ROAD-MAP FOR CONDUCTING MEDICAL EXAMS IN RESOURCE LIMITED COUNTRIES DURING COVID-19 PANDEMIC

The COVID-19 pandemic has adversely affected medical education worldwide. Developed countries have successfully managed this by adopting modified ways of teaching and assessment and utilizing their resources but low income countries have struggled in managing the challenges they have faced in teaching and assessment. Medical exams have been postponed multiple times because of no clear way forward due to limited resources. This has not only resulted in wasting of the time of students but also adds to desperation and frustration of the students as well as teachers and institutes. Newer modes of information transfer including E-lectures, pre-recorded videos, simulation based learning and assessment (Kahoot, Socrative etc) have been introduced over the past two years. This paper illustrates a modified model for medical exams which may prove a suitable alternative for low income countries during pandemic. © 2022, Khyber Medical University. All rights reserved.

A new ridge estimator for linear regression model with some challenging behavior of error term

Ridge regression is a variant of linear regression that aims to circumvent the issue of collinearity among predictors. The ridge parameter (Formula presented.) has an important role in the bias-variance tradeoff. In this article, we introduce a new approach to select the ridge parameter to deal with the multicollinearity problem with different behavior of the error term. The proposed ridge estimator is a function of the number of predictors and the standard error of the regression model. An extensive simulation study is conducted to assess the performance of the estimators for the linear regression model with different error terms, which include normally distributed, non-normal and heteroscedastic or autocorrelated errors. Based upon the criterion of mean square error (MSE), it is found that the new proposed estimator outperforms OLS, commonly used and closely related estimators. Further, the application of the proposed estimator is provided on the COVID-19 data of India. © 2023 Taylor & Francis Group, LLC.

Impact of Geriatric Assessment and Management on Quality of Life, Unplanned Hospitalizations, Toxicity, and Survival for Older Adults With Cancer: The Randomized 5C Trial.

PURPOSE: American Society of Clinical Oncology recommends that older adults with cancer being considered for chemotherapy receive geriatric assessment (GA) and management (GAM), but few randomized controlled trials have examined its impact on quality of life (QOL). PATIENTS AND METHODS: The 5C study was a two-group parallel 1:1 single-blind multicenter randomized controlled trial of GAM for 6 months versus usual oncologic care. Eligible patients were age 70+ years, diagnosed with a solid tumor, lymphoma, or myeloma, referred for first-/second-line chemotherapy or immunotherapy or targeted therapy, and had an Eastern Cooperative Oncology Group performance status of 0-2. The primary outcome QOL was measured with the global health scale of the European Organisation for the Research and Treatment of Cancer QOL questionnaire and analyzed with a pattern mixture model using an intent-to-treat approach (at 6 and 12 months). Secondary outcomes included functional status, grade 3-5 treatment toxicity; health care use; satisfaction; cancer treatment plan modification; and overall survival. RESULTS: From March 2018 to March 2020, 350 participants were enrolled. Mean age was 76 years and 40.3% were female. Fifty-four percent started treatment with palliative intent. Eighty-one (23.1%) patients died. GAM did not improve QOL (global QOL of 4.4 points [95% CI, 0.9 to 8.0] favoring the control arm). There was also no difference in survival, change in treatment plan, unplanned hospitalization/emergency department visits, and treatment toxicity between groups. CONCLUSION: GAM did not improve QOL. Most intervention group participants received GA on or after treatment initiation per patient request. Considering recent completed trials, GA may have benefit if completed before treatment selection. The COVID-19 pandemic may have affected our QOL outcome and intervention delivery for some participants.

