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The construction projects are rising in Pakistan to overcome the flow of traffic on the main road of big cities. Karachi is the metropolitan city of Pakistan facing uncontrolled growth and urbanization, which leads to an increase in the demand for urban transport facilities. The study focuses on the assessment of the environmental impacts of the Tariq Road underpass construction site. The data was collected with the help of community consultation using analytical methods. It includes public chat, site visits, interviews, questioners, and the samples collection of environmental components. The results show that the most common hazards were related to excavation, working practice variation, and personal protective equipment (PPEs). Faulty and unmaintained machinery with the lack of proper barrier producing noise and air pollution.

This exploratory research aims to explore and access the factors which are involved in Pakistan’s water conflict with India and how they are challenging the political existence of Pakistan. As human survival and economic progression are profoundly and directly linked with its accessibility and usability of it. Water is becoming a source of growing distress among nations around the globe. But in this research paper, the water conflict discussed is between the two neighboring nuclear-armed nations (India and Pakistan) with fraught relationships, who have fought three wars, and deeply doubt each other. Both the countries signed a trilateral water treaty with the collaboration of the World Bank in 1961. Though the treaty is usually presented among the few successful examples of water treaties in the world, it is facing threats for the last two decades. This study recommends that government must consider the warning issued by the UN in 2013 regarding the water crisis, Pakistan will face in the coming decade. Government must focus on the timely completion of mega dams and must take all necessary steps required to minimize the domestic and commercial water loses on war footings.

PurposeIn this article the authors will focus on the state of the art on information filtering and recommender systems based on trust. Then the authors will represent a variety of filtering and recommendation techniques studied in different literature, like basic content filtering, collaborative filtering and hybrid filtering. The authors will also examine different trust-based recommendation algorithms. It will ends with a summary of the different existing approaches and it develops the link between trust, sustainability and recommender systems.Design/methodology/approachMethodology of this study will begin with a general introduction to the different approaches of recommendation systems; then define trust and its relationship with recommender systems. At the end the authors will present their approach to “trust-based recommendation systems”.FindingsThe purpose of this study is to understand how groups of users could improve trust in a recommendation system. The authors will examine how to evaluate the performance of recommender systems to ensure their ability to meet the needs that led to its creation and to make the system sustainable with respect to the information. The authors know very well that selecting a measure must depend on the type of data to be processed and user interests. Since the recommendation domain is derived from information search paradigms, it is obvious to use the evaluation measures of information systems.Originality/valueThe authors presented a list of recommendations systems. They examined and compared several recommendation approaches. The authors then analyzed the dominance of collaborative filtering in the field and the emergence of Recommender Systems in social web. Then the authors presented and analyzed different trust algorithms. Finally, their proposal was to measure the impact of trust in recommendation systems.

Fetal abnormalities are detected in 3% of all pregnancies and are responsible for approximately 20% of all perinatal deaths. Chromosomal microarray analysis (CMA) and exome sequencing (ES) are widely used in prenatal settings for molecular genetic diagnostics with variable diagnostic yields. In this study, we aimed to determine the diagnostic yield of trio-ES in detecting the cause of fetal abnormalities within a highly consanguineous population. In families with a history of congenital anomalies, a total of 119 fetuses with structural anomalies were recruited and DNA from invasive samples were used together with parental DNA samples for trio-ES and CMA. Data were analysed to determine possible underlying genetic disorders associated with observed fetal phenotypes. The cohort had a known consanguinity of 81%. Trio-ES led to diagnostic molecular genetic findings in 59 fetuses (with pathogenic/likely pathogenic variants) most with multisystem or renal abnormalities. CMA detected chromosomal abnormalities compatible with the fetal phenotype in another 7 cases. Monogenic ciliopathy disorders with an autosomal recessive inheritance were the predominant cause of multisystem fetal anomalies (24/59 cases, 40.7%) with loss of function variants representing the vast majority of molecular genetic abnormalities. Heterozygous de novo pathogenic variants were found in four fetuses. A total of 23 novel variants predicted to be associated with the phenotype were detected. Prenatal trio-ES and CMA detected likely causative molecular genetic defects in a total of 55% of families with fetal anomalies confirming the diagnostic utility of trio-ES and CMA as first-line genetic test in the prenatal diagnosis of multisystem fetal anomalies including ciliopathy syndromes.

