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BackgroundDespite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. ObjectiveWe conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. MethodsThese two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. ResultsThe baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. ConclusionsThe substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. Trial RegistrationPROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 International Registered Report Identifier (IRRID)DERR1-10.2196/29084

Background: Inclusive research requires adapting methodologies to meet the needs of people with all degrees of intellectual disabilities. However, it must also balance this with the requirements of academic research. Building from previous research a study was completed to illustrate how photovoice could not only be adapted to meet the needs of people with intellectual disabilities who have limited or no verbal communication but to also explore how they express their identity. Methods: A qualitative multiple case study method was used to explore identity expression amongst three participants with intellectual disabilities and limited or no verbal communication. The methodology integrated ethnographic observations, photovoice and interview techniques. Findings: Integrating the ethnographic observations, photovoice and interview techniques offered families and carers the opportunity to become curious about participants' identities, and this methodology was considered valuable in getting to know more about the person. Conclusions: It is hoped that through conducting research that directly involves people with intellectual disabilities, more creative and inclusive methods can be explored, verified and applied across various research contexts.

Simulation has proven effective for teaching skills to children with autism spectrum disorders (ASD). It involves supervised imitation of real-life activities in a controlled environment. As ASD children struggle with observational learning, simulated scenarios help them comprehend and learn appropriate behaviors. Simulation, like video modeling, where kids imitate behavior shown in videos, provides lifelike experiences for exploring and practicing skills. Research on the simulation method's impact on ASD children's social skills is limited, especially in developing countries like Pakistan. This study focused on using video modeling to enhance greeting and sharing skills in ASD students in Lahore. Employing a single-subject ABA design, three ASD students showed significant improvement in goal attainment after the intervention. The findings suggest that simulation method (video modeling) positively influences ASD children's social skills. [ABSTRACT FROM AUTHOR]

Sparfloxacin is a quinolone carboxylic acid derivative that shows activity as an antimicrobial agent, against a wide range of Gram-negative and Gram-positive organisms. It is clinically useful for the treatment of urinary tract infections, respiratory tract infections and gynecological infections. In this study in vitro drug-drug interaction of sparfloxacin has been carried out with famotidine and ranitidine. For these studies a two-component spectrophotometric process has been developed for sparfloxacin assay in the presence of famotidine or ranitidine. The reproducibility of the method is within ±5%. The technique has been applied to the development of sparfloxacin in methanol. The interaction studies of sparfloxacin with ranitidine and famotidine were carried out in methanol and methanol: Water mixtures (30:70, v/v; 50:50, v/v) and the kinetics of sparfloxacin degradation were evaluated in the presence and absence of famotidine and ranitidine. The decrease in the rate of degradation of sparfloxacin in the presence of famotidine or ranitidine, compared to that of sparfloxacin alone, indicated the possibility of interaction between the sparfloxacin and famotidine or ranitidine. The Thin layer chromatography (TLC) of the degraded solution showed the presence of a degradation product of sparfloxacin. The studies show that complexation with famotidine or ranitidine may affect the bioavailability of sparfloxacin. [ABSTRACT FROM AUTHOR]

The Individuals with High Prevalence Disabilities can be more annoying, uncooperative, and difficult type of human beings as compared to any normal individual (Federici, et al., 2017). This ultimately raises the level of burden related to clinical and of functional variable of families with disabilities (Irazábal, et al., 2012). Major objectives of the study were to see the significant differences between parents’ sufferings about children with High Prevalence Disabilities living in urban and rural areas, house wives or professional working mothers, their gender and qualification. A Sample of (N = 421) parents living in urban areas (N= 220) and rural areas (N = 201) was randomly taken from the province of Punjab, Pakistan. The researchers used self-developed research tool (reliable at Alpha= 0.93) to answer the questions of present study. The researchers in to two teams personally visited the parents and collected the data by translating the questionnaire in their native languages. The major findings confirmed that there are significant differences among all demographic variables such as gender, age, locality, and education of parents on enduring individuals with high prevalence disabilities in Punjab. It isrecommended that awareness seminars and workshops should be conducted at all levels by the teachers to change negative attitudes of parents to endure their children with high prevalence disabilities. [ABSTRACT FROM AUTHOR]

