Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: Results from a qualitative study

Background: Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals\u27 attitudes and perceptions related to MITS.Methods: A qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software.Results: A total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS.Conclusions: This formative research provided a unique opportunity to explore health professionals\u27 views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings

Design and Performance Estimation of a Photonic Integrated Beamforming Receiver for Scan-On-Receive Synthetic Aperture Radar

Synthetic aperture radar is a remote sensing technology finding applications in a wide range of fields, especially related to Earth observation. It enables a fine imaging that is crucial in critical activities, like environmental monitoring for natural resource management or disasters prevention. In this picture, the scan-on-receive paradigm allows for enhanced imaging capabilities thanks to wide swath observations at finer azimuthal resolution achieved by beamforming of multiple simultaneous antenna beams. Recently, solutions based on microwave photonics techniques demonstrated the possibility of an efficient implementation of beamforming, overcoming some limitations posed by purely electronic solutions, offering unprecedented flexibility and precision to RF systems. Moreover, photonics-assisted RF beamformers can nowadays be realized as integrated circuits, with reduced size and power consumption with respect to digital beamforming approaches. This paper presents the design analysis and the challenges of the development of a hybrid photonic-integrated circuit as the core element of an X-band scan-on-receive spaceborne synthetic aperture radar. The proposed photonic-integrated circuit synthetizes three simultaneous scanning beams on the received signal, and performs the frequency down-conversion, guaranteeing a compact 15 cm2-form factor, less than 6 W power consumption, and 55 dB of dynamic range. The whole photonics-assisted system is designed for space compliance and meets the target application requirements, representing a step forward toward a deeper penetration of photonics in microwave applications for challenging scenarios, like the observation of the Earth from space

Perceptions of parents and religious leaders regarding minimal invasive tissue sampling to identify the cause of death in stillbirths and neonates: Results from a qualitative study

Background: Recently, the minimal invasive tissue sampling (MITS) procedure has been developed to support determination of the cause of death as an alternate to conventional autopsy, especially in countries where complete diagnostic autopsy is not routine. To assess the feasibility of implementation of the MITS procedure for a study to determine cause of death in premature births and stillbirths in south Asia, we explored the views and perceptions of parents and religious leaders on the acceptability of MITS.Methods: A qualitative study was conducted at the National Institute of Child Health (NICH) hospital of Karachi, Pakistan. Focus group discussions (FGDs) were conducted with parents of newborns who visited well-baby clinics of the NICH hospital for post-natal check-ups. Key-informant interviews (KIIs) were conducted with religious leaders. Data were analyzed using NVivo 10 software.Results: A total of 13 interviews (FGDs = 8; KIIs = 5) were conducted. Three overarching themes were identified: (I) acceptability of MITS; (II) concerns affecting the implementation of MITS; and (III) religious and cultural perspectives. Participants\u27 acceptance of MITS was based on personal, religious, cultural and social beliefs. Parents widely recognized the need for this procedure in cases where the couple had experienced multiple stillbirths, neonatal deaths and miscarriages. Counseling of parents was considered vital to address emotional concerns of the parents and the family. Religious leaders indicated acceptability of the MITS procedure from a religious perspective and advised that respect for the deceased and consent of the guardians is mandatory when performing MITS.Conclusions: This qualitative study provided a unique opportunity to understand the views of parents and religious leaders towards the use of MITS. Generally, MITS appears to be an acceptable method for identifying the cause of death in neonates and stillbirths, provided that the deceased is respected and buried as soon as possible without any delays and parents are counseled appropriately. Findings from this research are essential in approaching families for consent for MITS

Estrogen receptor-α gene codon 10 (T392C) polymorphism in Iranian women with breast cancer: a case study

A case study was conducted to establish a database of polymorphisms in Iranian population in order to compare Western and Iranian (Middle East) distributions and to evaluate ESR1 polymorphism as an indicator of clinical outcome. The ESR1 gene was scanned in Iranian patients newly diagnosed invasive breast tumors, (150 patients) and in healthy individuals (147 healthy control individuals). PCR single-strand conformation polymorphism methodology and direct sequencing were performed. The silent single nucleotide polymorphism (SNPs) was performed, as reported previously in other studies, but at significantly different frequencies, with further increasing predictive accuracy in Iranian population. Data suggest that ESR1 polymorphisms are correlated with various aspects of breast cancer in Iranian ESR1 genotype, as determined during pre-surgical evaluation, might represent a surrogate marker for predicting breast cancer