With the sudden onset of the COVID-19 pandemic and disruption of the education systems worldwide, private universities in Bangladesh transitioned to online classes to ensure continuity of education. Therefore, it was important to investigate the private university teachers' and students' perceptions regarding various dimensions of accessing online instruction and coping strategies used by teachers. A mixed-methods approach was used to collect data from 208 teachers and 674 students through questionnaires and focus group discussions. The findings indicate that teachers and students encountered several barriers, including unstable internet connection, costly internet packages, minimal support for teachers, issues with online assessment, and an unsuitable home environment. To combat existing problems related to assessment and to increase interaction in the classroom, teachers used a small range of coping strategies. Measures are suggested to ensure access to stable internet connectivity, financial support to students and teacher training on online pedagogy and assessment. © 2021 European Knowledge Development (EUROKD). All Rights Reserved.

Online education appeared to be effective among stakeholders worldwide following the closure of educational institutions due to the COVID-19 pandemic. Though the technology used for online education has hardly been explored to such a massive extent earlier, stakeholders soon self-educated themselves in new technological skills. However, challenges became more complex when the issues of assessment arose. Maintaining the validity, reliability, fairness, and academic integrity in online-based assessment became an insurmountable task; again, there was a pressing need for endorsing resilience and empathy for the assessors and assesses, especially for those who faced discrimination due to COVID-19. This study draws on the findings of a nationwide survey of online programmes offered by Bangladeshi private universities during the late 2020. They reveal the locally adopted methods and supports for assessing learners online, identify several challenges of online assessment, including the use of assessment methods, inadequate assessment-related support, fairness, and reliability, and ensuring accessibility to the assesses. It also reveals the stakeholders' choices to deal with the challenges in assessment, including flexibility, designing questions, and adopting process approach among others. Resilience and empathy for the stakeholders towards each other were required to successfully deal with the challenges of an online assessment.

The wellbeing of teachers and students has emerged as a common concern in research studies in recent times, specifically during the critical period of COVID-19. Based on the findings drawn from the qualitative data through focus group discussions of five groups of teachers (16 females and 8 males) and students (10 males and nine females) at the tertiary level of education in Bangladesh, this paper shows that online teaching during COVID-19 is affected by personal and social challenges, and consequently, both teachers and students experience anxieties and stresses. Teachers are anxious because of the university authorities' surveillance, frequent pay cuts, and fear of losing jobs due to students' low enrollment in universities. They also suffer from physical discomforts, such as back pain, blur vision, and headache because of the prolonged engagement with online activities. Students, especially those from a non-privileged background located in peripheral rural contexts, seem to suffer more from contextual realities that are non-conducive for technology-based learning. Increased numbers and various forms of online assessments also seem to become a burden for them. In general, educational experiences of online teaching seemed to have a peripheral role in their conceptualization of wellbeing. The paper concludes that the insurmountable attention given to online pedagogic practices across the world needs to be balanced out by an equal effort in improving the wellbeing of both teachers and students.

Background Fetal abnormalities are detected in 3% of all pregnancies and are responsible for approximately 20% of all perinatal deaths. Chromosomal microarray analysis (CMA) and exome sequencing (ES) are widely used in prenatal settings for molecular genetic diagnostics with variable diagnostic yields. In this study, we aimed to determine the diagnostic yield of trio-ES in detecting the cause of fetal abnormalities within a highly consanguineous population. Methods In families with a history of congenital anomalies, a total of 119 fetuses with structural anomalies were recruited and DNA from invasive samples were used together with parental DNA samples for trio-ES and CMA. Data were analysed to determine possible underlying genetic disorders associated with observed fetal phenotypes. Results The cohort had a known consanguinity of 81%. Trio-ES led to diagnostic molecular genetic findings in 59 fetuses (with pathogenic / likely pathogenic variants) most with multisystem or renal abnormalities. CMA detected chromosomal abnormalities compatible with the fetal phenotype in another 7 cases. Monogenic ciliopathy disorders with an autosomal recessive inheritance were the predominant cause of multisystem fetal anomalies (24/59 cases, 40.7%) with loss of function variants representing the vast majority of molecular genetic abnormalities. Heterozygous de novo pathogenic variants were found in 4 fetuses. A total of 23 novel variants predicted to be associated with the phenotype were detected. Conclusion Prenatal trio-ES and CMA detected likely causative molecular genetic defects in a total of 55% of families with fetal anomalies confirming the diagnostic utility of trio-ES and CMA as first line genetic test in the prenatal diagnosis of multisystem fetal anomalies including ciliopathy syndromes.

