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Background: Lung cancer in Australia contributes 9% of all new cancer diagnoses and is the leading cause of cancer death and burden. Clinical practice guidelines provide evidence-based treatment recommendations for best practice management. We aimed to determine the extent of delivery of guideline-concordant treatment (GCT) and to identify modifiable variables influencing receipt of GCT and survival., Methods: Data was sourced from the Victorian Lung Cancer Registry (VLCR) in Victoria, Australia. Descriptive statistics were used to summarize patient and disease characteristics according to treatment type: GCT versus non-GCT versus no/declined treatment. Statistical analyses included multiple logistic regression, multiple COX regression and Kaplan-Meier survival estimates., Results: 52% of patients were treated with GCT, 32.8% non-GCT and 15.2% declined or received no treatment. GCT treated patients were younger, never smoked, had no comorbidities, had better performance status, had early stage cancer, were discussed at a multidisciplinary meeting or had treatment at a higher volume hospital. Overall, patients that received GCT had a 24% lower risk of mortality compared to patients that received non-GCT., Conclusion: Modifiable variables impacting likelihood of receiving GCT included age, smoking status and treating hospital characteristics. Several modifiable variables were identified with positive impacts on survival including increased treatment of the elderly, smoking cessation, delivery of GCT, and treatment in higher volume hospitals. The measurement and reporting of delivery of GCT has positive impacts on survival and therefore merits consideration as an evidence-based quality indicator in the reporting of lung cancer quality and safety outcomes., Competing Interests: Disclosure All other authors state that they have no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background and Aim: Risk adjustment following percutaneous coronary intervention (PCI) is vital for clinical quality registries, performance monitoring, and clinical decision-making. There remains significant variation in the accuracy and nature of risk adjustment models utilised in international PCI registries/databases. Therefore, the current systematic review aims to summarise preoperative variables associated with 30-day mortality among patients undergoing PCI, and the other methodologies used in risk adjustments., Method: The MEDLINE, EMBASE, CINAHL, and Web of Science databases until October 2022 without any language restriction were systematically searched to identify preoperative independent variables related to 30-day mortality following PCI. Information was systematically summarised in a descriptive manner following the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. The quality and risk of bias of all included articles were assessed using the Prediction Model Risk Of Bias Assessment Tool. Two independent investigators took part in screening and quality assessment., Results: The search yielded 2,941 studies, of which 42 articles were included in the final assessment. Logistic regression, Cox-proportional hazard model, and machine learning were utilised by 27 (64.3%), 14 (33.3%), and one (2.4%) article, respectively. A total of 74 independent preoperative variables were identified that were significantly associated with 30-day mortality following PCI. Variables that repeatedly used in various models were, but not limited to, age (n=36, 85.7%), renal disease (n=29, 69.0%), diabetes mellitus (n=17, 40.5%), cardiogenic shock (n=14, 33.3%), gender (n=14, 33.3%), ejection fraction (n=13, 30.9%), acute coronary syndrome (n=12, 28.6%), and heart failure (n=10, 23.8%). Nine (9; 21.4%) studies used missing values imputation, and 15 (35.7%) articles reported the model's performance (discrimination) with values ranging from 0.501 (95% confidence interval [CI] 0.472-0.530) to 0.928 (95% CI 0.900-0.956), and four studies (9.5%) validated the model on external/out-of-sample data., Conclusions: Risk adjustment models need further improvement in their quality through the inclusion of a parsimonious set of clinically relevant variables, appropriately handling missing values and model validation, and utilising machine learning methods., Competing Interests: Conflicts of Interest There are no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Aims: We aimed to assess the association of a low carbohydrate diet score (LCD) with the incidence of type 2 diabetes (T2D) using Melbourne Collaborative Cohort Study (MCCS) data., Methods: Between 1990 and 1994, the MCCS recruited 41,513 people aged 40-69 years. The first and second follow-ups were conducted in 1995-1998 and 2003-2007, respectively. We analyzed data from 39,185 participants. LCD score was calculated at baseline as the percentage of energy from carbohydrate, fat, and protein. The higher the score the less percentage of carbohydrates contributed to energy intake. The association of LCD quintiles with the incidence of diabetes was assessed using modified Poisson regression, adjusted for lifestyle, obesity, socioeconomic and other confounders. Mediation of the association by adiposity (BMI) was assessed., Results: LCD was positively associated with diabetes risk. Higher LCD score (p for trend = 0.001) was associated with increased risk of T2D. Quintile 5 (38 % energy from carbohydrates) versus quintile 1 (55 % energy from carbohydrates) showed a 20 % increased diabetes risk (incidence risk ratio (IRR) = 1.20 (95 % CI: 1.05-1.37)). A further adjustment for BMI (Body Mass Index) and WHR (Waist-to-Hip-Ratio) eliminated the association. Mediation analysis demonstrated that BMI mediated 76 % of the LCD & diabetes association., Conclusions: Consuming a low carbohydrate diet, reflected as a high LCD score, may increase the risk of T2D which is largely explained by obesity. Results highlight the need for further studies, including clinical trials investigating the effects of a low carbohydrate diet in T2D., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Professor Barbora de Courten reports financial support was provided by VicHealth, Cancer Council Victoria and Australian National Health and Medical Research Council. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This retrospective study was conducted in 2017 during the dual dengue and chikungunya outbreak in Bangladesh. Febrile participants underwent blood tests for chikungunya, dengue, and ABO groups and rhesus (Rh) factors. Blood grouping information was gathered from healthy donors. Males and those aged between 18 and 49 years had a higher risk of contracting dengue and chikungunya. Blood group O exhibited the highest infection rates at ∼50%, whereas group AB had the lowest at ∼9% among the participants in the study. Yet, when considering the general population's blood group distribution, the combined odds of infection were 2.0, 3.5, and 1.4 times higher in groups B, O, and AB, respectively, than in group A. Infection rates were greater in Rh-negative people. Blood groups B, O, and AB showed higher susceptibility than blood group A according to adjusted odds ratios. Blood groups ABO and Rh factor hold significance in disease susceptibility and vaccine effectiveness. Keeping these implications in mind, further investigations are necessary to understand the mechanisms underlying these connections and their effects on the efficacy of dengue and chikungunya vaccines.