The role of country of origin image, brand image and eWOM in the intention to receive the Sinopharm vaccine

Purpose: This study aims to explain the factors associated with receiving a specific brand of Covid-19 vaccine within the framework of the theory of reasoned action. The study extends the theory of reasoned action with the country of origin image, brand image and electronic word of mouth (e-WOM) variables. Design/methodology/approach: The study is based on a cross-sectional survey conducted among 460 people who received the Sinofarm vaccine. Participants were selected using an online convenience sampling method. The structural equation modeling (SEM) technique tests the proposed hypotheses. Findings: The results showed that the essential factor associated with the intent to get the Chinese Sinopharm vaccine is the attitude toward the Signopharm vaccine. Also, WOM, subjective norms and brand image are the most critical factors that play a role in forming a favorable attitude toward the Sinopharm vaccine. Finally, the country-of-origin image does not affect attitudes toward the Sinopharm vaccine. Originality/value: The area of vaccine marketing has been given limited attention in academic literature. This study addresses this area with little research and is greatly attractive to many brands targeting the consumer market. The study results can form a foundation for creating the branding strategy of this product category and assessing its demand in various markets. © 2023, Emerald Publishing Limited.

Use of Hybrid Veno-venous-pulmonary Artery ECMO in A Patient with Respiratory Failure Secondary to COVID-19

Background: Extracorporeal membrane oxygenation (ECMO) is a form of cardio-pulmonary life support used for patients with respiratory and/or cardiac failure. Hybrid ECMO is a sophisticated circuit to match the exact hemodynamic demands in patients who are refractory to traditional ECMO settings. Case: A 43-year-old male presented with dyspnea for four days. On physical examination, he exhibited increased work of breathing and decreased breath sounds bilaterally. Pulse oximetry was 70% on room air, minimally improved to 75% on maximum high flow nasal cannula. He was found to be COVID-19 positive and demonstrated diffuse bilateral lung consolidation on CT chest consistent with severe acute respiratory distress syndrome. Patient was intubated but continued to show poor oxygenation with P/F ratio of 71 (Normal: >400). Veno-Venous (VV) ECMO was started with cannulations into the right femoral vein (RFV) and right internal jugular vein (RIJV);this resulted in an initial improvement of partial pressure of oxygen (pO2) in arterial blood gas. However, within a few days, pO2 started to decrease with visual evidence of recirculation of oxygenated blood into the venous drainage line. A transthoracic echocardiography revealed severe pulmonary artery (PA) hypertension secondary to respiratory failure with PA pressure of 116mmHg (Normal: 18-25mmHg). This prompted a revision of the ECMO circuit to offload the right ventricle. Revised circuit included a cannula in the RFV for venous drainage and oxygenated venous return through two pathways: cannula in the RIJV (approximately 1 liter return), and a third cannula inserted through the left subclavian vein terminating into the main PA (approximately 4 liters return). Hereon, patient was able to maintain adequate pO2 for the remainder of his hospital stay until he was transferred to a lung transplant center. Conclusion: Our case illustrates the clinical sophistication of hybrid VV-PA ECMO-especially in patients with PA hypertension and impending right-sided heart failure. As respiratory failure secondary to COVID-19 becomes more prevalent, hybrid ECMO may provide a practical solution to protect the right heart in the journey to lung transplant.

Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults.

INTRODUCTION: Older adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postoperative disability is an important patient-centred outcome to measure intermediate-to-long recovery after major surgery in older adults. METHODS AND ANALYSIS: The Functional Improvement Trajectories After Surgery (FIT After Surgery) study is a multicentre cohort study of 2000 older adults (≥65 years) having major non-cardiac surgery. Its objectives are to characterise the incidence, trajectories, risk factors and impact of new significant disability after non-cardiac surgery. Disability is assessed using WHO Disability Assessment Schedule (WHODAS) 2.0 instrument and participants' level-of-care needs. Disability assessments occur before surgery, and at 1, 3, 6, 9 and 12 months after surgery. The primary outcome is significantly worse WHODAS score or death at 6 months after surgery. Secondary outcomes are (1) significantly worse WHODAS score or death at 1 year after surgery, (2) increased care needs or death at 6 months after surgery and (3) increased care needs or death at 1 year after surgery. We will use multivariable logistic regression models to determine the association of preoperative characteristics and surgery type with outcomes, joint modelling to characterise longitudinal time trends in WHODAS scores over 12 months after surgery, and longitudinal latent class mixture models to identify clusters following similar trajectories of disability. ETHICS AND DISSEMINATION: The FIT After Surgery study has received research ethics board approval at all sites. Recruitment began in December 2019 but was placed on hold in March 2020 because of the COVID-19 pandemic. Recruitment was gradually restarted in October 2020, with 1-year follow-up expected to finish in 2023. Publication of the primary results is anticipated to occur in 2024.