Fetal abnormalities are detected in 3% of all pregnancies and are responsible for approximately 20% of all perinatal deaths. Chromosomal microarray analysis (CMA) and exome sequencing (ES) are widely used in prenatal settings for molecular genetic diagnostics with variable diagnostic yields. In this study, we aimed to determine the diagnostic yield of trio-ES in detecting the cause of fetal abnormalities within a highly consanguineous population. In families with a history of congenital anomalies, a total of 119 fetuses with structural anomalies were recruited and DNA from invasive samples were used together with parental DNA samples for trio-ES and CMA. Data were analysed to determine possible underlying genetic disorders associated with observed fetal phenotypes. The cohort had a known consanguinity of 81%. Trio-ES led to diagnostic molecular genetic findings in 59 fetuses (with pathogenic/likely pathogenic variants) most with multisystem or renal abnormalities. CMA detected chromosomal abnormalities compatible with the fetal phenotype in another 7 cases. Monogenic ciliopathy disorders with an autosomal recessive inheritance were the predominant cause of multisystem fetal anomalies (24/59 cases, 40.7%) with loss of function variants representing the vast majority of molecular genetic abnormalities. Heterozygous de novo pathogenic variants were found in four fetuses. A total of 23 novel variants predicted to be associated with the phenotype were detected. Prenatal trio-ES and CMA detected likely causative molecular genetic defects in a total of 55% of families with fetal anomalies confirming the diagnostic utility of trio-ES and CMA as first-line genetic test in the prenatal diagnosis of multisystem fetal anomalies including ciliopathy syndromes.

During the brief coronavirus-induced hiatus in March and April 2020, educational institutions in Bangladesh including public universities began preparations for online classes. By the end of June, almost all private universities and a few public universities had started online classes with limited or no preparation which was met with appreciation as well as censure from different stakeholders. Against this backdrop, this study was conducted with a view to examining the online teaching learning scenario at Bangladeshi public universities from the perspective of one important stakeholder, the students, with a specific focus on the challenges they faced in this new mode of instruction. Suggestions were also sought from them regarding how the barriers to online instruction could be overcome. Data were collected from 26 students of English Departments of 11 public universities through semi-structured interviews. The major challenges reported in the data include issues of access and equity, inadequate logistic support and poor infrastructure. Concerns related to curriculum, pedagogy, assessment and psychological issues were also highlighted. In addition, lack of prior experience and training were identified as serious obstacles. Major suggestions from the participants include ensuring access and equity, providing training opportunities and digital devices to students and engaging in curriculum and assessment reforms.

This chapter presents a research study that investigates the testing practices in English language secondary schools in Bangladesh and their impact on test takers and on education in general. It focuses on the test specifications and test items currently in use and the extent to which the testing practices are aligned to the curriculum objectives. The findings indicate that syllabus content is confused with the curriculum objectives and validity and reliability requirements of test items are flouted. As tests are not aligned to the objectives of the curriculum and valid testing principles are not applied to test design, teachers and learners find alternative ways of coping with the tests, thus spawning practices of teaching to the test, often relying on private tutoring and rote learning. The insights drawn from this study discuss the significance of the washback effect and the impact of testing and the crucial need to develop assessment literacy among teachers, test-setters, and scorers. Assessment literacy would facilitate test designers/users to recognize the consequences of flawed practices that are detrimental to teaching and learning.