Objective: To analyze the efficacy of a modified approach to thyroplasty type one using prolene mesh implant., Study Design: Interventional study., Place and Duration of Study: Combined Military Hospital Kharian, Pakistan, in Ent department, from July 2020 to Jan 2021., Methodology: Medialization thyroplasty with prolene mesh was performed on the patients satisfying the inclusion criteria. They were analyzed objectively as well as subjectively in terms of Mean Maximum phonation time, maximum word count, and visual analog score about the quality of voice. Data analysis was done with SPSS version 20. Pre-operative and post-operative records were compared using paired sample t-test., Results: A total of 39 patients underwent vocal cord medialization with prolene mesh implant. The Mean age for medialization was 41.09 + 13.37. 23 patients were females and 15 were males. 26 patients had unilateral and 13 patients had bilateral vocal dysfunction. 18 of them had vocal dysfunction due to thyroidectomy, eight had idiopathic causes and 13 had miscellaneous. The improvement in mean visual analog score was 2.87 postoperatively. Median maximum phonation time increased about five seconds postoperatively, seven seconds in males, and 4.5 seconds for females. The maximum word count increased from 11.33 preoperatively to 18.28 postoperatively. There were no major complications observed in our study., Conclusion: These results were comparable to many other studies for vocal cord medialization with different implant materials. But prolene mesh implant offers an easily available yet cost-effective alternative with similar benefits., Level of Evidence: III (Treatment benefits: Non-randomized controlled cohort/follow-up study)., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Growth in the online survey market may be increasing response burden and possibly jeopardizing higher response rates. This meta-analysis evaluated survey trends over one decade (2011-2020) to determine: (1) changes in survey publication rates over time, (2) changes in response rates over time, (3) typical response rates within health sciences education research, (4) the factors influencing survey completion levels, and (5) common gaps in survey methods and outcomes reporting. Study I estimated survey publication trends between 2011 and 2020 using articles published in the top three health sciences education research journals. Study II searched the anatomical sciences education literature across six databases and extracted study/survey features and survey response rates. Time plots and a proportional meta-analysis were performed. Per 2926 research articles, the annual estimated proportion of studies with survey methodologies has remained constant, with no linear trend (p > 0.050) over time (Study I). Study II reported a pooled absolute response rate of 67% (95% CI = 63.9-69.0) across 360 studies (k), totaling 115,526 distributed surveys. Despite response rate oscillations over time, no significant linear trend (p = 0.995) was detected. Neither survey length, incentives, sponsorship, nor population type affected absolute response rates (p ≥ 0.070). Only 35% (120 of 339) of studies utilizing a Likert scale reported evidence of survey validity. Survey response rates and the prevalence of studies with survey methodologies have remained stable with no linear trends over time. We recommend researchers strive for a typical absolute response rate of 67% or higher and clearly document evidence of survey validity for empirical studies., (© 2023 American Association for Anatomy.)

Recovery of noble materials from waste is essential for industries around the globe. Dielectrophoretic (DEP) filtration, an electrically switchable particle separation technique, can be applied to tackle this challenge. It is highly selective regarding particle size, material or shape. Expanding the scope of DEP towards high throughput and improving the trapping efficiency are vital to make DEP a viable robust alternative to conventional separation methods. DEP filtration works by selective immobilisation of particles in a porous medium by the action of an inhomogeneous electric field. The field inhomogeneity comes from scattering an electric field at the phase boundary between the particle suspension and the filter surface. In this article, we show how the filter structure affects the DEP separation. We study fixed bed filters of three different grain types and find that the morphology of the grains highly influences the DEP filter efficiency. Specifically, grains with irregular surface structure and high perceived angularity show high separation efficiency. We believe these insights into the design of DEP filtration will pave the way towards its application in, for example, the recovery of valuable materials from electronic waste dust., (© 2023 The Authors. Electrophoresis published by Wiley-VCH GmbH.)