FREQUENCY OF MYOCARDITIS IN COVID-19 PATIENTS

Objective: To determine frequency of myocarditis in COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology-National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi and Pak Emirates Military Hospital (PEMH), Rawalpindi, from Dec 2020 to May 2021. Methodology: A total of 143 hospitalized patients who had tested positive for COVID-19 infection via RT-PCR were included in the study. Patients with pre-existing cardiac conditions were excluded. All patients underwent transthoracic echocardiography and their ejection fractions were recorded. Meticulous testing for the inflammatory markers including CRP, serum ferritin, procalcitonin and interleukin-6 (IL-6) and cardiac biomarker (NT-pro-BNP) was carried out. The data was recorded on a specially designed questionnaire and later transferred to SPSS-23 for analysis. Myocarditis was diagnosed on the basis of reduced Ejection Fraction or raised NT pro BNP or both in a person without any known cardiac pathologies before getting COVID-19. Results: Out of total 143 COVID-19 patients included in the study, 24 patients (16.8%) developed myocarditis. The frequency of myocarditis in COVID-19 positive male population was 14.6% (10.5% of all myocarditis cases) and that of female population was 22.5% (6.3% of all myocarditis cases). The raised pro-inflammatory markers IL-6 and CRP were significantly associated with development of myocarditis while ferritin was not significantly associated. Only 28% of the study population recovered and got discharged from the hospital, however, there were no survivors among those who developed myocarditis. Conclusion: Myocarditis is a serious complication of COVID-19 and directly linked to increased mortality risk. There is an increasing need to perform serial assays for the inflammatory as well as cardiac biomarkers including IL-6, Trop-I and NT-pro-BNP for early detection and prompt treatment of this not so uncommon complication. © 2021, Army Medical College. All rights reserved.

PRNet: Progressive Resolution based Network for Radiograph based disease classification

COVID-19 and Pneumonia have impacted human life significantly. The number of infected people and deaths are increasing every day due to COVID. Rapid COVID detection is important to control and stop the spread of the disease. Considering that AI can play a significant role in accurate and fast detection of such diseases, EE-RDS conducted a multi-class classification challenge by providing chest X-rays of pneumonia, COVID-19 and normal patients. We proposed PRNet, a novel deep learning pipeline and achieved 96.3% accuracy winning the 2nd position on the test set Leaderboard. © 2021 IEEE.

The role of world the fight against covid-19

In under two decades, the world has encountered three flare-ups of fatal Coronaviruses, including the ongoing pandemic of Coronavirus Disease 2019 (COVID-19) in China. COVID-19 represented a crisis of worldwide concerns, and cases have been accounted for more than 200 nations/districts that came about in wellbeing, lives, and monetary misfortunes. China's financial development is anticipated to tumble to 5.6% this year, the International Monetary Fund (IMF) anticipated that arrangement venture and expense strategies to execute $3.3 trillion and contributes further $4.5 trillion. IMF conjectures develop from 3.7% of worldwide total national output (GDP) in 2019 to 9.9% in 2020. Gross domestic product proportion anticipated from 3.0% in 2019 to become 10.7% in 2020, the US proportion expected to increment from 5.8-15.7%. There is a desperate requirement for local and universal co-activity to stretch out hands to forestall further spreading of COVID-19. The IMF has reacted to the COVID emergency with exceptional speed and greatness of financial aid. This paper shows the response of the world against COVID-19. How the countries are helping each other to control the spread and discovering the cure of this virus. Asia has survived usefully and also defending the second wave of virus, but on the other hand, the Europe is the most infected region with the highest rate of death. Why Asia is near to win this fight with a stable economy, but the Europe is not, instead of this the economy is going to be crashed. These questions raises to the Economy, Behavior and Policies, of respective Countries. © 2021, Army Medical College. All rights reserved.

