NOONAN’S SYNDROME

The clinical case an adult patient with rare genetically heterogeneous disorder combine with congenital heart diseases and multiple stigmas of disembryogenesis, currently presenting mostly with signs of pulmonary hypertension have been reviewed. Patient is presented with definitive Noonan’s syndrome according scoring system of Van Der Burgt (has 2 major criteria). The data of the laboratory and instrumental diagnostic methods, clinical diagnosis, selection of the optimized treatment and modification of the habit of life are given

International financial reporting standards (IFRSs) adoption in Africa: Abibliometric analysis

Countries in Africa have since joined their counterparts in other regions of the world in adopting IFRSs with over 30 countries either requiring or permitting its use for its companies. This study contributes to academic literature as it presents a bibliometric analysis on the state of IFRS research in Africa. The analysis involves 73 published articles listed on Scopus database between 2005 and 2018. Key findings in the study indicate that the first research document on Scopus database on IFRS in Africa was in 2005, despite its early adoption since 1993 in Zimbabwe. There is a continued upward growth in the volume of publications and citations over the years. The year of first IFRSs adoption is not associated with the volume of publication. Top five leaders in the volume of publication on IFRSs include Tunisia and Egypt, these countries are yet to adopt IFRSs. The dominant subject areas on IFRSs research are Business, Management & Accounting, Economics, Econometrics & Finance and Social Sciences. Only 21 authors and 18 institutions out of over 600 institutions in Africa contribute more than one publication to IFRS research. These institutions and authors are all in six African countries (South Africa, Nigeria, Tunisia, Egypt, Uganda and Ghana). Recommendations from the result include the need for higher visibility of research on IFRS. Approximately 87% of the publications are non-open access and the need for more academic conference on IFRS as conference proceedings accounts for only 11%

Diacritics improve comprehension of the Arabic script by providing access to the meanings of heterophonic homographs

The diacritical markers that represent most of the vowels in the Arabic orthography are generally omitted from written texts. Previous research revealed that the absence of diacritics reduces reading comprehension performance even by skilled readers of Arabic. One possible explanation is that many Arabic words become ambiguous when diacritics are missing. Words of this kind are known as heterophonic homographs and are associated with at least two different pronunciations and meanings when written without diacritics. The aim of the two experiments reported in this study was to investigate whether the presence of diacritics improves the comprehension of all written words, or whether the effects are confined to heterophonic homographs. In Experiment 1, adult readers of Arabic were asked to decide whether written words had a living meaning. The materials included heterophonic homographs that had one living and one non-living meaning. Results showed that diacritics significantly increased the accuracy of semantic decisions about ambiguous words but had no effect on the accuracy of decisions about unambiguous words. Consistent results were observed in Experiment 2 where the materials comprised sentences rather than single words. Overall, the findings suggest that diacritics improve the comprehension of heterophonic homographs by facilitating access to semantic representations that would otherwise be difficult to access from print

Quality of care in elder emergency department patients with pneumonia: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The goals of the study were to assess the relationship between age and processes of care in emergency department (ED) patients admitted with pneumonia and to identify independent predictors of failure to meet recommended quality care measures.</p> <p>Methods</p> <p>This was a prospective cohort study of a pre-existing database undertaken at a university hospital ED in the Midwest. ED patients ≥18 years of age requiring admission for pneumonia, with no documented use of antibiotics in the 24 hours prior to ED presentation were included. Compliance with Pneumonia National Quality Measures was assessed including ED antibiotic administration, antibiotics within 4 hours, oxygenation assessment, and obtaining of blood cultures. Odds ratios were calculated for elders and non-elders. Logistic regression was used to identify independent predictors of process failure.</p> <p>Results</p> <p>One thousand, three hundred seventy patients met inclusion criteria, of which 560 were aged ≥65 years. In multiple variable logistic regression analysis, age ≥65 years was independently associated with receiving antibiotics in the ED (odds ratio [OR] = 2.03, 95% CI 1.28–3.21) and assessment of oxygenation (OR = 2.10, 95% CI, 1.18–3.32). Age had no significant impact on odds of receiving antibiotics within four hours of presentation (OR 1.10, 95% CI 0.84–1.43) or having blood cultures drawn (OR 1.02, 95%CI 0.78–1.32). Certain other patient characteristics were also independently associated with process failure.</p> <p>Conclusion</p> <p>Elderly patients admitted from the ED with pneumonia are more likely to receive antibiotics while in the ED and to have oxygenation assessed in the ED than younger patients. The independent association of certain patient characteristics with process failure provides an opportunity to further increase compliance with recommended quality measures in admitted patients diagnosed with pneumonia.</p

Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians

BACKGROUND: As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates (LMG) in the US, and compared their characteristics to those of US medical graduates (USMG) and other international medical graduates (IMG). METHODS: We evaluated the number of LMG using the 2004 the American Medical Association Physicians' Professional Data (AMA-PPD) and then compared it to the number of graduates of other countries. We evaluated the historical trends using the 1978–2004 historical files of the AMA-PPD. We analyzed the characteristics of all LMG and compared them to a random sample of 1000 USMG and a random sample of 1000 IMG using the 2004 AMA-PPD. RESULTS: In 2004, there were 2,796 LMG in the US, constituting 1.3% of all IMG. Compared to other foreign countries contributing to the US physician workforce, Lebanon ranked 2nd after adjusting for country population size (about 4 million) and 21st overall. About 40% of those who graduated from Lebanese medical schools in the last 25 years are currently active physicians in the US. Since 1978, the number of LMG in the US showed a consistent upward trend at a rate of approximately 71 additional graduates per year. Compared with USMG and IMG, LMG were more likely to work in medical research (OR = 2.31; 95% Confidence Interval (CI) = 1.21; 4.43 and OR = 2.63; 95% CI = 1.34; 5.01, respectively) and to be board certified (OR = 1.43; 95% CI = 1.14; 1.78 and OR = 2.04; 95% CI = 1.65;2.53, respectively) and less likely to be in family practice (OR = 0.14; 95% CI = 0.10; 0.19 and OR = 0.18; 95% CI = 0.12; 0.26, respectively). CONCLUSION: Given the magnitude and historical trends of migration of LMG to the US, further exploration of its causes and impact is warranted. High income countries should consider the consequences of their human resources policies on both low income countries' and their own healthcare systems

Post-graduation migration intentions of students of Lebanese medical schools: a survey study

<p>Abstract</p> <p>Background</p> <p>The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans.</p> <p>Methods</p> <p>Our target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about student's demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon.</p> <p>Results</p> <p>Of 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2^ndcitizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty.</p> <p>Conclusion</p> <p>An alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.</p

Multicenter phase II study of brequinar sodium in patients with advanced gastrointestinal cancer

Eighty-six patients with advanced colorectal, gastric or pancreatic carcinoma and no prior exposure to chemotherapy were treated with brequinar sodium. Brequinar was administered at a median weekly dose of 1200 mg/m 2 intravenously. The toxicity was moderate, with thirty patients (35%) experiencing grade 3 or 4 toxicity. Objective responses were observed in 1/32 evaluable colorectal and 2/29 evaluable gastric carcinoma patients. There were no objective responses in 17 evaluable pancreatic cancer patients. We conclude that, at this dose and schedule, brequinar does not have sufficient activity in these gastrointestinal malignancies to warrant further evaluation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45168/1/10637_2004_Article_BF00873913.pd

Recruitment of a SAP18-HDAC1 Complex into HIV-1 Virions and Its Requirement for Viral Replication

HIV-1 integrase (IN) is a virally encoded protein required for integration of viral cDNA into host chromosomes. INI1/hSNF5 is a component of the SWI/SNF complex that interacts with HIV-1 IN, is selectively incorporated into HIV-1 (but not other retroviral) virions, and modulates multiple steps, including particle production and infectivity. To gain further insight into the role of INI1 in HIV-1 replication, we screened for INI1-interacting proteins using the yeast two-hybrid system. We found that SAP18 (Sin3a associated protein 18 kD), a component of the Sin3a-HDAC1 complex, directly binds to INI1 in yeast, in vitro and in vivo. Interestingly, we found that IN also binds to SAP18 in vitro and in vivo. SAP18 and components of a Sin3A-HDAC1 complex were specifically incorporated into HIV-1 (but not SIV and HTLV-1) virions in an HIV-1 IN–dependent manner. Using a fluorescence-based assay, we found that HIV-1 (but not SIV) virion preparations harbour significant deacetylase activity, indicating the specific recruitment of catalytically active HDAC into the virions. To determine the requirement of virion-associated HDAC1 to HIV-1 replication, an inactive, transdominant negative mutant of HDAC1 (HDAC1H141A) was utilized. Incorporation of HDAC1H141A decreased the virion-associated histone deacetylase activity. Furthermore, incorporation of HDAC1H141A decreased the infectivity of HIV-1 (but not SIV) virions. The block in infectivity due to virion-associated HDAC1H141A occurred specifically at the early reverse transcription stage, while entry of the virions was unaffected. RNA-interference mediated knock-down of HDAC1 in producer cells resulted in decreased virion-associated HDAC1 activity and a reduction in infectivity of these virions. These studies indicate that HIV-1 IN and INI1/hSNF5 bind SAP18 and selectively recruit components of Sin3a-HDAC1 complex into HIV-1 virions. Furthermore, HIV-1 virion-associated HDAC1 is required for efficient early post-entry events, indicating a novel role for HDAC1 during HIV-1 replication

Configurational Thermodynamics of Alloyed Nanoparticles with Adsorbates

Changes in the chemical configuration of alloyed nanoparticle (NP) catalysts induced by adsorbates under working conditions, such as reversal in core–shell preference, are crucial to understand and design NP functionality. We extend the cluster expansion method to predict the configurational thermodynamics of alloyed NPs with adsorbates based on density functional theory data. Exemplified with PdRh NPs having O-coverage up to a monolayer, we fully detail the core–shell behavior across the entire range of NP composition and O-coverage with quantitative agreement to in situ experimental data. Optimally fitted cluster interactions in the heterogeneous system are the key to enable quantitative Monte Carlo simulations and design