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Abstract BackgroundIncreasing and substantial reliance on electronic health records (EHRs) and data types (ie, diagnosis, medication, and laboratory data) demands assessment of their data quality as a fundamental approach, especially since there is a need to identify appropriate denominator populations with chronic conditions, such as type 2 diabetes (T2D), using commonly available computable phenotype definitions (ie, phenotypes). ObjectiveTo bridge this gap, our study aims to assess how issues of EHR data quality and variations and robustness (or lack thereof) in phenotypes may have potential impacts in identifying denominator populations. MethodsApproximately 208,000 patients with T2D were included in our study, which used retrospective EHR data from the Johns Hopkins Medical Institution (JHMI) during 2017‐2019. Our assessment included 4 published phenotypes and 1 definition from a panel of experts at Hopkins. We conducted descriptive analyses of demographics (ie, age, sex, race, and ethnicity), use of health care (inpatient and emergency room visits), and the average Charlson Comorbidity Index score of each phenotype. We then used different methods to induce or simulate data quality issues of completeness, accuracy, and timeliness separately across each phenotype. For induced data incompleteness, our model randomly droppedreplacedincremental shift ResultsLess than a quarter (n=47,326, 23%) of the population overlapped across all phenotypes using EHRs. The population identified by each phenotype varied across all combinations of data types. Induced incompleteness identified fewer patients with each increment; for example, at 100% diagnostic incompleteness, the Chronic Conditions Data Warehouse phenotype identified zero patients, as its phenotypic characteristics included only diagnosis codes. Induced inaccuracy and timeliness similarly demonstrated variations in performance of each phenotype, therefore resulting in fewer patients being identified with each incremental change. ConclusionsWe used EHR data with diagnosis, medication, and laboratory data types from a large tertiary hospital system to understand T2D phenotypic differences and performance. We used induced data quality methods to learn how data quality issues may impact identification of the denominator populations upon which clinical (eg, clinical research and trials, population health evaluations) and financial or operational decisions are made. The novel results from our study may inform future approaches to shaping a common T2D computable phenotype definition that can be applied to clinical informatics, managing chronic conditions, and additional industry-wide efforts in health care.

Background PP‐007 is a polyethylene glycol (PEG)ylated bovine carboxyhemoglobin gas transfer molecule with pleotropic cytoprotective effects, vasodilatation, plasma expansion, and optimization of oxygen delivery. Rodent middle cerebral artery occlusion models have demonstrated that PP‐007 increases blood flow in the collateral circulation and reduces final infarct volumes, supporting a potential role as neuroprotective agent in acute ischemic stroke. We aim to evaluate the safety and feasibility of PP‐007 as an adjunctive treatment to mechanical thrombectomy (MT) in patients with stroke secondary to large vessel occlusion. Methods HEMERA‐1 (CarboxyHEMoglobin OxygEn delivery for Revascularization in Acute Stroke) was a multicenter, prospective, randomized, controlled phase 1 clinical trial. Anterior circulation large vessel occlusion patients were assigned in a 3:1 ratio to receive either PP‐007 (320 mg/kg: 30 min bolus followed by 2‐h infusion) plus MT or MT alone within 24 hours after symptom onset. Comprehensive safety evaluation was performed by independent Data Monitoring Safety Board and Imaging Core Lab. Results From October 1, 2021 to June 30, 2022, a total of 17 patients were recruited. Age, baseline National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT Score were 74.8±12.7 years, 17.3±4.2, and 7.9±1.8, respectively. Twelve patients were randomized to PP‐007 plus MT, 1 was randomized but not treated, 4 patients were randomized to MT alone. Recanalization of the occluded vessel was achieved in all patients. A transient systolic blood pressure increase (20–40 mm Hg) during the bolus was observed in all PP‐007 patients without any clinical consequences. There were no other safety concerns. Conclusion No significant safety concerns were identified for the adjunctive use of PP‐007 in patients undergoing MT. (The study was funded by Prolong Pharmaceuticals. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04677777.