Objectives: To systematically review the impact of mindfulness-based interventions (MBIs) on the academic performance of undergraduate medicine, nursing and allied health students., Methods: Randomised controlled trials that examined the effects of MBIs in medicine, nursing and allied health students on academic performance were eligible for inclusion. Electronic database searches were conducted across Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), PsycINFO and ERIC databases. Two authors independently reviewed citations, extracted data and assessed the quality of evidence using the Cochrane Collaboration's risk of bias tool. A descriptive analysis of included studies and a meta-analysis using a random-effects model of standardised mean difference were performed., Results: A total of 267 studies were returned from the search, of which 2 met the inclusion criteria. The overall risk of bias was assessed as unclear risk of bias for one study and high risk of bias for second included study. A meta-analysis of MBIs on student academic performance as measured by marks in written examination indicated no statistical difference between interventions (Standardised Mean Difference (SMD)=0.43, 95% CI -1.77 to 2.62, I 2 =96%)., Discussion: Our systematic review highlights a lack of evidence to either support, or refute, the use of mindfulness interventions on the academic performance of undergraduate medical students. We encourage that future randomised controlled trials pay heed to the dosing of mindfulness and include a measurement of mindfulness to enable us to draw a clearer causal relationship., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Uncertainty tolerance (UT) is increasingly valued as a medical graduate attribute and broadly measured among medical student populations. However, the validity evidence underpinning UT scale implementation has not been summarised across studies. The present work evaluates UT scale validity evidence to better inform when, why and how UT scales ought to be used and to identify remaining validity evidence gaps., Methods: A literature search for psychometric studies of UT scales was completed in 2022. Records were included if they implemented one of the four most cited UT scales (i.e. Physicians' Reactions to Uncertainty scale 1990 [PRU1990] or 1995 [PRU1995], Tolerance for Ambiguity [TFA] scale or Tolerance of Ambiguity in Medical Students and Doctors scale [TAMSAD]) in a population of physicians and/or medial students and presented validity evidence according to the Standards for Educational and Psychological Testing framework. Included studies were rated and analysed according to evidence for test content, response processes, internal structure, relations to other variables and consequences of testing., Results: Among the investigated scales, 'relations to other variables' and 'internal structure' were the most commonly reported forms of validity evidence. No evidence of 'response processes' or 'consequences of testing' was identified. Overall, the PRU1990 and PRU1995 demonstrated the strongest validity evidence, although evidence primarily related to physician populations., Conclusions: None of the studied scales demonstrated evidence for all five sources of validity. Future research would benefit from assessing validity evidence for 'response processes' and 'consequences of testing' among physicians and medical students at different training/career stages to better understand UT construct conceptualisation in these populations. Until further and stronger validity evidence for UT scales is established, we caution against implementing UT scales outside of research settings (e.g. for higher stakes decision making)., (© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Aim: To assess the associations of total dietary fibre and fibre from different food sources (ie, cereal, fruit and vegetables) with the risk of diabetes., Materials and Methods: The Melbourne Collaborative Cohort Study enrolled 41 513 participants aged 40 to 69 years from 1990 to 1994. The first and second follow-ups were conducted in 1994 to 1998 and 2003 to 2007, respectively. Self-reported diabetes incidence was recorded at both follow-ups. We analysed data from 39 185 participants, with a mean follow-up of 13.8 years. The relationships between dietary fibre intake (total, fruit, vegetable and cereal fibre) and the incidence of diabetes were assessed using modified Poisson regression, adjusted for dietary, lifestyle, obesity, socioeconomic and other possible confounders. Fibre intake was categorized into quintiles., Results: At total of 1989 incident cases were identified over both follow-up surveys. Total fibre intake was not associated with diabetes risk. Higher intake of cereal fibre (P for trend = 0.003), but not fruit (P for trend = 0.3) and vegetable fibre (P for trend = 0.5), was protective against diabetes. For cereal fibre, quintile 5 versus quintile 1 showed a 25% reduction in diabetes risk (incidence risk ratio [IRR] 0.75, 95% confidence interval [CI] 0.63-0.88). For fruit fibre, only quintile 2 versus quintile 1 showed a 16% risk reduction (IRR 0.84, 95% CI 0.73-0.96). Adjustment for body mass index (BMI) and waist-to-hip ratio eliminated the association and mediation analysis showed that BMI mediated 36% of the relationship between fibre and diabetes., Conclusion: Intake of cereal fibre and, to a lesser extent, fruit fibre, may reduce the risk of diabetes, while total fibre showed no association. Our data suggest that specific recommendations regarding dietary fibre intake may be needed to prevent diabetes., (© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Objective: To compare the efficacy of two main treatment modalities of microdebrider and carbon dioxide laser excision for juvenile onset recurrent respiratory papillomatosis., Methods: The retrospective study was conducted in May 2021 at the Combined Military Hospital, Kharian, Pakistan, and comprised data from July 1, 2007, to January 31, 2020, of patients of either gender aged 2-12 years who were treated for juvenile onset recurrent respiratory papillomatosis either with microdebrider excision in group A or carbon dioxide laser excision in group B. Extent and severity of disease was documented as per the Derkay-Coltrera grading system. Data was analysed using SPSS 20., Results: Of the 39 patients, 23(59%) were girls and 16(41%) were boys. The overall mean age at the time of procedure was 6.62±2.06 years. Group A had 22(56.4%) subjects; 15(68.2%) girls and 7(31.8%) boys, while group B had 17(43.6%) cases; 8(47%) girls and 9(53%) boys. The mean operative time for group A was 40.91±11.50 minutes and for group B it was 60.59±19.51 minutes. Postoperative breathing and oedema status was better for group A (p<0.05), while there was no significant difference regarding postoperative pain, residual disease and repeat surgeries (p>0.05)., Conclusions: Microdebrider was found to be superior to carbon dioxide laser excision in the treatment of juvenile onset recurrent respiratory papillomatosis.