PurposeThe application of genomic sequencing to investigate unexplained death during early human development, a form of lethality likely enriched for severe Mendelian disorders, has been limited.MethodsIn this study, we employed exome sequencing as a molecular autopsy tool in a cohort of 44 families with at least one death or lethal fetal malformation at any stage of in utero development. Where no DNA was available from the fetus, we performed molecular autopsy by proxy, i.e., through parental testing.ResultsPathogenic or likely pathogenic variants were identified in 22 families (50%), and variants of unknown significance were identified in further 15 families (34%). These variants were in genes known to cause embryonic or perinatal lethality (ALPL, GUSB, SLC17A5, MRPS16, THSD1, PIEZO1, and CTSA), genes known to cause Mendelian phenotypes that do not typically include embryonic lethality (INVS, FKTN, MYBPC3, COL11A2, KRIT1, ASCC1, NEB, LZTR1, TTC21B, AGT, KLHL41, GFPT1, and WDR81) and genes with no established links to human disease that we propose as novel candidates supported by embryonic lethality of their orthologs or other lines of evidence (MS4A7, SERPINA11, FCRL4, MYBPHL, PRPF19, VPS13D, KIAA1109, MOCS3, SVOPL, FEN1, HSPB11, KIF19, and EXOC3L2).ConclusionOur results suggest that molecular autopsy in pregnancy losses is a practical and high-yield alternative to traditional autopsy, and an opportunity for bringing precision medicine to the clinical practice of perinatology.

Ciliopathies are highly heterogeneous clinical disorders of the primary cilium. We aim to characterize a large cohort of ciliopathies phenotypically and molecularly. Detailed phenotypic and genomic analysis of patients with ciliopathies, and functional characterization of novel candidate genes. In this study, we describe 125 families with ciliopathies and show that deleterious variants in previously reported genes, including cryptic splicing variants, account for 87% of cases. Additionally, we further support a number of previously reported candidate genes (BBIP1, MAPKBP1, PDE6D, and WDPCP), and propose nine novel candidate genes (CCDC67, CCDC96, CCDC172, CEP295, FAM166B, LRRC34, TMEM17, TTC6, and TTC23), three of which (LRRC34, TTC6, and TTC23) are supported by functional assays that we performed on available patient-derived fibroblasts. From a phenotypic perspective, we expand the phenomenon of allelism that characterizes ciliopathies by describing novel associations including WDR19-related Stargardt disease and SCLT1- and CEP164-related Bardet–Biedl syndrome. In this cohort of phenotypically and molecularly characterized ciliopathies, we draw important lessons that inform the clinical management and the diagnostics of this class of disorders as well as their basic biology.

This paper investigates the stabilization of frequency of a grid connected microgrid in presence of solar photovoltaic (PV), wind turbine (WT) and biodiesel electric generator (BDEG) as electric source and heat pump (HP), plug-in hybrid electric vehicles (PHEV) as controllable load along with a critical load. Virtual power plant (VPP) coordinated control concept has been applied where proportional-integral (PI) or proportional-integral-derivate (PID) controller are used with BDEG, HP, PHEV to adjust the output power as decided by the VPP coordinator. A metaheuristic algorithm, Firefly Algorithm (FFA) is used to tune the controllers. The Microgrid is stimulated for step variations in the PV and WT generation and critical load. The comparative analysis of two metaheuristic algorithms (PSO and FFA) optimized PI/PID controllers have been investigated in terms of peak deviations, settling time and objective function. The proposed system is simulated under MATLAB-Simulink environment and shows that FFA optimized PID controller is better than rest one.

Background Inherited cystic kidney disorders are a common cause of end-stage renal disease. Over 50 ciliopathy genes, which encode proteins that influence the structure and function of the primary cilia, are implicated in cystic kidney disease. Methods To define the phenotype and genotype of cystic kidney disease in fetuses and neonates, we correlated antenatal ultrasound examination and postnatal renal ultrasound examination with targeted exon sequencing, using a renal gene panel. A cohort of 44 families in whom antenatal renal ultrasound scanning findings in affected cases included bilateral cystic kidney disease, echogenic kidneys or enlarged kidneys was investigated. Results In this cohort, disease phenotypes were severe with 36 cases of stillbirth or perinatal death. Extra renal malformations, including encephalocele, polydactyly and heart malformations, consistent with ciliopathy phenotypes, were frequently detected. Renal gene panel testing identified causative mutations in 21 out of 34 families (62%), where patient and parental DNA was available. In the remaining 10 families, where only parental DNA was available, 7 inferred causative mutations were found. Together, mutations were found in 12 different genes with a total of 13 novel pathogenic variants, including an inferred novel variant in NEK8 . Mutations in CC2D2A were the most common cause of an antenatal cystic kidney disease and a suspected ciliopathy in our cohort. Conclusions In families with ciliopathy phenotypes, mutational analysis using a targeted renal gene panel allows a rapid molecular diagnosis and provides important information for patients, parents and their physicians.