Children with cerebral palsy (CWCP) were the focus of this study, which aimed to develop an interventional package to improve their fine motor skills (FMS). Study was applied research in its nature. In addition, it was a R & D study that utilized a qualitative research approach. The study's participants included physiotherapists and occupational therapists who work with children with cerebral palsy. A total of 100 professionals, including 50 physiotherapists and 50 occupational therapists, were selected for the study's data collection. Purposive sampling was used to pick the participants. A variety of exercises and therapies were the subject of in-depth interviews in order to compile a comprehensive intervention package. Incorporating the suggestions and recommendations of physiotherapists and occupational therapists, the package included a variety of exercises, activities, and practices aimed at improving FMS in CWCP. The package's validity, usability, and feasibility were verified by the opinions of experts. The package was developed for students in special education programmes ranging from public and private schools with CWCP ages 5 to ten. Thematic analysis was used to examine the study's qualitative data. The package developed by the researcher was found to be useful, feasible, and practical for teachers to implement for the development of the FMS of the C.W.C.P. The study's findings and conclusions will have a significant impact on future research. [ABSTRACT FROM AUTHOR]

Sports and physical activity tend to contributes in improving balance, posture, coordination,motor skills and quality of life among children with visual impairment (VI) (Bouchard &Tétreault, 2000; Ilhan et al., 2021). It promotes fitness, ensures health benefits (Haegele&Porretta, 2015) and positively impact on ability to perform daily live activities (EngelYeger&Hamed-Daher, 2013). This study intends to identify the barriers of physical activity for children with VI in Pakistan, and at the same time aims to explore the possible facilitators that may be in practice or are possible in the context of Pakistan to support inclusive sports and physical activity of children with VI in Pakistan. Using descriptive research, a sample of 200 special education teachers of students with VI (senior special education teachers (N=75), junior special education teachers (N=75) and orientation mobility instructors(N= 50)) was taken from special education department Govt. of Punjab, Pakistan by using simple random sampling technique. Two self-developed scales, Barriers Identification Scale and Facilitating Strategies Scale were used for the data collection. The collected data was analyzed by computing mean scores, ANOVA & t-test through SPSS. [ABSTRACT FROM AUTHOR]