Introduction: Globally, the coronavirus (COVID-19) pandemic poses fundamental challenges in everyday life. Various controlling measures, including nationwide lockdowns, movement restrictions, travel bans, social distancing, and improved hygiene practices, have been widely introduced to curtail transmission of the disease. Notably, these measures have affected the execution of population health research that typically involves face-to-face data collection. This paper details a subjective reflective account of the challenges and mitigating strategies in conducting a nationwide study during the COVID-19 pandemic in 2021. Challenges and strategies: The research team faced a wide range of challenges in conducting this study. The major categories of challenges were defined as follows: (i) challenges relating to the COVID-19 pandemic, such as insufficient access to field sites; (ii) challenges related to contextual factors, such as cultural and gender sensitivity and extreme weather events; and (iii) challenges related to data quality and validity. The key mitigating strategies to overcoming these challenges included engaging a local-level field supervisor, hiring data collectors from respective study sites, incorporating team members' reviews of literature and experts' views to develop research instruments, modifying original research instruments, organizing regular meetings and debriefing, adjusting field operation plans, building gender-sensitive teams, understanding local norms and adopting culturally appropriate dress codes, and conducting interviews in local languages. Conclusions: This paper concludes that despite several COVID-19-related challenges coupled with contextual factors, data were successfully collected through timely and successful adaptations of several mitigating strategies. The strategies adopted in this study may be useful for overcoming unforeseeable challenges in planning and conducting future population-based health research in similar circumstances elsewhere.

Background: The rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs)., Methods: A cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities' readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered 'ready' to manage NCDs., Results: The general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs., Conclusion: All levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh., (© 2023. The Author(s).)

Dengue is among the fastest-spreading vector-borne infectious disease, with outbreaks often overwhelm the health system and result in huge morbidity and mortality in its endemic populations in the absence of an efficient warning system. A large number of prediction models are currently in use globally. As such, this study aimed to systematically review the published literature that used quantitative models to predict dengue outbreaks and provide insights about the current practices. A systematic search was undertaken, using the Ovid MEDLINE, EMBASE, Scopus and Web of Science databases for published citations, without time or geographical restrictions. Study selection, data extraction and management process were devised in accordance with the 'Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies' ('CHARMS') framework. A total of 99 models were included in the review from 64 studies. Most models sourced climate (94.7%) and climate change (77.8%) data from agency reports and only 59.6% of the models adjusted for reporting time lag. All included models used climate predictors; 70.7% of them were built with only climate factors. Climate factors were used in combination with climate change factors (13.4%), both climate change and demographic factors (3.1%), vector factors (6.3%), and demographic factors (5.2%). Machine learning techniques were used for 39.4% of the models. Of these, random forest (15.4%), neural networks (23.1%) and ensemble models (10.3%) were notable. Among the statistical (60.6%) models, linear regression (18.3%), Poisson regression (18.3%), generalized additive models (16.7%) and time series/autoregressive models (26.7%) were notable. Around 20.2% of the models reported no validation at all and only 5.2% reported external validation. The reporting of methodology and model performance measures were inadequate in many of the existing prediction models. This review collates plausible predictors and methodological approaches, which will contribute to robust modelling in diverse settings and populations., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright: © 2023 Leung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The clinical utility of transthoracic echocardiography with contrast (TTE-C) for detection of right-to-left shunt (RLS) remains unknown. In this meta-analysis we evaluated the accuracy of TTE-C for RLS diagnosis compared with transesophageal echocardiography (TEE) as the reference standard., Methods: A systematic review and meta-analysis was performed using a search of MEDLINE, EMBASE, PubMed, and Cochrane library databases. Studies that were included provided data to assess sensitivity and specificity of TTE-C compared with TEE for RLS detection., Results: A total of 35 studies, involving 4209 patients, were analyzed. The average patient age was 49.1 ± 11.2 years and 53.9% were male. For RLS detection in the entire cohort, TTE-C sensitivity was 73% (95% confidence interval [CI], 66%-80%) and specificity was 94% (95% CI, 92%-96%). The sensitivity of TTE-C was 80% (95% CI, 74%-86%) in studies published in 2000 or later compared with 51% (95% CI, 36%-65%) in those published before 2000. In studies that used harmonic imaging, TTE-C sensitivity was 82% (95% CI, 77%-87%) and specificity was 95% (95% CI, 93%-97%). Among those with patent foramen ovale closure indications, TTE-C sensitivity was 74% (95% CI, 59%-89%) and specificity was 98% (95% CI, 95%-100%). In patients in whom RLS was diagnosed using a guideline-suggested 3 cardiac cycle cutoff, TTE-C sensitivity was 75% (95% CI, 66%-83%) and specificity was 94% (95% CI, 92%-97%). Provocative manoeuvres increased sensitivity by approximately 40%., Conclusions: TTE-C offers excellent specificity and moderate sensitivity for RLS diagnosis compared with TEE, and it might therefore serve as an initial screening modality for selected patients with a high likelihood of having RLS and for indications for treatment., (Copyright © 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Introduction: The weak health system is viewed as a major systematic obstacle to address the rising burden of non-communicable diseases (NCDs) in resource-poor settings. There is little information about the health system challenges and opportunities in organizing NCD services. This study examined the health system challenges and opportunities in organizing NCD services for four major NCDs (cervical cancer, diabetes mellitus, cardiovascular diseases, and chronic respiratory illnesses) at the primary healthcare (PHC) level in Bangladesh., Methods: Using a qualitative method, data were collected from May to October 2021 by conducting 15 in-depth interviews with local healthcare providers, 14 key informant interviews with facility-based providers and managers, and 16 focus group discussions with community members. Based on a health system dynamics framework, data were analyzed thematically. Information gathered through the methods and sources was triangulated to validate the data., Results: Organization of NCD services at the PHC level was influenced by a wide range of health system factors, including the lack of using standard treatment guidelines and protocols, under-regulated informal and profit-based private healthcare sectors, poor health information system and record-keeping, and poor coordination across healthcare providers and platforms. Furthermore, the lack of functional referral services; inadequate medicine, diagnostic facilities, and logistics supply; and a large number of untrained human resources emerged as key weaknesses that affected the organization of NCD services. The availability of NCD-related policy documents, the vast network of healthcare infrastructure and frontline staff, and increased demand for NCD services were identified as the major opportunities., Conclusion: Despite the substantial potential, the health system challenge impeded the organization of NCD services delivery at the PHC level. This weakness needs be to addressed to organize quality NCD services to better respond to the rising burden of NCDs at the PHC level., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kabir, Karim and Billah.)