ABSTRACTStudents’ scientific literacy may be improved by the integration of social issues into biology courses, enabling them to make informed decisions on social issues in the context of their scientific knowledge. Additionally, this may allow students to recognize the connection between science and society. Although there are a number of benefits with having students learn about social issues in biology courses, most undergraduate courses may follow a traditional curriculum, which emphasizes the scientific content without framing it in a social context. Here, we investigated whether undergraduate students have been exposed to social issues in previous biology courses and examined how their perceptions changed before and after taking a biology course that incorporated social issues. In surveys, most students reported having no exposure to social issues in biology courses. Most students, especially females and persons excluded because of their ethnicity or race (PEERs), agreed with the integration of social issues in biology courses before taking the course. Students found reflection essays to be a useful tool in allowing them to think and share their thoughts on social issues as well as relate the course content to their personal lives. These results highlight students’ interest in learning about social issues from a scientific perspective and how reflection essays may be used to practice applying their knowledge to real-world issues.

Recently updated COVID-19 mRNA vaccines encode the spike protein of the omicron subvariant XBB.1.5 and are recommended for patients with inflammatory bowel disease (IBD) on immunosuppressive treatment. Nonetheless, their immunogenicity in patients with IBD against rapidly expanding virus variants remains unknown. This prospective multicenter cohort study is the first study to investigate the immunogenicity of XBB.1.5-adapted vaccines in patients with IBD. Systemic and mucosal antibodies targeting the receptor-binding domains (RBDs) of the omicron subvariants XBB.1.5, EG.5.1, and BA.2.86, as well as their neutralization were quantified before and two to four weeks after vaccination with monovalent XBB.1.5-adapted mRNA vaccines. Vaccination increased levels of serum anti-RBD IgG targeting XBB.1.5, EG.5.1, and BA.2.86 (1.9-fold, 1.8-fold, and 2.6-fold, respectively) and enhanced corresponding neutralization responses (2.3-fold, 3.1-fold, and 3.5-fold, respectively). Following vaccination, anti-TNF-treated patients had reduced virus neutralization compared to patients on treatments with other cellular targets. 11.1% and 16.7% of patients lacked EG.5.1 and BA.2.86 neutralization, respectively; all these patients received anti-TNF treatment. At mucosal sites, vaccination induced variant-specific anti-RBD IgG but failed to induce RBD-targeting IgA. Our findings provide a basis for future vaccine recommendations while highlighting the importance of frequent booster vaccine adaptation and the need for mucosal vaccination strategies in patients with IBD.

This research aimed to measure the concentration of various fatty acids, in the dorsal muscle tissue of Cyprinus carpio fish from Dukan Lake and Qaikand pond using gas-liquid chromatography (GLC) VARIAN gas chromatograph (GC) (CP3800 Walnut Creek model). The presence of highly digestible proteins and fatty acids in fish is critical for a healthy lifestyle since they provide nutritional value. Fatty acids play significant roles in metabolism and function as hormones and signalling molecules. this study was conducted in November and December 2020, 30 fish samples ( length: 28 - 38 cm and weight: 965-1640 grams) were collected from Dukan Lake and Qaikand Pond. The average levels of the saturated, monounsaturated, and polyunsaturated fatty acids in the fish from the Dukan were 22.51%, 51.47%, and 21.94%, respectively, and in fish from the Qaikand, they were 25.80%, 44.79%, and 18.93%, respectively. The present study's findings suggest carp could be an excellent component of low-fat, high-polyunsaturated fatty acid diets.

Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Radiology clerkships have the potential to give medical students a better appreciation towards the responsibilities of radiologists towards patient care, while also raising interest and improving student confidence in diagnostic imaging skills. Unfortunately, many radiology clerkships across the US have developed a reputation for being unorganized, and unengaging. This narrative review is focused on summarizing various clerkship practices performed across the US that have been well received by students, as well as specific weaknesses with the traditional clerkship format from the student perspective, with the aim of effective approaches to revamping electives to showcase the realities of the specialty while also attracting bright and motivated students. This narrative review examined 28 studies that gathered survey responses from medical students that completed radiology clerkships to determine their perceptions towards the clerkship. Major findings to be discussed in detail include weaknesses with the traditional format related to passive learning through observing, and unclear expectations for medical students, as well as certain challenges that clerkship directors may face while attempting to implement changes to their clerkship. This narrative review will also discuss specific well-received practices involving more active learning, including interactive workstations, interactive simulators, flipped classrooms, and case banks and online learning modules.