This research identified the maritime English skills that Bangladeshi seafarers need for working on-board ships and getting employment opportunities in the maritime sector both in the domestic and international levels. This study also sought to determine the level of maritime English proficiency expected by the recruiting agencies in Bangladesh. The present study was conducted on 135 senior cadets and 24 recruiting agencies in a mixed-method design by collecting both quantitative and qualitative responses. 68 maritime tasks on-board were identified and those were categorized on a range of ‘less needed’ to ‘highly needed’ skills. Among those tasks 23 were identified as highly needed by the respondents. This study discovered that communication efficiency (speaking) was the most important skill over the other three skills because most recruitment agencies in Bangladesh tested their spoken language skills during interviews. Most of the manning agencies expected their cadets to have intermediate level of proficiency in speaking and elementary level of efficiency in listening, reading and writing. However, the senior cadets emphasized on the necessity of using the four language skills in on-board tasks.

Patients with succinyl-CoA:3-oxoacid CoA transferase (SCOT) deficiency and 3-hydroxy-3-methylglutaryl (HMG)-CoA lyase deficiency are at increased risk of developing metabolic acidosis and hypoglycemia during pregnancy, delivery, and postpartum period. This can be fatal if not treated appropriately. Pregnancy in such patients should be managed in a specialist center by a multidisciplinary team including metabolic physician, high-risk obstetrician, and metabolic dietician. We report two pregnancies in women with SCOT deficiency and HMG-CoA lyase deficiency, which were successfully managed at this tertiary care center. The patient with SCOT deficiency had recurrent ketoacidosis due to severe nausea and vomiting requiring several hospital admissions during pregnancy, while the patient with HMG-CoA lyase deficiency remained metabolically stable. Both patients, nevertheless, had normal delivery of live-born infants and had uneventful postpartum period.

Any policy reform in education is highly effective when it is planned and implemented ‘holistically’ and yet, it is the most challenging way forward. Many countries in Asia have reformed their English language policies and syllabi in the last two decades due to the increasing value of the language worldwide. Motivated by a ‘communicative approach’ to English language teaching, Bangladesh was one of the countries that launched such a reform in the 1990s. However, this reform has been criticised for imposing the changes on teachers without preparing them sufficiently. More importantly, there is limited evidence as to how much the secondary English language assessment system is aligned with the changes introduced in the curriculum. In order to explore this gap, a medium-scale study was conducted in 38 secondary schools in Bangladesh, following a mixed methods approach. The findings highlighted a ‘mismatch’ between the intended English language learning outcomes and current assessment practices, including the...

The time required to conduct drug and alcohol screening has been a major barrier to its implementation in mainstream healthcare settings. Because patient self-administered tools are potentially more efficient, we translated the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) into an audio guided computer assisted self interview (ACASI) format. This study reports on the test–retest reliability of the ACASI ASSIST in an adult primary care population. Adult primary care patients completed the ACASI ASSIST, in English or Spanish, twice within a 1–4week period. Among the 101 participants, there were no significant differences between test administrations in detecting moderate to high risk use for tobacco, alcohol, or any other drug class. Substance risk scores from the two administrations had excellent concordance (90–98%) and high correlation (ICC 0.90–0.97) for tobacco, alcohol, and drugs. The ACASI ASSIST has good test–retest reliability, and warrants additional study to evaluate its validity for detecting unhealthy substance use.

