What predicts word reading in Arabic?

Efficient and accurate word reading ability is critical for later reading success. As such, it is important to understand the component skills that underlie strong word reading ability. Although a growing research base points to the importance of phonological processing, morphological processing and orthographic processing for accurate and fluent word reading in Arabic, there are few studies that examine all three areas at one time to better understand their role in word reading. Additionally, it remains unclear whether the contribution of the various processes might differ across the early years when children are learning to read. 1,098 pupils in grades 1–3 participated in this study and took tests for phonological processing, morphological processing, orthographic processing, and word reading accuracy and fluency. According to the findings of regression analyses, the relative contribution of these underlying processes differed according to the method used to test word reading and the student’s grade level. Regarding accuracy, several subscales of phonological processing and two measures of orthographic processing accounted for significant differences in word reading accuracy for first graders. For second grade students, nonword repetition, elision, and all three measures of orthographic processing accounted for variance. In third grade, elision and memory for digits, word creation and morpheme identification, and letter/sound identification and orthographic fluency were significant predictors of word reading accuracy. In terms of fluency, two subscales of phonological processing, two measures of orthographic processing, and two measures of morphological processing explained significant differences in word reading fluency for first graders. For second grade students, nonword repetition, elision, RAN-digits, isolation, segmenting and all the measures of orthographic processing and word creation explained unique variance in word reading fluency. In third grade, elision, RAN-letters, RAN-digits and phoneme isolation, all measures of orthographic processing and morphological processing, explained variance in word reading fluency. Implications and future directions in research are discussed

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Social Support, Resilience, and Quality of Life for Families with Children with Intellectual Disabilities

A family’s quality of life (FQOL) has been shown to impact the quality of life for the child with intellectual disabilities. Therefore, it is important to understand the factors that contribute to FQOL to inform the types of interventions and supports that are provided to families. The goal of this study was to determine whether social support and resilience account for variance in Family Quality of Life as reported by mothers of children with intellectual disabilities. Eight-eight Qatari mothers responded to three surveys, the Brief Resilience Scale, the 2-Way Social Support Scale, and the Beach Center Family Quality of Life Scale. Regression results indicate that giving and receiving social support accounted for significant variance in FQOL, explaining 62 % of the variance. Resilience was not a significant predictor. Implications for research and practice are discussed

Cognitive emotion regulation strategies, anxiety, and depression in mothers of children with or without neurodevelopmental disorders

Background: A large number of studies have examined psychological distress and emotion regulation (ER) in parents of children with Autism Spectrum Disorder (ASD). However, no study has previously examined “purely” cognitive ER strategies in parents of children with ASD compared to parents of children with other disabilities. Method: The Cognitive Emotion Regulation Questionnaire (CERQ) along with anxiety and depression sub-scales of the Personality Inventory for DSM-5 (PID-5) were administered online to three groups of mothers (N = 90) of children with either ASD or intellectual disability (ID) as well as mothers of typically developed (TD) children. Results: Mothers of children with ASD experienced higher levels of anxiety and depression and reported less use of positive reappraisal, positive refocusing, and refocus on planning than mothers of TD children. In addition, mothers of children with ASD had a higher level of anxiety (but not depression) and a lower use of positive reappraisal than mothers of children with ID. Other CERQ strategies (self-blame, rumination, putting into perspective, catastrophizing, and other-blame) were used equally by all mothers. In addition, the patterns of correlations between cognitive ER strategies and anxiety and depression are generally consistent across the three groups of mothers; but anxiety and depression positively correlated with other-blame only in mothers of children with ASD. Conclusions: Cognitive ER strategies correlated with anxiety and depression in mothers of children with ASD. Accordingly, effective intervention for psychological distress in families of children with ASD should aim to incorporate these strategies

Examining Factors That Predict Arabic Word Reading in First and Second Graders

Although there is a growing research base on Arabic literacy development to inform our understanding of the factors that account for variability in word reading skill, the current body of research is limited by two major constraints. First, although several studies examine one or more early literacy constructs, we were able to locate only two studies that included phonological, orthographic and morphological factors together. Second, all of the studies conducted to date rely on the use of researcher-developed measures that include tasks associated with the construct(s) of interest, but that are not based on a comprehensive conceptual framework of these constructs. In this study, 188 students in grades 1–2 completed measures of phonological processing, orthographic knowledge, morphological awareness, and word reading. Results of multiple regression analyses indicate that phonological awareness, and, in particular, elision, accounted for significant variance in word reading, regardless of how word reading was measured. Morphological awareness and orthographic knowledge measures also accounted for significant variance in some word reading measures. RAN and Phonological Memory measures only contributed to some measures of word reading ability. Results are discussed in the context of the existing literature on Arabic. Implications and next steps for research are discussed

Developing a Test of Early Arabic Literacy Skills

In recent years, stronger literacy development has emerged as a critically important issue in Arabic speaking nations. Results of international assessments indicate that most of the participating Arab countries are near the bottom of achievement levels. Additionally, recent studies indicate the prevalence rate of reading disability ranges from between 5 − 18%, which means that approximately one in six students may be at risk for poor reading outcomes. A necessary first step toward improving instructional programming that increases reading achievement is the development of standardized assessments that: 1) align with the construct of reading, 2) inform instructional planning, and 3) identify students potentially at-risk for poor reading outcomes. This manuscript presents the theoretical framework and a synthesis of the research that is guiding the development of the Test of Early Arabic Literacy Skills (TEALS), the first standardized measure of early literacy skills for students in grades 1 through 3. The TEALS will assess students’ reading ability across four areas: 1) word reading, 2) phonological processing, 3) orthographic processing, and 4) morphological processing. There are currently no standardized measures of Arabic reading available, and this constrains our ability to better understand reading development, and to improve reading instruction