Background: To trigger quit intention and practice of preventive measures for COVID-19 among tobacco users; it is imperative for them to be well aware of the fact that they are at higher risk of COVID-19 infection and should be at higher efficacy to practice preventive measures for the disease as compared to nonusers of tobacco. Objectives: This community-based cross-sectional analytical study was conducted from April 2020 to May 2020 among 1203 adult participants to compare the threat and efficacy perception among users and nonusers of tobacco. Materials and Methods: Perception of threat was assessed using three questions on perceived threat and one question on perceived susceptibility; whereas perception of efficacy was assessed using four questions each on self-efficacy and response efficacy through telephonic interview. Results: There was no significant difference in the overall threat perception among users and nonusers of tobacco. However, state-wise analysis showed that tobacco users had higher perception of threat for SARS-CoV-2 infection in all the states except Telangana. The overall perception of efficacy among tobacco users was significantly higher as compared to nonusers of tobacco. Conclusion: The study calls for active collaboration between tobacco control enthusiasts and the Government to promote awareness of a higher risk of COVID-19 disease among tobacco users. In essence, the study's implications extend beyond COVID-19 and can guide targeted efforts to promote awareness, behavior change, and collaboration in the context of other infectious diseases among tobacco users.

Abstract Partons traversing the strongly interacting medium produced in heavy-ion collisions are expected to lose energy depending on their color charge and mass. We measure the nuclear modification factors for charm- and bottom-decay electrons, defined as the ratio of yields, divided by the number of binary nucleon–nucleon collisions, in $$\sqrt{s_{\textrm{NN}}}=200$$ s NN = 200 GeV Au+Au collisions to p+p collisions ( $$R_{\textrm{AA}}$$ R AA ), or in central to peripheral Au+Au collisions ( $$R_{\textrm{CP}}$$ R CP ). We find the bottom-decay electron $$R_{\textrm{AA}}$$ R AA and $$R_{\textrm{CP}}$$ R CP to be significantly higher than those of charm-decay electrons. Model calculations including mass-dependent parton energy loss in a strongly coupled medium are consistent with the measured data. These observations provide evidence of mass ordering of charm and bottom quark energy loss when traversing through the strongly coupled medium created in heavy-ion collisions.

The objective of the present study was to investigate the concentration of some heavy metals in the dorsal muscle, gills, and liver of common carp (Cyprinus carpio) from the Dukan lake, Suleimani, Iraq, and its relationship with fish protein content. The sampling was carried out in both the summer and winter seasons of 2021. Fish samples were collected from the water of Dukan lake. Biometry analysis and determining of protein content were carried out. Moreover, the heavy metal concentrations were measured in different tissues and organs of fish (the dorsal muscle, gills, and liver). The metal concentration varied considerably among different tissues and organs. Overall, the mean metal concentration revealed an order of Zn > Fe > Cr > Cd > Cu > As > Pb. The mean concentrations of Zn and Pb were determined as the maximum and minimum concentrations of metals in the fish organs, respectively. Metal accumulation was higher in the gills and liver than in the muscle (except Cr). The content of protein showed a close relationship with some of the metal concentrations. The concentrations of metals like As, Cd, and Cu were higher during the summer than in the winter, except for Cr and Fe. Due to the concerns related to the adverse effects of heavy metals in fish meat on human health, investigation of the concentration of pollution and regular monitoring of the physicochemical and heavy metal contents and its relationship with those measured in fish is strongly recommended.