Background With rising rates of prescription drug abuse and associated overdose deaths, there is great interest in having accurate and efficient screening tools that identify nonmedical use of prescription drugs in health care settings. The authors sought to gain a better understanding of how patients interpret questions about misuse of prescription drugs, with the goal of improving the accuracy and acceptability of instruments intended for use in primary care. Methods A total of 27 English-speaking adult patients were recruited from an urban safety net primary care clinic to complete a cognitive interview about a 4-item screening questionnaire for tobacco, alcohol, illicit drugs, and misuse of prescription drugs. Detailed field notes were analyzed for overall comprehension of the screening items on illicit drug use and prescription drug misuse, the accuracy with which participants classified drugs into these categories, and whether the screening response correctly captured the participant's substance use behavior. Results Based on initial responses to the screening items, 6 (22%) participants screened positive for past-year prescription drug misuse, and 8 (30%) for illicit drug use. The majority (26/27) of participants correctly interpreted the item on illicit drug use, and appropriately classified drugs in this category. Eleven (41%) participants had errors in their understanding of the prescription drug misuse item. The most common error was classifying use of medications without abuse potential as nonmedical use. All cases of misunderstanding the prescription drug misuse item occurred among participants who screened negative for illicit drug use. Conclusions The results suggest that terminology used to describe misuse of prescription medications may be misunderstood by many primary care patients, particularly those who do not use illicit drugs. Failure to improve upon the language used to describe prescription drug misuse in screening questionnaires intended for use in medical settings could potentially lead to high rates of false-positive results.

The regulation of pain and other emotions is a developmental process that takes place in the context of attachment relationships. Children with chronic, medically unexplained pain struggle to accurately identify, communicate and regulate negative body states, and to connect these body states to their day-to-day experience. This article describes an individual intervention – one component of a multimodal treatment programme – whose aim is to help children find skills to manage their pain. The intervention incorporates ideas and practices from several theoretical models – the dynamic-maturational model of attachment, cognitive-behavioural theories, narrative therapy, art therapy, sensorimotor approaches –pragmatically selected and adapted to help children presenting to our Chronic Pain Service achieve good clinical outcomes. At the outset we assess the child’s capacity to identify, regulate and communicate positive and negative body states, and tailor our individual intervention so as to extend each child’s proximal level of development. We initially focus on the body in an effort to equip the child with a non-verbal, image-based language for identifying and communicating pain and other negative body states. Once the child has developed a non-verbal way of knowing her body, a range of cognitive-behavioural, narrative and other strategies are introduced. The intervention aims to increase the child’s emotional functioning: her skill in identifying, symbolically representing, communicating and managing pain and other negative body states.

Effect of potassium-magnesium citrate on urinary biochemistry and crystallization of stone-forming salts was compared with that of potassium citrate at same dose of potassium in five normal subjects and five patients with calcium nephrolithiasis. Compared to the placebo phase, urinary pH rose significantly from 6.06 +/- 0.27 to 6.48 +/- 0.36 (mean +/- SD, p less than 0.0167) during treatment with potassium citrate (50 mEq/day for 7 days) and to 6.68 +/- 0.31 during therapy with potassium-magnesium citrate (containing 49 mEq K, 24.5 mEq Mg, and 73.5 mEq citrate per day). Urinary pH was significantly higher during potassium-magnesium citrate than during potassium citrate therapy. Thus, the amount of undissociated uric acid declined from 118 +/- 61 mg/day during the placebo phase to 68 +/- 54 mg/day during potassium citrate treatment and, more prominently, to 41 +/- 46 mg/day during potassium-magnesium citrate therapy. Urinary magnesium rose significantly from 102 +/- 25 to 146 +/- 37 mg/day during potassium-magnesium citrate therapy but not during potassium citrate therapy. Urinary citrate rose more prominently during potassium-magnesium citrate therapy (to 1027 +/- 478 mg/day from 638 +/- 252 mg/day) than during potassium citrate treatment (to 932 +/- 297 mg/day). Consequently, urinary saturation (activity product) of calcium oxalate declined significantly (from 1.49 x 10(-8) to 1.03 x 10(-8) M2) during potassium-magnesium citrate therapy and marginally (to 1.14 x 10(-8) M2) during potassium citrate therapy.(ABSTRACT TRUNCATED AT 250 WORDS).

