Study of the Factors that Influence the Completion of the Thesis of Master of Health Professions Education Graduates: A Qualitative Study

Objective: To investigate the experience of timely thesis completion by the graduates of the Master of Health Professions Education (MHPE) program in Pakistan.Study Design: Qualitative interpretative study design.Settings: Riphah University Islamabad and HITEC-IMS Taxila.Duration: May 2018 to June 2019.Materials and Methods: Data was collected by semi-structured interviews. All interviews were carried out in person. Detailed notes were taken, and conversations were audio-recorded. Three authors analyzed data independently using iterative thematic analysis. Inconsistencies were resolved through discussion.Results: Two major themes out of five were identified: Intrinsic attributes of the graduates and the role of the supervisor. including sub-themes of intrinsic motivation, self-regulation, age of the participant, supervisor-trainee relationship, supervisor’s availability, supervisor’s commitment, personality traits of the supervisor. Periods of face-to-face contact sessions were considered to increase internal motivation during which participants believe to have greater self-regulation. Positive relationship with a committed supervisor who was readily available and had a friendly, yet professional attitude aided in the completion of the thesis on time while a supervisor lacking these traits posed challenges for the graduates.Conclusion: Several factors were identified which influenced thesis completion among the graduates of MHPE in Pakistan. The five major ones consisted of the following, 1) Research Project-Related Problems; 2) Support System; 3) Supervisor Guidance; 4) Attributes of the Researcher; 5) Conducive Research Environment. These results can help influence policies to evaluate and improve this program

The utility of Ki-67 as a prognostic biomarker in pulmonary neuroendocrine tumours: protocol for a systematic review and meta-analysis

INTRODUCTION: The omission of the immunohistochemical proliferation marker Ki-67 labelling index (henceforth, simply Ki-67) from the 2015 WHO classification system of pulmonary neuroendocrine tumours (Lung-NETs) as a prognostic and grading criterion remains controversial. This systematic review along with meta-analysis will be conducted to assess the prognostic/grading utility of Ki-67 in Lung-NETs.METHODS: This systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic search of MEDLINE Ovid, Embase, Scopus and the Cochrane Library will be performed from the inception of each database to 28 February 2019 for studies investigating any role of Ki-67 in Lung-NETs. Only full papers published in English detailing survival outcomes and HRs according to Ki-67 will be included. The primary endpoint will be establishing whether Ki-67 is a reliable marker in determining prognosis and thus assessing grade of Lung-NETs patients.ETHICS AND DISSEMINATION: Ethical approval will not be required as this is an academic review of published literature. Findings will be disseminated through the preparation of a manuscript for publication in a peer-reviewed journal as well as presentation at national and international conferences.PROSPERO REGISTRATION NUMBER: CRD42018093389.</p

Automated Analysis of Proliferating Cells Spatial Organisation Predicts Prognosis in Lung Neuroendocrine Neoplasms

SIMPLE SUMMARY: Lung neuroendocrine neoplasms (lung NENs) are categorised by morphology, defining a classification sometimes unable to reflect ultimate clinical outcome, particularly for the intermediate domains of adenocarcinomas and large-cell neuroendocrine carcinomas. Moreover, subjectivity and poor reproducibility characterise diagnosis and prognosis assessment of all NENs. The aim of this study was to design and evaluate an objective and reproducible approach to the grading of lung NENs, potentially extendable to other NENs, by exploring a completely new perspective of interpreting the well-recognised proliferation marker Ki-67. We designed an automated pipeline to harvest quantitative information from the spatial distribution of Ki-67-positive cells, analysing its heterogeneity in the entire extent of tumour tissue—which currently represents the main weakness of Ki-67—and employed machine learning techniques to predict prognosis based on this information. Demonstrating the efficacy of the proposed framework would hint at a possible path for the future of grading and classification of NENs. ABSTRACT: Lung neuroendocrine neoplasms (lung NENs) are categorised by morphology, defining a classification sometimes unable to reflect ultimate clinical outcome. Subjectivity and poor reproducibility characterise diagnosis and prognosis assessment of all NENs. Here, we propose a machine learning framework for tumour prognosis assessment based on a quantitative, automated and repeatable evaluation of the spatial distribution of cells immunohistochemically positive for the proliferation marker Ki-67, performed on the entire extent of high-resolution whole slide images. Combining features from the fields of graph theory, fractality analysis, stochastic geometry and information theory, we describe the topology of replicating cells and predict prognosis in a histology-independent way. We demonstrate how our approach outperforms the well-recognised prognostic role of Ki-67 Labelling Index on a multi-centre dataset comprising the most controversial lung NENs. Moreover, we show that our system identifies arrangement patterns in the cells positive for Ki-67 that appear independently of tumour subtyping. Strikingly, the subset of these features whose presence is also independent of the value of the Labelling Index and the density of Ki-67-positive cells prove to be especially relevant in discerning prognostic classes. These findings disclose a possible path for the future of grading and classification of NENs