Objectives: To perform a systematic review and meta-analysis of the literature to understand the variation in the reporting of neuroendocrine staining and determine the influence of reporting neuroendocrine staining at diagnosis on patient outcomes., Methods: Medical databases were searched to identify studies in which adenocarcinoma specimens were stained with any of the following four neuroendocrine markers: chromogranin A (CgA), neuron-specific enolase (NSE), synaptophysin and CD56. The prevalence of neuroendocrine staining and correlation of the prevalence of neuroendocrine staining to patient outcomes were analysed using a random-effects model. All statistical tests were two-sided., Results: Sixty-two studies spanning 7616 patients were analysed. The pooled prevalence for the most common marker, CgA (41%), was similar to that of NSE (39%) and higher than that of synaptophysin (31%). The prevalence of CgA staining was significantly influenced by reporting criteria, where objective thresholds reduced the variation in prevalence to 26%. No correlation was found between CgA prevalence and tumour grade. Patients positive for CgA staining using objective criteria had more rapid biochemical progression (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.49 to 2.65) and poorer prostate cancer-specific survival (HR 7.03, 95% CI 2.55 to 19.39) compared to negative patients, even among those with low-risk cancers., Conclusion: Discrepancies in the reported prevalence of neuroendocrine cells in adenocarcinoma are driven by the inconsistent scoring criteria. This study unequivocally demonstrates that when neuroendocrine cell staining is assessed with objective criteria it identifies patients with poor clinical outcomes. Future studies are needed to determine the exact quantifiable thresholds for use in reporting neuroendocrine cell staining to identify patients at higher risk of progression., (© 2021 The Authors BJU International © 2021 BJU International.)

Purpose: Uncertainty tolerance (UT) is a construct describing individuals' perceptions of, and responses to, uncertainty across their cognition, emotion, and behavior. Various UT scales have been designed for physician and medical student populations. However, links between UT and other variables (e.g., training stages) are inconsistent, raising concerns about scale reliability and validity. As reliability is a precondition for validity, a necessary first step in assessing UT scales' efficacy is evaluating their reliability. Accordingly, the authors conducted a meta-analysis of the reliability of UT scales designed for, and implemented among, physician and medical student populations., Method: In 2020, the authors searched 4 electronic databases alongside a citation search of previously identified UT scales. They included English-language, peer-reviewed studies that implemented UT scales in physician and/or medical student populations and reported reliability evidence. A meta-analysis of studies' Cronbach's alphas evaluated aggregated internal consistency across studies; subgroup analyses evaluated UT scales by named scale, population, and item characteristics., Results: Among 4,124 records screened, 35 studies met the inclusion criteria, reporting 75 Cronbach's alphas. Four UT scales appeared in at least 3 included studies: Physicians' Reactions to Uncertainty scale 1990 (PRU1990) and 1995 (PRU1995) versions, Tolerance for Ambiguity scale (TFA), and Tolerance of Ambiguity in Medical Students and Doctors scale (TAMSAD). The scores from these scales ranged in reliability from very good (PRU1990: 0.832, PRU1995: 0.818) to respectable (TFA: 0.761, TAMSAD: 0.711). Aggregated internal consistency was significantly higher ( P < .001) among physicians (0.797) than medical students (0.711)., Conclusions: UT scales generally demonstrated respectable internal consistency when administered among physicians and medical students, yet the reliability among medical students was significantly lower. The authors caution against using UT scores for decision-making purposes (e.g., applicant selection, program evaluation), especially among medical student populations. Future research should explore the reasons underlying these observed population differences., (Copyright © 2022 by the Association of American Medical Colleges.)

To estimate the age-standardized prevalence of diabetes and prediabetes and identify factors associated with these conditions at individual, household, and community levels. Data from 11952 Bangladeshi adults aged 18-95 years available from the most recent Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of diabetes and prediabetes were age-standardized with direct standardization, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance. The overall age-standardised prevalence of diabetes was 9.2% (95%CI 8.7-9.7) (men: 8.8%, women: 9.6%), and prediabetes was 13.3% (95%CI 12.7-13.9) (men: 13.0%, women: 13.6%). Among people with diabetes, 61.5% were unaware that they had the condition. 35.2% took treatment regularly, and only 30.4% of them had controlled diabetes. Factors associated with an increased prevalence of having diabetes were increasing age, male, overweight/obesity, hypertension, being in the highest wealth quintile, and living in the Dhaka division. People currently employed and living in the Rangpur division were less likely to have diabetes than those currently not employed and living in the Barishal division. Diabetes and prediabetes affect a substantial proportion (over one-quarter) of the Bangladeshi adult population. Continuing surveillance and effective prevention and control measures, focusing on obesity reduction and hypertension management, are urgently needed., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2022 Hossain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: The significance of niacin in embryonic development has clinical implications in the counseling of pregnant women and may be used to inform nutrition recommendations. This study, therefore, aims to review the associations between maternal periconceptional niacin intake and congenital anomalies., Methods: A systematic search of Ovid MEDLINE, ClinicalTrials.gov, AMED, CENTRAL, Emcare, EMBASE, Maternity & Infant Care and Google Scholar was conducted between inception and 30 September 2020. Medical subject heading terms included "nicotinic acids" and related metabolites, "congenital anomalies" and specific types of congenital anomalies. Included studies reported the association between maternal niacin intake and congenital anomalies in their offspring and reported the measure of association. Studies involved solely the women with co-morbidities, animal, in vitro and qualitative studies were excluded. The risk of bias of included studies was assessed using the Newcastle-Ottawa Scale (NOS). A random effects-restricted maximum likelihood model was used to obtain summary estimates, and multivariable meta-regression model was used to adjust study-level covariates., Results: Of 21,908 retrieved citations, 14 case-control studies including 35,743 women met the inclusion criteria. Ten studies were conducted in the U.S, three in Netherlands and one in South Africa. The meta-analysis showed that expectant mothers with an insufficient niacin intake were significantly more likely to have babies with congenital abnormalities (odds ratio 1.13, 95% confidence interval 1.02-1.24) compared to mothers with adequate niacin intake. A similar association between niacin deficiency and congenital anomalies was observed (OR 1.15, 95% CI 1.03-1.26) when sensitivity analysis was conducted by quality of the included studies. Meta-regression showed neither statistically significant impact of study size (p = 0.859) nor time of niacin assessment (p = 0.127). The overall quality of evidence used is high-thirteen studies achieved a rating of six or seven stars out of a possible nine based on the NOS., Conclusion: Inadequate maternal niacin intake is associated with an increased risk of congenital anomalies in the offspring. These findings may have implications in dietary counseling and use of niacin supplementation during pregnancy., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

