Efficacy of learning through play plus intervention to reduce maternal depression in women with malnourished children: A randomized controlled trial from Pakistan

BACKGROUND:The risk factors and adverse outcomes related to maternal depression and child malnutrition are a leading cause of morbidity and mortality in low and middle-income countries (LMIC) including Pakistan. Above 25% of women suffer from maternal depression. Up to 50% children are under-nourished which contributes to 35% of all under-5 deaths in the country. AIM:To determine the efficacy of Learning through Play Plus Thinking Healthy Program (LTP Plus) intervention to reduce maternal depression in mothers with undernourished children. METHODS:In this randomised controlled trial, all eligible mothers presenting to the paediatric departments were invited to participate in the study. Out of the total 256 mothers screened, 107 were included, 54 of those were randomly allocated to LTP Plus group and 53 to treatment as usual (TAU). Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depression. Hamilton Depression Rating Scale (HDRS), Maternal Attachment Inventory (MAI), Social Support Scale (OSLO-3) and the Euro-QoL (EQ-5D) were used to measure the severity of depression, mother-child attachment, level of support and health related quality of life dimensions. Assessments were completed at baseline, end of intervention (3 months from baseline) and at 6 months from baseline. RESULTS:Mothers in the LTP Plus group significantly showed improvements in depression (p<0.001), social support (p = 0.02) and quality of life (p<0.001) at the end of the intervention (LTP Plus), as compared to the TAU group, which were sustained up to 6 months after baseline. CONCLUSION:The outcomes of LTP Plus intervention for mothers of malnourished children show promising results in reducing maternal depression and improving child outcomes. A full trial with longer-term outcomes and cost-effectiveness needs to be conducted

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Primary malignant pericardial mesothelioma: a case report

Metastases to the heart and pericardium are much more common than primary malignant neoplasms. Primary malignant pericardial mesothelioma is a rare tumor that arises from the mesothelial cells of the pericardium. It is usually characterized by a delayed diagnosis, a low response to treatment, and a poor prognosis with an overall survival up to six months after the onset of symptoms. We report a rare case of a 32-year-old woman with primary pericardial malignant mesothelioma that was diagnosed 4 months after the onset of pericardial effusion as the first clinical manifestation

University Instructors’ Perceptions toward Online Teaching at the Onset of the COVID-19 Outbreak in Lebanon: A Descriptive Study

Purpose: The study aims at understanding to what extent university instructors are ready for the sudden shift from face-to-face teaching to online teaching and how they perceive the usefulness and feasibility of this new modality of teaching. Methodology/Approach/Design: Faculty members from the nine campuses of the largest private university in Lebanon were invited to participate in the completion of a survey, made available in English and Arabic. The survey was completed by 692 respondents. Descriptive analyses were performed by summarizing the count and percentage of responses within each category. Results: Analyses showed that university instructors possess the infrastructure for online teaching. Moreover, they reported positive perceptions about their readiness to teach online and about the feasibility and usefulness of online teaching. However, instructors reported that online teaching was deficient in assessment, teaching large classrooms, and delivering the practical components of the courses they taught. Practical Implications: Findings suggest that instructors require formal training on how to integrate pedagogy with technology. Originality/Value: Since online instruction is new in Lebanon, the study findings can help universities and other educational institutions direct their efforts in their endeavor to improve their online experience

Effects of Exports Instability on Economic Growth in SAARC Region Countries

This study analyzed the hypothesis that export instability affects the economic growth for SAARC region countries (Pakistan, India, Sri-Lanka and Nepal) by using neoclassical aggregate production with export and export instability as the additional variables. TheAugmented Dickey Fuller (ADF) and Johansson Cointegration tests are used to test stationarity for all variables and cointegration respectively. The results of these tests demonstrate that all variables are non-stationary at levels but stationary at their firstdifference and co integrated of order I(1). Export instability has deleterious effects for these four countries on economic growth and its magnitude is higher for Sri Lanka economy. The exports and investment has positive and significant effects on economicgrowth for all countries except the Nepalese economy where export has negative but insignificant effect on its economic growth. The most important policy implications for these countries are that they should diversify their exports horizontally and liberalize their foreign exchange markets and capital accounts to control the instability in exports

Untangling the causal relationship between tax burden distribution and economic growth in 23 OECD countries: Fresh evidence from linear and non-linear Granger causality

The aim of the paper is to investigate the linear and nonlinear causality between a set of alternative tax burden ratios and economic growth in 23 OECD countries. To that end, the linear causality approach of Toda– Yamamoto (1995) and the nonparametric causality method of Kyrtsou and Labys (2006) are applied to annual data spanning from 1970 to 2014. Results obtained from the nonlinear causality test tend to reject the neutrality hypothesis for the tax structure–growth relationship in 19 of the 23 OECD countries. In the majority of the countries under investigation, the evidence is in line with the growth hypothesis where causality running from economic growth to tax burden ratios was detected in Australia, Denmark, Finland, Japan, New Zealand, and Norway. The opposite causality running from tax structure to economic growth was found in Germany, Netherlands, Portugal, and Sweden. In contrast, the neutrality hypothesis was supported in Austria, Italy, Luxembourg, and the USA, whereas the feedback hypothesis was supported in Turkey and the UK. Additional robustness checks show that when the signs of variations are taken into account, there is an asymmetric causality running from positive tax burden shocks to positive per capita GDP shocks for Belgium, France, and Turkey. Overall, our findings suggest that policy implications of the tax structure-economic growth relationships should be interpreted with caution, taking into account the test-dependent and country-specific results

Untangling the causal relationship between tax burden distribution and economic growth in 23 OECD countries: Fresh evidence from linear and non-linear granger causality

The aim of the paper is to investigate the linear and nonlinear causality between a set of alternative tax burden ratios and economic growth in 23 OECD countries. To that end, the linear causality approach of Toda– Yamamoto (1995) and the nonparametric causality method of Kyrtsou and Labys (2006) are applied to annual data spanning from 1970 to 2014. Results obtained from the nonlinear causality test tend to reject the neutrality hypothesis for the tax structure–growth relationship in 19 of the 23 OECD countries. In the majority of the countries under investigation, the evidence is in line with the growth hypothesis where causality running from economic growth to tax burden ratios was detected in Australia, Denmark, Finland, Japan, New Zealand, and Norway. The opposite causality running from tax structure to economic growth was found in Germany, Netherlands, Portugal, and Sweden. In contrast, the neutrality hypothesis was supported in Austria, Italy, Luxembourg, and the USA, whereas the feedback hypothesis was supported in Turkey and the UK. Additional robustness checks show that when the signs of variations are taken into account, there is an asymmetric causality running from positive tax burden shocks to positive per capita GDP shocks for Belgium, France, and Turkey. Overall, our findings suggest that policy implications of the tax structure-economic growth relationships should be interpreted with caution, taking into account the test-dependent and country-specific results