Developing reading skills of primary children in government school

When the children go to school it is very important to them to learn reading and writing. Their classroom activities come under these two skills. The children working on some projects have to accomplish their work by reading books. Though reading is emphasized more but unfortunately a large number of the students in schools generally and in Government schools particularly, find the reading task challenging and as result most of the students face many reading difficulties. To investigate how I as a teacher could help the primary children to develop their reading skills, I conducted a study in one of the Government schools in Karachi where the medium of instruction was Urdu. What strategies could help the children to enhance their reading skills and what challenges hinder the process of reading? The study showed that reading skills could be enhanced if the tasks were according to the needs, interests and the abilities of the students. They are motivated to learn if they find something is relevant to them. Different strategies were found useful to promote students\u27 reading skills. Their involvement and active participation in different reading activities encouraged the learners to enhance their reading skills. They could learn better if opportunities and a conducive learning environment is provided to them. The study also indicates that children are reluctant to read because they are afraid of making mistakes. They should be encouraged to take chances and correct themselves because they learn by making mistakes. In case they make mistakes they need support to correct themselves rather than be corrected by the teacher. The study showed that the teacher needs professional support to work with children to develop their reading skills. A teacher who is not professionally developed cannot help them to enhance their reading skills as they also need to learn many skills to achieve the goal successfully

The Attitudes of Teachers towards English Language Training Programs at Primary Level in Pakistan

Teacher training programs are the subject of heated controversy and criticism in Pakistan. A review of the research reveals that English language teacher training has a significant impact on the performance of teachers and their pupils. The primary issues addressed in this research piece are trainers' English language competency, the use of audiovisual aids and new technology, instructional methodologies, and microteaching strategies. The research has been conducted in primary schools of district Vehari and data has been collected through a questionnaire (aptitude scale). A questionnaire was organized and arranged based on the questions about trainers, training environment and training material. Likert Type Questionnaire which contains 21 statements. Teachers have been asked to mark the most appropriate answer. After collecting data, it has been analyzed in tabular form.  The results show that training programs are effective in terms of upgrading knowledge, lesson plans and teaching materials. So the main purpose of this research is to highlight the strengths and weaknesses of English teacher training programs at primary level. Further recommendations are also provided for the betterment of conditions. Higher authorities should pay attention to improve the pedagogical conditions of teachers particularly in rural schools. Highly qualified trainers must be chosen for conducting the trainings in cluster centers furthermore it is highly necessary to adopt modern technologies and methodologies to improve the understandings of trainees

Utility of KI-67 as a prognostic biomarker in pulmonary neuroendocrine neoplasms: a systematic review and meta-analysis