In many low and middle-income countries, iodine-deficient hypothyroidism leads to complex public health consequences. However, increasing evidence from population-based studies has linked thyroid autoimmunity with excess iodine intake. The iodine supplementation program in Bangladesh was a success story. This cross-sectional study aims to assess the pattern and predictors of autoimmunity among Bangladeshi hypothyroid patients. In this study, 154 consecutive, newly detected, biochemically-confirmed patients with primary hypothyroidism were recruited from the Endocrinology outpatient department of Bangabandhu Sheikh Mujib Medical University and tested for anti-thyroid peroxidase and anti-thyroglobulin antibody levels from October 2015 and November 2016. Patterns of thyroid autoimmunity were assessed via descriptive statistics. Predictors of autoimmunity were assessed with multivariable mixed-effect logistic regression. The mean age of participants was 36.1±11.0 years, and 70.1% were female. The frequency of thyroid autoimmunity in the study subjects was very high, 89.0% were positive for either anti-TPO or anti-Tg antibodies and 48.7% were positive for both. More participants were positive for anti-TPO antibodies (82.5%) than anti-Tg antibodies (55.2%). The risk of autoimmunity was associated with the thyroid's structural abnormalities but not with functional status. Weight gain and hypertension were associated with autoimmunity, whereas diabetes was protective against autoimmunity.

Gold (Au) is an inert metal in a bulk state; however, it can be used for the preparation of Au nanoparticles (i.e., AuNPs) for multidimensional applications in the field of nanomedicine and nanobiotechnology. Herein, monodisperse concave cube AuNPs (CCAuNPs) were synthesized and functionalized with a natural antioxidant lipoic acid (LA) and a tripeptide glutathione (GSH) because different crystal facets of AuNPs provide binding sites for distinct ligands. There was an ∼10 nm bathochromic shift of the UV-vis spectrum when CCAuNPs were functionalized with LA, and the size of the as-synthesized monodisperse CCAu nanoparticles was 76 nm. The LA-functionalized CCAu nanoparticles (i.e., CCAuLA) showed the highest antibacterial activity against Bacillus subtilis . Both fluorescence images and scanning electron microscopy images confirm the damage of the bacterial cell wall as the mode of antibacterial activity of CCAuNPs. CCAuNPs also cause the oxidation of bacterial cell membrane fatty acids to produce reactive oxygen species, which pave the way for the death of bacteria. Both CCAu nanoparticles and their functionalized derivatives showed excellent hemocompatibility (i.e., percentage of hemolysis is <5% at 80 μg of AuNPs) to human red blood cells and very high biocompatibility to HeLa, L929, and Chinese hamster ovary-green fluorescent protein (CHO-GFP) cells. Taken together, LA and GSH enhance the antibacterial activity and biocompatibility, respectively, of CCAu nanoparticles that interact with the bacteria through Coulomb as well as hydrophobic interactions before demonstrating antibacterial propensity.

Background: There is conflicting and limited information regarding factors that influence undergraduate nursing students' academic and clinical performance prior to entry to practice., Objective: To identify factors influencing the academic and clinical performance of undergraduate nursing students throughout the course., Design: Mixed methods study utilizing a retrospective cohort and a qualitative study., Setting: Monash University, Melbourne, Australia., Participants: Longitudinal existing data of nursing undergraduate students who commenced in 2017 ( n = 176) and 2018 ( n = 76), and two focus groups with final year nursing students were analyzed., Methods: Retrospective students' records were used to determine the students' academic and clinical performance using the weighted average mark (WAM) of the theoretical and clinical components of the curriculum, separately. The WAM considered the year level of each unit and was scored out of 100. Multivariate linear regression was used to determine predictor factors of academic and clinical performance. Variables include entry cohort (with no previous nursing qualification vs. diploma of nursing), admission category (domestic vs. international), campus (metropolitan vs. outer metropolitan), and secondary school (year 12) results. Two focus group discussions were conducted and thematically analyzed., Results: More than two-thirds of the students were aged 18-20 years and mainly female. Almost 20% of the participants were international students. Students with higher secondary school (year 12) results and studying at the outer metropolitan campus achieved a higher academic performance while international students had significantly lower academic performance compared to domestic students. Students with a previous diploma of enrolled nursing and international students had lower clinical performance. Students identified that a comprehensive orientation, interactive curriculum, formal and informal support structure, and educator qualities influenced their academic and/or clinical performance., Conclusions: A supportive educational environment with an interactive curriculum may enhance students' academic and clinical performance and readiness for practice. Furthermore, targeted interventions for international students, those with lower secondary school (year 12) results, and those with a former diploma of nursing may be required to increase academic and clinical performance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fooladi, Karim, Vance, Walker, Zanjani, Ilic and Brand.)