Pain is a complex phenomenon: a sensory experience originating in traumatized tissues; an emotional (affective) experience that signals danger in the internal (body) or external environment; and a "disposition to act" that results either in "action" that prioritizes escape or in "inhibition of action" to minimize injury or facilitate healing. Recent advances in our understanding of the affective components of pain have significant implications for the treatment of chronic pain in children and adolescents. This article describes a chronic pain clinic for children and adolescents developed by the pain service of a large pediatric teaching hospital. Pain is conceptualized and managed in terms of multiple, interrelating systems (the body level, the psychological level, and the social level). This model of care is illustrated with reference to the management of two cases of children with chronic pain and significant functional impairment. A brief overview of the care utilization of 62 children referred to the Chronic Pain Clinic is also provided, with the clinical characteristics of 40 children with somatoform pain disorder (SPD) being described in more detail. Of 28 children with SPD treated with our systems intervention, 82% reported significant reductions in pain intensity, 71% returned to school full time, and 29% part time. An advantage of this integrated, family-based assessment and treatment approach is the overarching emphasis on identifying the contribution of each system to the child's subjective experience of pain, thereby avoiding the deleterious polarization of the pain as either physical or psychogenic in origin.

Background — Although the prenatal diagnosis of most fetal structural heart defects and dysrhythmias has been described, there is a paucity of information about cardiomyopathies (CMs) in prenatal life. Methods and Results —- To determine the pathogenic mechanisms, hemodynamic findings, and outcome of fetal CM, we reviewed the fetal echocardiograms and perinatal histories of 55 affected fetuses. Dilated CM was diagnosed in 22 cases, including 2 with congenital infections, 5 familial cases, 6 with endocardial fibroelastosis related to maternal anti-Ro/La antibodies, and 9 idiopathic cases. Thirty-three had hypertrophic CM, 7 associated with maternal diabetes, 2 with Noonan’s syndrome, 2 with α-thalassemia, 18 with twin-twin transfusion syndrome, 1 with familial hypertrophy, and 3 with idiopathic hypertrophy. Systolic dysfunction was present in all cases of dilated CM and 15 cases of hypertrophic CM. Diastolic dysfunction was present in 19 of 30 fetuses with assessment of diastolic function parameters. Significant mitral or tricuspid valve regurgitation was seen in 32 cases. Eight fetuses were hydropic and 23 had signs of early hydrops. Seven pregnancies were terminated. Of 46 continued pregnancies with follow-up, 29 (63%) died perinatally. The presence of systolic dysfunction, diastolic dysfunction, and significant atrioventricular valve regurgitation were identified as risk factors for mortality. By multiple logistic regression, diastolic dysfunction was associated with an 8-fold increased risk relative to the other parameters. Conclusions — Fetal CM has a broad spectrum of intrinsic and extrinsic causes. A poor outcome is observed in many affected fetuses. Diastolic dysfunction in fetal CM is associated with the highest risk of mortality.

Background, To assess the efficacy of a single measurement of amniotic fluid optical density deviation at 450 nanometers in predicting fetal anemia in Rhesus-alloimmunization before 27 weeks gestation. Methods. In this cross-sectional study, fetal blood and amniotic fluid samples from 43 Rhesus-alloimmunized pregnancies at 18 to 26 weeks gestation were obtained under ultrasound guidance. Amniotic fluid samples were scanned by spectrophotometry for optic density at various wavelengths. Deviation at 450 nanometers was calculated between 550 and 365 nanometers. The fetuses were divided into three groups based on their hematocrit levels and the predictive efficacy of optic density zones for anemia was evaluated. Results, A high number of false positive and false negative results were observed when the delta-amniotic fluid optical density of fetuses at risk for anemia was plotted to the zones recently proposed to manage Rhesus-alloimmunized pregnancies. Conclusions, These data confirm previous results that the diagnosis of fetal anemia in Rhesus-alloimmunized pregnancies before 27 weeks' gestation cannot be accurately made by a single measurement of amniotic fluid optical density at 450 nanometers.