Limnological survey of Anzali Wetland data during 1990-2003 by use of GIS system

Anzali wetland at south west of Caspian located along of North West and southeast and with its unique feature were add on the Ramsar convention list in 1975. There were recorded a high rich of fauna and flora including 276 plant species, 23 reptiles and amphibians, 60 fishes, 26 mammals and 195 birds. Anzali wetland were encountered with numerous disorder with the eutrophication and the early dismissing. The first studies on Anzali wetland started by many international institutions in 1964. In this study the data of biotic and abiotic factors in Anzali wetland analyzed which belongs to different sites (15 to 38 stations) during 1991 to 2000 and were sampled seasonally or monthly in different years. The results showed the increasing trend of phytoplankton abundance from 7.9 to 66 million C./l. and the western part had the most abundant. The Cyanophyta had the most development than other 7 phylum observed in the area. In Anzali wetland identified 143 phytoplankton genus that 9 genus dominated in more than 80 % replicates and 7 genus had the abundance of more than 5 million cell/l. The Zooplankton abundant increased from 580 to 2200 ind./l. The Rotatoria had the most abundant followed by Copepoda. There was identified 104 zooplankton genus that 5 genus were dominated in more than 80 % replicates and 11 genus had the abundance of more than 30 ind./L. The chlorophyll a varied from 8.8 to 50.2 μg/l. and had a increasing trend after 1996, meanwhile it was measured higher than 25 μg/l in most of the stations. The results of benthic study showed that the Chironomidae and Tubificidae were observed more than other organisms which comprised 12.2 to 23.5% of total biomass of benthic organisms in studied period. The range of biomass was 1.1 to 7.8 g/m2. The ichthyologic survey showed presence of 60 species that 11 species were exotic. 28 species belong to freshwater, 17 species were anadromous and 8 species were resident in estuary. The highest and lowest fish catch were 640 and 288 ton in 1994 and 1999 respectively and it was about 500 ton at the end of period. The hydrochemical factors had the various fluctuation so that the nutrients parameters had a significant difference over studied period. Total nitrogen was varied from 0.78 to 1.41 mg/l and total phosphorus varied from 0.05 to 0.1 μg/l.. The oxygen dissolved amount was from 4.6 to 8.7. EC was between 3 to 5 ms/cm during September and October that indicated of Caspian water projection. According to geographic position of station, all biotic and abiotic data, were arranged. The data bank is used by Idrisi software to produce of necessary maps. Analysis of data showed that there must be a responsible department with a vast authority. Conservation and eutrophication prevention of Anzali wetland connect to special attention to catchment area and landuse management of the wetland. Also there is an urgent need for well-developed technologies and managements to reduce the organic pollution and its environmental impacts on the Anzali Lagoon

Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study

Background Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals’ attitudes and perceptions related to MITS. Methods A qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software. Results A total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS. Conclusions This formative research provided a unique opportunity to explore health professionals’ views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings

Perceptions of parents and religious leaders regarding minimal invasive tissue sampling to identify the cause of death in stillbirths and neonates: results from a qualitative study

Background Recently, the minimal invasive tissue sampling (MITS) procedure has been developed to support determination of the cause of death as an alternate to conventional autopsy, especially in countries where complete diagnostic autopsy is not routine. To assess the feasibility of implementation of the MITS procedure for a study to determine cause of death in premature births and stillbirths in south Asia, we explored the views and perceptions of parents and religious leaders on the acceptability of MITS. Methods A qualitative study was conducted at the National Institute of Child Health (NICH) hospital of Karachi, Pakistan. Focus group discussions (FGDs) were conducted with parents of newborns who visited well-baby clinics of the NICH hospital for post-natal check-ups. Key-informant interviews (KIIs) were conducted with religious leaders. Data were analyzed using NVivo 10 software. Results A total of 13 interviews (FGDs = 8; KIIs = 5) were conducted. Three overarching themes were identified: (I) acceptability of MITS; (II) concerns affecting the implementation of MITS; and (III) religious and cultural perspectives. Participants’ acceptance of MITS was based on personal, religious, cultural and social beliefs. Parents widely recognized the need for this procedure in cases where the couple had experienced multiple stillbirths, neonatal deaths and miscarriages. Counseling of parents was considered vital to address emotional concerns of the parents and the family. Religious leaders indicated acceptability of the MITS procedure from a religious perspective and advised that respect for the deceased and consent of the guardians is mandatory when performing MITS. Conclusions This qualitative study provided a unique opportunity to understand the views of parents and religious leaders towards the use of MITS. Generally, MITS appears to be an acceptable method for identifying the cause of death in neonates and stillbirths, provided that the deceased is respected and buried as soon as possible without any delays and parents are counseled appropriately. Findings from this research are essential in approaching families for consent for MITS

Mortality and disability-adjusted life years in North Africa and Middle East attributed to kidney dysfunction : a systematic analysis for the Global Burden of Disease Study 2019

The authors would like to thank the hard work of the staff of the Institute for Health Metrics and Evaluation (IHME) for providing the best possible epidemiologic estimation of diseases in almost all regions and countries of the world, trying to reduce and eliminate poverty of knowledge and information about the diseases globally. Also, the core team authors sincerely thank all the collaborators of the GBD 2019 study who contributed to this study by providing data or a precise review of the manuscript. Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.Peer reviewe

Design and performance estimation of a photonic integrated beamforming receiver for scan-on-receive synthetic aperture radar

Synthetic aperture radar is a remote sensing technology finding applications in a wide range of fields, especially related to Earth observation. It enables a fine imaging that is crucial in critical activities, like environmental monitoring for natural resource management or disasters prevention. In this picture, the scan-on-receive paradigm allows for enhanced imaging capabilities thanks to wide swath observations at finer azimuthal resolution achieved by beamforming of multiple simultaneous antenna beams. Recently, solutions based on microwave photonics techniques demonstrated the possibility of an efficient implementation of beamforming, overcoming some limitations posed by purely electronic solutions, offering unprecedented flexibility and precision to RF systems. Moreover, photonics-assisted RF beamformers can nowadays be realized as integrated circuits, with reduced size and power consumption with respect to digital beamforming approaches. This paper presents the design analysis and the challenges of the development of a hybrid photonic-integrated circuit as the core element of an X-band scan-on-receive spaceborne synthetic aperture radar. The proposed photonic-integrated circuit synthetizes three simultaneous scanning beams on the received signal, and performs the frequency down-conversion, guaranteeing a compact 15 cm2-form factor, less than 6 W power consumption, and 55 dB of dynamic range. The whole photonics-assisted system is designed for space compliance and meets the target application requirements, representing a step forward toward a deeper penetration of photonics in microwave applications for challenging scenarios, like the observation of the Earth from space