Objective: To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs)., Design: Systematic review., Data Sources: Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice., Eligibility Criteria: Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs)., Data Extraction and Synthesis: Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework., Results: Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research., Conclusion: The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Diabetes Distress (DD)-an emotional or affective state arise from challenge of living with diabetes and the burden of self-care-negatively impact diabetes management and quality of life of T2DM patients. Early detection and management of DD is key to efficient T2DM management. The study aimed at developing a valid and reliable instrument for Bangladeshi patients as unavailability such a tool posing challenge in diabetes care. Linguistically adapted, widely used, 17-item Diabetes Distress Scale (DDS), developed through forward-backward translation from English to Bengali, was administered on 1184 T2DM patients, from four diabetes hospitals in Bangladesh. Psychometric assessment of the instrument included, construct validity using principal component factor analysis, internal consistency using Cronbach's α and discriminative validity through independent t-test and test-retest reliability using intraclass-correlation coefficient (ICC) and Kappa statistics. Factor analysis extracted 4 components similar to original DDS domains, confirms the construct validity. The scale demonstrated satisfactory internal consistency (α = 0.838), stability (test-retest ICC = 0.941) and good agreement across repeated measurements (Kappa = 0.584). Discriminative validity revealed that patients with complication (p < 0.001) and those are on insulin (p < 0.001) had significantly higher distress scores in all domains. Bengali version of DDS is a valid and reliable tool for assessing distress among Bangladeshi T2DM patients., (© 2022. The Author(s).)

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Demographic differential has been linked with the treatment outcome and survival in recent literature, mostly from the developed world. Considering diversity in population characteristics across income strata, it's worth assessing the link in low- and middle-income population as well. Current study aimed to assess the association of demographic characteristics with lung cancer survival in Bangladeshi lung cancer patients., Methods & Results: All newly diagnosed primary lung cancer cases attending the national institute of cancer research & Hospital (NICRH), a tertiary cancer care center in Dhaka, Bangladesh between 2018 and 2019 were considered for the study. Demographic information and clinical data were obtained from the patients' medical records by a trained physician. Survival estimate was generated using the Kaplan-Meier method and compared across demographic and clinicopathological categories using the log-rank test. Hazard ratio and 95% CI for treatment options are generated fitting multivariable Cox proportional hazard regression. Among 1868 patients, 84.6% were males and 15.4% were females, average (± standard deviation) age at diagnosis was 59.6±10.9 years, only 10.8% had not consumed tobacco of any form. Around two-thirds of the patient had Eastern Cooperative Oncology Group (ECOG) performance score ≥2, 29.5% had at least one comorbidity and 19.4% had metastasis at the time of presentation. Higher survival was associated with institutional education (HR 0.9; 95% CI 0.77, 0.99), and receipt of combined radiotherapy and chemotherapy (HR 0.56; 95% CI 0.46, 0.65; p <0.001). In contrast, lower survival was associated with older age between 60-69 years (HR 1.3; 95% CI 1.3, 1.5;), age ≥ 70 years (HR 1.4; 95% CI 1.1, 1.7), having any comorbidity (HR 1.1; 95% CI 1.0, 1.3), with ECOG score ≥ 3 (HR 1.41; 95% CI 1.01, 1.96) and receipt of radiotherapy treatments only (HR 1.6; 95% CI 1.3, 1.9)., Conclusion: Older age, presence of one or more comorbidity, poorer performance status, and treatment with only RT appeared as a significant predictor of poorer prognosis of lung cancer in Bangladeshi patients. In contrast, having institutional education and treatment with combined Radiotherapy and Chemotherapy appeared as a predictor of a better prognosis. The finding of this study could serve as a basis for future studies inquiring into novel approaches for certain subgroups of patients believed to be challenged in limited resources., Competing Interests: The authors have declared that no competing interests exist.

Objective: To ascertain which of the Alternative Healthy Eating Index (AHEI) 2010, Dietary Inflammatory Index (DII®) and Mediterranean Diet Score (MDS) best predicted BMI and waist-to-hip circumference ratio (WHR)., Design: Body size was measured at baseline (1990-1994) and in 2003-2007. Diet was assessed at baseline using a FFQ, along with age, sex, socio-economic status, smoking, alcohol drinking, physical activity and country of birth. Regression coefficients and 95 % CI for the association of baseline dietary scores with follow-up BMI and WHR were generated using multivariable linear regression, adjusting for baseline body size, confounders and energy intake., Setting: Population-based cohort in Melbourne, Australia., Participants: Included were data from 11 030 men and 16 774 women aged 40-69 years at baseline., Results: Median (IQR) follow-up was 11·6 (10·7-12·8) years. BMI and WHR at follow-up were associated with baseline DII® (Q5 v. Q1 (BMI 0·41, 95 % CI 0·21, 0·61) and WHR 0·009, 95 % CI 0·006, 0·013)) and AHEI (Q5 v. Q1 (BMI -0·51, 95 % CI -0·68, -0·35) and WHR -0·011, 95 % CI -0·013, -0·008)). WHR, but not BMI, at follow-up was associated with baseline MDS (Group 3 most Mediterranean v. G1 (BMI -0·05, 95 % CI -0·23, 0·13) and WHR -0·004, 95 % CI -0·007, -0·001)). Based on Akaike's Information Criterion and Bayesian Information Criterion statistics, AHEI was a stronger predictor of body size than the other diet scores., Conclusions: Poor quality or pro-inflammatory diets predicted overall and central obesity. The AHEI may provide the best way to assess the obesogenic potential of diet.