Abstract Background Clear cell renal cell carcinoma (ccRCC), the predominant subtype of kidney cancer, possesses characteristic alterations to multiple metabolic pathways, including the accumulation of cytosolic lipid droplets. However, the pathways that drive lipid droplet accumulation in ccRCC cells and their importance to cancer biology remain poorly understood. Methods We sought to identify the carbon sources necessary for lipid droplet accumulation using Oil red O staining and isotope-tracing lipidomics. The role of the acyl-CoA synthetase (ACSL) family members, an important group of lipid metabolic enzymes, was investigated using siRNA and drug mediated inhibition. CTB and XTT assays were performed to determine the effect of ACSL3 knockdown and lipid starvation on ccRCC cell viability and shRNA was used to study the effect of ACSL3 in an orthotopic mouse model. The relationship between ferroptosis susceptibility of ccRCC and ACSL3 controlled lipid metabolism was examined using CTB and FACS-based assays. The importance of 5-LOX in ferroptosis susceptibility in ccRCC was shown with XTT survival assays, and the expression level and predictive value of 5-LOX in TCGA ccRCC data was assessed. Results We found that ccRCC cells obtain the necessary substrates for lipid droplet accumulation by metabolizing exogenous serum derived lipids and not through de novo lipogenesis. We show that this metabolism of exogenous fatty acids into lipid droplets requires the enzyme acyl-CoA synthetase 3 (ACSL3) and not other ACSL family proteins. Importantly, genetic or pharmacologic suppression of ACSL3 is cytotoxic to ccRCC cells in vitro and causes a reduction of tumor weight in an orthotopic mouse model. Conversely, ACSL3 inhibition decreases the susceptibility of ccRCC cells to ferroptosis, a non-apoptotic form of cell death involving lipid peroxidation. The sensitivity of ccRCC to ferroptosis is also highly dependent on the composition of exogenous fatty acids and on 5-lipoxygenase (5-LOX), a leukotriene producing enzyme which produces lipid peroxides that have been implicated in other cancers but not in ccRCC. Conclusions ACSL3 regulates the accumulation of lipid droplets in ccRCC and is essential for tumor growth. In addition, ACSL3 also modulates ferroptosis sensitivity in a manner dependent on the composition of exogenous fatty acids. Both functions of ACSL3 could be exploited for ccRCC therapy.

ABSTRACT To better prepare undergraduate students as informed citizens, they need skills to evaluate and interpret scientific data that are relevant to real world scenarios. Socioscientific issues are typically complicated or debatable issues that require individuals to evaluate their background knowledge and make decisions with respect to social and cultural contexts. Incorporation of socioscientific issues into a course allows students opportunities to demonstrate their argumentation skills. In this study, we investigated the relationship between students’ biological content knowledge and their argumentation skills. We evaluated students’ content knowledge of primary research articles on mRNA vaccine development and clinical trials. There was no correlation of content knowledge and students’ argumentation skills to counter vaccine hesitancy. While most students demonstrated understanding of the primary research articles, almost half the students did not include specific biological knowledge in their arguments, indicating they had difficulty in applying their knowledge to the real world. These results suggest there is a need to provide students with additional opportunities to practice and develop their argumentation skills with respect to socioscientific issues.

The current study aimed to identify the viewpoint of the students of University of Zakho about the reality of applying Bologna process in university education, and the significance of the differences in their viewpoints according to the demographic variables: gender, class, and specialization. The sample consisted of (750) male and female students who were chosen in a stratified random manner from the colleges and faculties of University of Zakho. To achieve the objectives of the study, the researchers prepared a questionnaire consisting of (41) items divided into four dimensions. The study’s validity and reliability indicators were verified. The data were treated statistically using the arithmetic means and standard deviations, in addition to using the t-test for one sample and for two independent samples. The results indicated that the reality of applying Bologna Process from the students’ point of view is good or high. Besides, there was a significant difference in the students’ point of view about the reality of applying Bologna Process due to the college variable and in favor of the humanities colleges. No significant differences appeared in their views according to gender and class. In light of the results, a set of recommendations and proposals were presented.

الاستعارة والرمز والفصل والوصل هي أنموذجـــــــً لأهم الأسس الدلاليــــة التـــي أنمازت بها رسائل الزرزوريات ,فشكلت محوراً أسلــــــوبياً ينضمُ إلى بقية المحاور الأخــرى, يكشف لنا أسلـــوب كتّابها في إتقان فن السخرية والفكاهة , وما ينطوي خلفها من رمزية في تــــــوظيف لمسميـــــات هذه الطيور , وماتمثله الطبيعة بكل تفاصيلها للكاتب الأندلســـي في كونها ملهماُ ومتنفساً له .

Abstract Introduction Information on the off–label use of Long–Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on– vs off–label LAIs and predictors of off–label First– or Second–Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off– or on–label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off–label group. Results SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on– and off–label use. Approximately 1 in 4 patients received an off–label prescription. In the off–label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off–label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co–morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns.

