18%, 88.89% and 90.0% respectively. Conclusion: This study concluded that grey scale ultrasound along with Doppler ultrasound  is a simple, non-invasive, economical, readily available imaging modality with high sensitivity and accuracy in diagnosing hepatocellular carcinoma.

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Quality Standards of Qualitative Research in Applied Linguistics: A Conceptual Review

This study inspects different dimensions of ensuring standards in qualitative research within the field of applied linguistics. It presents a conceptual review of already established key quality standards of qualitative research, their application, their significance followed by the recommendations to ensure quality standards in applied linguistics qualitative research. For this purpose, the researchers have considered journal articles, book chapters and books published between 2002 and 2023 on digital databases to examine the key standards of ensuring trustworthiness and their application in the field of applied linguistics qualitative research. The study presents recommendations for novice researchers who are attempting to conduct qualitative studies ensuring the maximum level of trustworthiness and credibility and making their studies sound in terms of quality standards