Spain's Budget Neglects Research

Letter.-- Carlos Fenollosa et al.Peer Reviewe

The “untouchable” who touched millions: Dr. B. R. Ambedkar, Navayana Buddhism, and complexity in social work scholarship on religion

Dr. B. R. Ambedkar was a twentieth century socio-political and religious reformer whose activities impacted millions of lives, especially among India’s Dalit community. This article illustrates his lifework and its lessons for social work scholarship on religion. Using the examples of Ambedkar and Navayana Buddhism, I discuss three sources of complexity for social work scholarship on religion: 1) religion may function as both oppressive and emancipatory; 2) religion is malleable, not monolithic; and 3) religion is situated in and interactive with contexts. I conclude with suggestions for how social work scholarship on religion may account for complexity

The Global Burden of Alveolar Echinococcosis

Human alveolar echinococcosis (AE), caused by the larval stage of the fox tapeworm Echinococcus multilocularis, is amongst the world's most dangerous zoonoses. Transmission to humans is by consumption of parasite eggs which are excreted in the faeces of the definitive hosts: foxes and, increasingly, dogs. Transmission can be through contact with the definitive host or indirectly through contamination of food or possibly water with parasite eggs. We made an intensive search of English, Russian, Chinese and other language databases. We targeted data which could give country specific incidence or prevalence of disease and searched for data from every country we believed to be endemic for AE. We also used data from other sources (often unpublished). From this information we were able to make an estimate of the annual global incidence of disease and disease burden using standard techniques for calculation of DALYs. Our studies suggest that AE results in a median of 18,235 cases globally with a burden of 666,433 DALYs per annum. This is the first estimate of the global burden of AE both in terms of global incidence and DALYs and demonstrates the burden of AE is comparable to several diseases in the neglected tropical disease cluster

Integrating religion and belief in social work practice: an exploratory study

This exploratory study examines how social work practitioners in England integrate service users’ religion, belief and spiritual identities. The study involved 34 semi-structured interviews with Qualified Social Workers and took a qualitative investigational perspective. By means of thematic analysis, the study suggests that practitioners employ either avoidant or utilitarian approaches, which may indeed be a coping strategy before the vast religious plurality in practice. The study also highlights when professionals perceive religion, belief and spirituality important. Those times are a) initial assessments, b) conditional intervention, c) referrals and d) response to this subject when safeguarding and child protection issues arise

Evaluation of the Growth Assessment Protocol (GAP) for antenatal detection of small for gestational age: The DESiGN cluster randomised trial

BACKGROUND: Antenatal detection and management of small for gestational age (SGA) is a strategy to reduce stillbirth. Large observational studies provide conflicting results on the effect of the Growth Assessment Protocol (GAP) in relation to detection of SGA and reduction of stillbirth; to the best of our knowledge, there are no reported randomised control trials. Our aim was to determine if GAP improves antenatal detection of SGA compared to standard care. METHODS AND FINDINGS: This was a pragmatic, superiority, 2-arm, parallel group, open, cluster randomised control trial. Maternity units in England were eligible to participate in the study, except if they had already implemented GAP. All women who gave birth in participating clusters (maternity units) during the year prior to randomisation and during the trial (November 2016 to February 2019) were included. Multiple pregnancies, fetal abnormalities or births before 24+1 weeks were excluded. Clusters were randomised to immediate implementation of GAP, an antenatal care package aimed at improving detection of SGA as a means to reduce the rate of stillbirth, or to standard care. Randomisation by random permutation was stratified by time of study inclusion and cluster size. Data were obtained from hospital electronic records for 12 months prerandomisation, the washout period (interval between randomisation and data collection of outcomes), and the outcome period (last 6 months of the study). The primary outcome was ultrasound detection of SGA (estimated fetal weight <10th centile using customised centiles (intervention) or Hadlock centiles (standard care)) confirmed at birth (birthweight <10th centile by both customised and population centiles). Secondary outcomes were maternal and neonatal outcomes, including induction of labour, gestational age at delivery, mode of birth, neonatal morbidity, and stillbirth/perinatal mortality. A 2-stage cluster-summary statistical approach calculated the absolute difference (intervention minus standard care arm) adjusted using the prerandomisation estimate, maternal age, ethnicity, parity, and randomisation strata. Intervention arm clusters that made no attempt to implement GAP were excluded in modified intention to treat (mITT) analysis; full ITT was also reported. Process evaluation assessed implementation fidelity, reach, dose, acceptability, and feasibility. Seven clusters were randomised to GAP and 6 to standard care. Following exclusions, there were 11,096 births exposed to the intervention (5 clusters) and 13,810 exposed to standard care (6 clusters) during the outcome period (mITT analysis). Age, height, and weight were broadly similar between arms, but there were fewer women: of white ethnicity (56.2% versus 62.7%), and in the least deprived quintile of the Index of Multiple Deprivation (7.5% versus 16.5%) in the intervention arm during the outcome period. Antenatal detection of SGA was 25.9% in the intervention and 27.7% in the standard care arm (adjusted difference 2.2%, 95% confidence interval (CI) -6.4% to 10.7%; p = 0.62). Findings were consistent in full ITT analysis. Fidelity and dose of GAP implementation were variable, while a high proportion (88.7%) of women were reached. Use of routinely collected data is both a strength (cost-efficient) and a limitation (occurrence of missing data); the modest number of clusters limits our ability to study small effect sizes. CONCLUSIONS: In this study, we observed no effect of GAP on antenatal detection of SGA compared to standard care. Given variable implementation observed, future studies should incorporate standardised implementation outcomes such as those reported here to determine generalisability of our findings. TRIAL REGISTRATION: This trial is registered with the ISRCTN registry, ISRCTN67698474

Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy

CONTEXT: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity. OBJECTIVE: To report a systematic literature review and cumulative analysis of perioperative outcomes and complications of RARC in comparison with ORC and LRC. EVIDENCE ACQUISITION: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. Cumulative analysis was conducted. EVIDENCE SYNTHESIS: The searches retrieved 105 papers. According to the different diversion type, overall mean operative time ranged from 360 to 420 min. Similarly, mean blood loss ranged from 260 to 480 ml. Mean in-hospital stay was about 9 d for all diversion types, with consistently high readmission rates. In series reporting on RARC with either extracorporeal or intracorporeal conduit diversion, overall 90-d complication rates were 59% (high-grade complication: 15%). In series reporting RARC with intracorporeal continent diversion, the overall 30-d complication rate was 45.7% (high-grade complication: 28%). Reported mortality rates were ≤3% for all diversion types. Comparing RARC and ORC, cumulative analyses demonstrated shorter operative time for ORC, whereas blood loss and in-hospital stay were better with RARC (all p values <0.003). Moreover, 90-d complication rates of any-grade and 90-d grade 3 complication rates were lower for RARC (all p values <0.04), whereas high-grade complication and mortality rates were similar. CONCLUSIONS: RARC can be performed safely with acceptable perioperative outcome, although complications are common. Cumulative analyses demonstrated that operative time was shorter with ORC, whereas RARC may provide some advantages in terms of blood loss and transfusion rates and, more limitedly, for postoperative complication rates over ORC and LRC. PATIENT SUMMARY: Although open radical cystectomy (RC) is still regarded as a standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RC are becoming more popular. Robotic RC can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications; however, as for open RC, the risk of postoperative complications is high, including a substantial risk of major complication and reoperation

Analisis Validitas dan Reliabilitas Butir Soal UTS Fisika Kelas X SMA Swasta Muhammadiyah 4 Langsa

Peneilitian ini dilakukan karena guru fisika belum melakukan analisis butir soal pada soal ujian tengah semester tahun ajaran 2019/2020 yang baru saja dilakukan. Penelitian ini bertujuan untuk mengetahui kualitas butir soal ujian tengah semester fisika yang dibuat oleh guru dengan menggunakan analisis validitas dan reliabilitas butir soal. Penelitian ini merupakan peneilitian analisis deskriptif kuantitatif. Soal ujian tengah semester dibuat sebanyak 15 butir soal pilihan ganda. Subyek peneilitian ini adalah siswa kelas X MIA 1 SMA Muhammadiyah 4 Langsa yang terdiri dari 17 orang siswa. Metode yang digunakan adalah dokumentasi. Hasil peneilitian menunjukkan bahwa dari 15 soal pilihan ganda 10 butir soal dinyatakan valid dan 5 butir soal dinyatakan tidak valid serta memiliki nilai reliabilitas yang tinggi yaitu sebesar 0,72. Sehingga soal ujian tengah semester fisika Kelas X tahun ajaran 2019/2020 SMA Muhammadiyah 4 Langsa dikatagorikan baik dan layak untuk digunakan

The prognostic impact of the log odds of positive lymph nodes in colon cancer

AimThis study aimed to investigate the prognostic impact of the log odds of positive lymph nodes (LODDS) in colon cancer