BackgroundMedical products incorporating nanoparticle drug delivery systems (nanomedicines) are therapeutic or imaging agents, which comprise a delivery system within the nanometer size range (1 – 1000 nm). As medical products, nanomedicines meet definitions of medicines according to various national legislations for regulation of medicines. However, for the regulation of nanomedicines, additional assessments including toxicological issues have to be considered. These complexities require extra regulatory effort. In the resource-limited context of low- and middle-income countries, many National Medicines Regulatory Authorities (NMRAs) lack resources and capacities to effectively assure the quality of medicinal products in their countries. With emerging trends in innovative technologies, including nanotechnology, this burden is worsened. The need to overcome regulatory challenges drove the formation of a work sharing initiative in the Southern African Development Community (SADC), ZaZiBoNA in 2013. Regulatory agencies participating in this initiative cooperate in the assessment of applications for registration of medicines.MethodsA cross-sectional exploratory study design with qualitative techniques was used to investigate the status of the regulation of nanomedicines in Southern African countries in particular those participating in the ZaZiBoNA initiative.ResultsThe study found that in general, NMRAs are aware of the existence of nanomedicines and they apply legislation applicable to other medical products. The NMRAs however neither have specific definition for nanomedicines and technical guidance documents, nor technical committees specific for consideration of nanomedicines. Collaboration with external experts or organisations in the regulation of nanomedicines was also found to be lacking.DiscussionCapacity building and collaboration in the area of regulation of nanomedicines is strongly encouraged.

BackgroundThe use of information and communication technologies for health—eHealth—is described as having potential to improve the quality of health care service delivery. Consequently, there is an increased global trend toward adoption of eHealth interventions by health care systems worldwide. Despite the proliferation of eHealth solutions, many health care institutions especially in transitioning countries are struggling to attain effective data governance approaches. The Ministry of Health in Botswana is an exemplar institution continually seeking better approaches to strengthen health data governance (HDG) approaches following the adoption of eHealth solutions. Recognizing the need for a global HDG framework, the Transform Health coalition conceptualized HDG principles that are structured around 3 interconnected objectives: protecting people, promoting the value of health, and prioritizing equity. ObjectiveThe aim of the study is to solicit and evaluate perceptions and attitudes of health sector workers in Botswana toward the HDG principles by Transform Health and derive any future guidance. MethodsPurposive sampling was used to select participants. A total of 23 participants from various health care organizations in Botswana completed a web-based survey and 10 participated in a follow-up remote round-table discussion. The aim of the round-table discussion was to gain further insight into participants’ responses from the web-based survey. Participants were from the following health care cadres: nurses, doctors, information technology professionals, and health informaticians. Both validity and reliability testing were performed for the survey tool before sharing it with study participants. An analysis of participants’ close-ended responses from the survey was performed using descriptive statistics. Thematic analysis of open-ended responses from the questionnaire and the round-table discussion was achieved using the Delve software and the widely accepted principles of thematic analysis. ResultsAlthough some participants highlighted having measures in place similar to the HDG principles, there were some who either did not know or disagreed that their organizations already had in place mechanisms similar to the proposed HDG principles. Participants further expressed relevance and importance of the HDG principles in the context of Botswana. However, some modifications to the principles were also suggested. ConclusionsThis study highlights the necessity of data governance in health care particularly toward meeting the requirements for Universal Health Coverage. The existence of other health data governance frameworks calls for a critical analysis to assess the most appropriate and applicable framework in the context of Botswana and similar transitioning countries. An organization-centered approach may be most appropriate, as well as strengthening of existing organizations’ HDG practices with the Transform Health principles.

Introduction: Hearing loss is the most common sensory deficit in humans today which is more prevalent during the school going years, due to late onset and identification, affecting a child’s educational, cognitive and social development. Aims and Objectives: This study was conducted to determine the common causes of hearing loss among the school going children. Methodology: This cross-sectional study done in two state government schools of Meghalaya and 108 students were assessed for the presence of hearing loss using preformed questionnaire. Otoscopic examination was done on all students. Results: Through this study the prevalence of hearing loss in the students studied was found to be 17.6% and the prevalence of ear disease (with or without hearing loss) was 22%.The prevalence of hearing loss was significantly higher in rural school than the semi urban school. The most common ear disease was ear wax, Chronic suppurative otitis media (CSOM) and Otitis media with effusion (OME). Conclusion: The hearing loss present in our study population was due to either preventable or treatable causes and its prevalence can be brought down with proper care of the ear and with adequate treatment.