Background and Aims: Pathogenic variants in the desmoplakin (DSP) gene are associated with the development of a distinct arrhythmogenic cardiomyopathy phenotype not fully captured by either dilated cardiomyopathy (DCM), non-dilated left ventricular cardiomyopathy (NDLVC), or arrhythmogenic right ventricular cardiomyopathy (ARVC). Prior studies have described baseline DSP cardiomyopathy genetic, inflammatory, and structural characteristics. However, cohort sizes have limited full clinical characterization and identification of clinical and demographic predictors of sustained ventricular arrhythmias (VAs), heart failure (HF) hospitalizations, and transplant/death. In particular, the relevance of acute myocarditis-like episodes for subsequent disease course is largely unknown., Methods: All patients with pathogenic/likely pathogenic (P/LP) DSP variants in the worldwide DSP-ERADOS Network (26 academic institutions across nine countries) were included. The primary outcomes were the development of sustained VA and HF hospitalizations during follow-up. Fine-Gray regressions were used to test association between clinical and instrumental parameters and the development of outcomes., Results: Eight hundred patients [40.3 ± 17.5 years, 47.5% probands, left ventricular ejection fraction (LVEF) 49.5 ± 13.9%] were included. Over 3.7 [1.4-7.1] years, 139 (17.4%, 3.9%/year) and 72 (9.0%, 1.8%/year) patients experienced sustained VA and HF episodes, respectively. A total of 32.5% of individuals did not fulfil diagnostic criteria for ARVC, DCM, or NDLVC; their VA incidence was 0.5%/year. In multivariable regression, risk features associated with the development of VA were female sex [adjusted hazard ratio (aHR) 1.547; P = .025], prior non-sustained ventricular tachycardia (aHR 1.721; P = .009), prior sustained VA (aHR 1.923; P = .006), and LVEF ≤ 50% (aHR: 1.645; P = .032), while for HF, they were the presence of T-wave inversion in 3+ electrocardiogram leads (aHR 2.036, P = .007) and LVEF ≤ 50% (aHR 3.879; P < .001). Additionally, 70 (8.8%) patients experienced a myocardial injury episode at presentation or during follow-up. These episodes were associated with an increased risk of VA and HF thereafter (HR 2.394; P < .001, and HR 5.064, P < .001, respectively)., Conclusions: Patients with P/LP DSP variants experience high rates of sustained VA and HF hospitalizations. These patients demonstrate a distinct clinical phenotype (DSP cardiomyopathy), whose most prominent risk features associated with adverse clinical outcomes are the presence of prior non-sustained ventricular tachycardia or sustained VA, T-wave inversion in 3+ leads on electrocardiogram, LVEF ≤ 50%, and myocardial injury events., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background and Aims: Pathogenic desmoplakin (DSP) gene variants are associated with the development of a distinct form of arrhythmogenic cardiomyopathy known as DSP cardiomyopathy. Patients harbouring these variants are at high risk for sustained ventricular arrhythmia (VA), but existing tools for individualized arrhythmic risk assessment have proven unreliable in this population., Methods: Patients from the multi-national DSP-ERADOS (Desmoplakin SPecific Effort for a RAre Disease Outcome Study) Network patient registry who had pathogenic or likely pathogenic DSP variants and no sustained VA prior to enrolment were followed longitudinally for the development of first sustained VA event. Clinically guided, step-wise Cox regression analysis was used to develop a novel clinical tool predicting the development of incident VA. Model performance was assessed by c-statistic in both the model development cohort (n = 385) and in an external validation cohort (n = 86)., Results: In total, 471 DSP patients [mean age 37.8 years, 65.6% women, 38.6% probands, 26% with left ventricular ejection fraction (LVEF) < 50%] were followed for a median of 4.0 (interquartile range: 1.6-7.3) years; 71 experienced first sustained VA events {2.6% [95% confidence interval (CI): 2.0, 3.5] events/year}. Within the development cohort, five readily available clinical parameters were identified as independent predictors of VA and included in a novel DSP risk score: female sex [hazard ratio (HR) 1.9 (95% CI: 1.1-3.4)], history of non-sustained ventricular tachycardia [HR 1.7 (95% CI: 1.1-2.8)], natural logarithm of 24-h premature ventricular contraction burden [HR 1.3 (95% CI: 1.1-1.4)], LVEF < 50% [HR 1.5 (95% CI: .95-2.5)], and presence of moderate to severe right ventricular systolic dysfunction [HR 6.0 (95% CI: 2.9-12.5)]. The model demonstrated good risk discrimination within both the development [c-statistic .782 (95% CI: .77-.80)] and external validation [c-statistic .791 (95% CI: .75-.83)] cohorts. The negative predictive value for DSP patients in the external validation cohort deemed to be at low risk for VA (<5% at 5 years; n = 26) was 100%., Conclusions: The DSP risk score is a novel model that leverages readily available clinical parameters to provide individualized VA risk assessment for DSP patients. This tool may help guide decision-making for primary prevention implantable cardioverter-defibrillator placement in this high-risk population and supports a gene-first risk stratification approach., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: The FLNC gene has recently garnered attention as a likely cause of arrhythmogenic cardiomyopathy, which is considered an actionable genetic condition. However, the association with disease in an unselected clinical population is unknown. We hypothesized that individuals with loss-of-function variants in FLNC ( FLNC LOF ) would have increased odds for arrhythmogenic cardiomyopathy-associated phenotypes versus variant-negative controls in the Geisinger MyCode cohort., Methods: We identified rare, putative FLNC LOF among 171 948 individuals with exome sequencing linked to health records. Associations with arrhythmogenic cardiomyopathy phenotypes from available diagnoses and cardiac evaluations were investigated., Results: Sixty individuals (0.03%; median age 58 years [47-70 interquartile range], 43% male) harbored 27 unique FLNC LOF . These individuals had significantly increased odds ratios for dilated cardiomyopathy (odds ratio, 4.9 [95% CI, 2.6-7.6]; P <0.001), supraventricular tachycardia (odds ratio, 3.2 [95% CI, 1.1-5.6]; P =0.048), and left-dominant arrhythmogenic cardiomyopathy (odds ratio, 4.2 [95% CI, 1.4-7.9]; P =0.03). Echocardiography revealed reduced left ventricular ejection fraction (52±13% versus 57±9%; P =0.001) associated with FLNC LOF . Overall, at least 9% of FLNC LOF patients demonstrated evidence of penetrant disease., Conclusions: FLNC LOF variants are associated with increased odds of ventricular arrhythmia and dysfunction in an unselected clinical population. These findings support genomic screening of FLNC for actionable secondary findings.