Due to the lack of molecular targets, triple-negative breast cancers (TNBCs) typically represent a worse prognosis compared to their hormone-positive counterparts. While neoadjuvant chemotherapy has been used for breast cancers for a long time, there is no standard chemotherapy regimen for TNBCs. Cisplatin has generally been regarded as an effective chemotherapy agent against TNBCs. However, here we present a pilot study involving the use of cisplatin in combination with oral capecitabine in the neoadjuvant setting in 16 patients with TNBC. Twelve patients were African American and 4 patients were white. Six patients completed all 4 cycles of chemotherapy, 6 patients completed 3 cycles, and 4 patients completed 2 cycles. A complete clinical response was observed in 2 patients, and 10 patients achieved partial clinical response. One patient had progressive disease, and 3 patients were lost to follow-up or taken off study. Following chemotherapy, 12 patients underwent surgery (7 patients had breast conservation, and 5 patients had a mastectomy). Ten of the 12 patients who had surgery achieved a partial pathologic response and the other 2 patients had complete pathologic response. Grade 3 nausea, vomiting, and diarrhea occurred in 7 patients; 1 patient experienced dehydration and renal failure; and 5 patients had grade 1/2 hand-foot syndrome. There were no grade 4 or 5 toxicities. The response to cisplatin-capecitabine combination chemotherapy in the neoadjuvant setting was suboptimal compared to that with single-agent cisplatin in prior studies. The toxicity profile with this combination was also worse than that of cisplatin alone. Based on our findings, we do not recommend this combination regimen in the neoadjuvant setting for TNBCs. However, future studies analyzing the use of cisplatin with other combinations are warranted.

OBJECTIVE To evaluate the possible association between protease inhibitor (PI) and premature birth and low birth-weight in HIV-infected pregnancies. MATERIALS AND METHODS Data were collected retrospectively for maternal and pregnancy characteristics, antiretroviral medication, lowest CD4 count and highest viral load during pregnancy, and pregnancy outcomes. χ(2) Analysis, Student's t-test, and multiple logistic regression analysis were performed. RESULTS Data from 161 HIV-infected women who delivered singleton gestation were analyzed. Fifty-three received an antepartum regimen with PI, 84 received a regimen without PI, and six did not receive antepartum treatment. The mean estimated gestational age (EGA)± SD at delivery was 37.7 ± 3.2 weeks. The premature birth rate was 18.4%. No difference was detected between women receiving the antiretroviral regimen including PI and those on the regimen without PI or on no antepartum medication with regard to: EGA ± SD at delivery (37.7 ± 3.2 vs. 37.6 ± 3.1 weeks, respectively, P=0.87), rate of premature birth (14% vs. 20.6%, respectively, P=0.32) and low birth-weight (12.5% vs. 20.2%, respectively, P=0.25). In multiple logistic regression analysis, PI was not associated with premature birth or low birth-weight. CONCLUSION Women receiving antiretroviral therapy with PI have a similar rate of premature birth and low birth-weight as women receiving antiretroviral therapy without PI or on no medication.

To determine the frequency of Plasmodium (P.) vivax and P. falciparum in cases of acute febrile illness, and the haematological parameters in patients suffering with acute malaria.An observational study.Baqai Medical University, Fatima Hospital Laboratory, Karachi, from January 2006 to December 2007.Patients with acute febrile illness were evaluated. Complete blood count and malarial parasite were performed. Descriptive statistics of haematological parameters was computed. Mean and standard deviations (SD) were calculated; p-value was determined using test of proportions on SPSS.Out of 3344 patients, 392 (11.72%) were proved as suffering from malaria with male to female ratio of 1.36. The age ranged from 1 month to 94 years. One hundred and seventy six (42.6%) had P. falciparum, 204 (52%) had P. vivax, and 21 (5.4%) had mixed infection. Haemoglobin varied from 1.10 g/dl -17.10 g/dl, (mean 9.83 + 3.09 g/dl). TLC ranged from 1.30 x 103/ul - 48.50 x 103/ul, (mean 6.80 + 5.15 x 103/ul. The platelet counts ranged from 10.0 x 103/ul - 850 x 103/ul, (mean 106 + 90.98 x 103/ul). Thrombocytopenia was observed in 70%, platelet count was significantly lower in patients with mixed infection as compared to patients with P. falciparum and P. vivax (p=.017).The frequency of malaria was 11.72%. Thrombocytopenia was the most common finding. In none of the patients platelet counts dropped below the critical levels of 10 x 103/microl.