OBJECTIVES: Ki-67, a marker of cellular proliferation, is associated with prognosis across a wide range of tumours, including gastroenteropancreatic neuroendocrine neoplasms (NENs), lymphoma, urothelial tumours and breast carcinomas. Its omission from the classification system of pulmonary NENs is controversial. This systematic review sought to assess whether Ki-67 is a prognostic biomarker in lung NENs and, if feasible, proceed to a meta-analysis. RESEARCH DESIGN AND METHODS: Medline (Ovid), Embase, Scopus and the Cochrane library were searched for studies published prior to 28 February 2019 and investigating the role of Ki-67 in lung NENs. Eligible studies were those that included more than 20 patients and provided details of survival outcomes, namely, HRs with CIs according to Ki-67 percentage. Studies not available as a full text or without an English manuscript were excluded. This study was prospectively registered with PROSPERO. RESULTS: Of 11 814 records identified, seven studies met the inclusion criteria. These retrospective studies provided data for 1268 patients (693 TC, 281 AC, 94 large cell neuroendocrine carcinomas and 190 small cell lung carcinomas) and a meta-analysis was carried out to estimate a pooled effect. Random effects analyses demonstrated an association between a high Ki-67 index and poorer overall survival (HR of 2.02, 95% CI 1.16 to 3.52) and recurrence-free survival (HR 1.42; 95% CI 1.01 to 2.00). CONCLUSION: This meta-analysis provides evidence that high Ki-67 labelling indices are associated with poor clinical outcomes for patients diagnosed with pulmonary NENs. This study is subject to inherent limitations, but it does provide valuable insights regarding the use of the biomarker Ki-67, in a rare tumour. PROSPERO REGISTRATION NUMBER: CRD42018093389

Recent advances in the molecular landscape of lung neuroendocrine tumors

Neuroendocrine tumors of the lung (Lung-NETs) make up a heterogenous family of neoplasms showing neuroendocrine differentiation and encompasses carcinoids and neuroendocrine carcinomas. On molecular grounds, they are considered two completely distinct and separate tumor groups with no overlap of molecular alterations nor common developmental mechanisms. Areas covered: Two perspectives were evaluated based on an extensive review and rethinking of literature: (i) the current classification as an instrument to obtaining clinical and molecular insights into the context of Lung-NETs; and (ii) an alternative and innovative interpretation of these tumors, proposing a tripartite separation into early aggressive primary high-grade neuroendocrine tumors (HGNET), differentiating or secondary HGNET, and indolent NET. Expert opinion: We herein provide an alternative outlook on Lung-NETs, which is a paradigm shift to current pathogenesis models and expands the understanding of these tumors

Analysis of immune landscape in pancreatic and ileal neuroendocrine tumours demonstrates an immune cold tumour microenvironment

INTRODUCTION: Neuroendocrine tumours (NETs) are rare tumours with an increasing incidence. While low- and intermediate-grade pancreatic NET (PanNET) and small intestinal NET (siNET) are slow growing, they have a relatively high rate of metastasizing to the liver, leading to substantially worse outcomes. In many solid tumours, the outcome is determined by the quality of the antitumour immune response. However, the quality and significance of antitumour responses in NETs are incompletely understood. This study provides clinico-pathological analyses of the tumour immune microenvironment in PanNET and siNETs.METHODS: Formalin-fixed paraffin-embedded tissue from consecutive resected PanNETs (61) and siNETs (131) was used to construct tissue microarrays (TMAs); 1-mm cores were taken from the tumour centre, stroma, tumour edge, and adjacent healthy tissue. TMAs were stained with antibodies against CD8, CD4, CD68, FoxP3, CD20, and NCR1. T-cell counts were compared with counts from lung cancers.RESULTS: For PanNET, median counts were CD8+ 35.4 cells/mm2, CD4+ 7.6 cells/mm2, and CD68+ macrophages 117.7 cells/mm2. For siNET, there were CD8+ 39.2 cells/mm2, CD4+ 24.1 cells/mm2, and CD68+ 139.2 cells/mm2. The CD8+ cell density in the tumour and liver metastases were significantly lower than in the adjacent normal tissues, without evidence of a cell-rich area at the tumour edge that might have suggested immune exclusion. T-cell counts in lung cancer were significantly higher than those in PanNET and siNETs: CD8+ 541 cells/mm2 and CD4+ 861 cells/mm2 (p ≤ 0.0001).CONCLUSION: PanNETs and siNETs are immune cold with no evidence of T cell exclusion; the low density of immune infiltrates indicates poor antitumour immune responses.</p