Type 2 diabetes mellitus is a common condition whose incidence is increasing worldwide, and for which obesity and diet are important risk factors. The aim of this study was to assess the association of three diet quality scores with diabetes risk and how much of the association was mediated through body size. The Melbourne Collaborative Cohort Study recruited 41,513 men and women aged 40-69 years during 1990-1994. At baseline, data were collected on lifestyle and diet, anthropometric measures were performed. Incident diabetes was assessed by self-report at follow-up surveys in 1994-1998 and 2003-2007. The associations between the dietary inflammatory index (DII ® ), Mediterranean Diet Score (MDS) and the Alternative Healthy Eating Index-2010 and incident diabetes were assessed using Poisson regression, adjusting for age, sex, physical activity, smoking, alcohol consumption, socio-economic status (area based) and family history of diabetes. Data from 39,185 participants were included in the analysis and 1989 cases of diabetes were identified. Both DII and AHEI-2010 were associated with diabetes incidence, but MDS was not. In the top quintile of DII (most pro-inflammatory) vs. the least inflammatory quintile IRR was 1.49 95% CI (1.30, 1.72), p trend across quintiles <0.001. For AHEI-2010 the IRR was 0.67 (0.58, 0.78), p trend <0.001 for the healthiest vs. the least healthy quintile. Mediation analysis indicated that body size (body mass index/waist to hip ratio) mediated 35-48% of the association with incident diabetes for the AHEI and DII. Healthier diets may reduce risk of diabetes both by reducing weight gain and other mechanisms such as reducing inflammation.

Background: Inflammatory Conditions of the Lactating Breast (ICLB) affect more than one in five lactating mothers, yet no fully validated outcome measures exist to aid clinicians in their patient-centred care of women with ICLB. The Breast Inflammatory Symptom Severity Index (BISSI) is an ICLB-specific clinician administered patient-reported outcome measure, currently used by Australian clinicians, who treat mothers with ICLB. To date the BISSI has undergone partial psychometric development. This study, therefore, aimed to undertake the next stage of psychometric development by determining the construct validity and internal consistency of the BISSI., Methods: A retrospective audit was conducted on patient records of 160 mothers who were treated for ICLB, at a private physiotherapy practice in Melbourne, Australia. An electronic data capture tool was used to collate BISSI scores and associated ICLB assessment variables. Construct validity was determined through factor analysis and discriminant performance. Reliability was determined by assessing measures of internal consistency., Results: Factor analysis established that BISSI items ( n = 10) loaded on to four factors, Wellness, Pain, Physical Characteristics of Affected Area (PCAA), and Inflammation, which together, explained 71.2% of variance. The remaining item ('Wellness/sickness unspecified') did not load. Wellness, Pain, PCAA and Inflammation factors individually and collectively displayed the ability to discriminate symptom severity, as scores were significantly higher in mothers with high symptom severity (assessed via AUC close to or >0.7 and P value <0.005 for each factor). The BISSI demonstrated internal consistency with an overall Cronbach alpha of 0.742., Conclusions: The BISSI has adequate construct validity, demonstrating behaviour consistent with theoretical constructs of inflammation severity, via its dimensionality and ability to discriminate symptom severity. The BISSI also has adequate internal consistency demonstrating reliability. Therefore, clinicians can have confidence that the BISSI is valid, the individual item scores are correlated, and the concepts are consistently measured., Competing Interests: The authors declare there are no competing interests., (©2021 Heron et al.)

Introduction: The burden of non-communicable diseases (NCDs) is rapidly increasing in Bangladesh. Currently, it contributes to 67% of annual deaths, and accounts for approximately 64% of the disease burden. Since 70% of the Bangladeshi population residing in the rural area rely on the primary healthcare system, assessment of its capacity is crucial for guiding public health decisions to prevent and manage NCDs. This protocol is designed to recognise and assess the Bangladeshi health system's readiness for NCDs at the primary level., Methods and Analysis: The study will use a mixed-method design. Numerical data will be collected using households and health facilities surveys, while qualitative data will be collected by interviewing healthcare providers, policy planners, health administrators and community members. The WHO's Service Availability and Readiness Assessment (SARA) methodology and Package of Essential Non-communicable (PEN) Disease Interventions for Primary Healthcare reference manuals will be used to assess the readiness of the primary healthcare facilities for NCD services. Furthermore, Health System Dynamics Framework will be used to examine health system factors. Using the supportive items outlined in the WHO PEN package, and indicators proposed in WHO SARA methodology, a composite score will be created to analyse facility-level data. Two independent samples t-test, analysis of variance and χ 2 test methods will be used for bivariate analysis, and multiple regression analysis will be used for multivariable analysis. Complementarily, the thematic analysis approach will be used to analyse qualitative data., Ethics and Dissemination: The project has been approved by the Monash University Human Research Ethics Committee (Project ID: 27112), and Bangladesh Medical Research Council (Ref: BMRC/NREC/2019-2022/270). The research findings will be shared through research articles, conference proceedings or in other scientific media. The reports or publications will not have any information that can be used to identify any of the study participants., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)