Battling COVID-19: The effectiveness of biometrics towards enhancing security of internet banking in malaysia

The research purpose is to identify which security factors that influence customer trust towards the intention to continue using Internet banking in Malaysia. The primary participants are internet banking users in Malaysia. A total of 227 respondents completed the questionnaires as requested. The results show that direct relationship of perceived privacy, perceived confidentiality, perceived data integrity, effectiveness of biometrics are significant factors influencing customer trust towards intention to continue using internet banking. This result shows the significant mediating effect between perceived privacy, perceived confidentiality, perceived data integrity, effectiveness of biometrics with customer trust. Trust is a significant effect towards intention to continue using internet banking. Security factors and effectiveness of biometrics have strong relationship towards increasing customer trust using internet banking. This is a strong signal to internet banking providers to enhance their security level towards multi factor authentication using biometrics solution. © 2021 IGI Global. All rights reserved.

A Pragmatic Non-Randomized Trial of Prehabilitation Prior to Cancer Surgery: Study Protocol and COVID-19-Related Adaptations.

BACKGROUND: Experimental data highlight the potential benefits and health system cost savings related to surgical prehabilitation; however, adequately powered randomized controlled trial (RCT) data remain nascent. Emerging prehabilitation services may be informed by early RCT data but can be limited in informing real-world program development. Pragmatic trials emphasize external validity and generalizability to understand and advise intervention development and implementation in clinical settings. This paper presents the methodology of a pragmatic prehabilitation trial to complement emerging phase III clinical trials and inform implementation strategies. METHODS: This is a pilot pragmatic clinical trial conducted in a large academic hospital in Toronto, Ontario, Canada to assess feasibility of clinical implementation and derive estimates of effectiveness. Feasibility data include program referral rates, enrolment and attrition, intervention adherence and safety, participant satisfaction, and barriers and facilitators to programming. The study aims to receive 150 eligible referrals for adult, English-speaking, preoperative oncology patients with an identified indication for prehabilitation (e.g., frailty, deconditioning, malnutrition, psychological distress). Study participants undergo a baseline assessment and shared-decision making regarding the intervention setting: either facility-based prehabilitation or home-based prehabilitation. In both scenarios, participants receive an individualized exercise prescription, stress-reduction psychological support, nutrition counseling, and protein supplementation, and if appropriate, smoking cessation program referrals. Secondary objectives include estimating intervention effects at the week prior to surgery and 30 and 90 days postoperatively. Outcomes include surgical complications, postoperative length of stay, mortality, hospital readmissions, physical fitness, psychological well-being, and quality of life. Data from participants who decline the intervention but consent for research-related access to health records will serve as comparators. The COVID-19 pandemic required the introduction of a 'virtual program' using only telephone or internet-based communication for screening, assessments, or intervention was introduced. CONCLUSION: This pragmatic trial will provide evidence on the feasibility and viability of prehabilitation services delivered under usual clinical conditions. Study amendments due to the COVID-19 pandemic are presented as strategies to maintain prehabilitation research and services to potentially mitigate the consequences of extended surgery wait times.

Covid-19 challenges and human resource management in organized retail operations

The study emphasizes on identifying and overcoming Covid-19 challenges, faced by human resource management (HRM) while managing personnel in organized retail stores. Data for this study were drawn from a review of secondary sources on practical insights about Covid-19 challenges, suggesting tangible solutions to solve them, which should be addressed at the earliest to ensure successful retail operations avoiding unexpected chaos created by the Covid-19 pandemic. © 2020, Universidad del Zulia. All rights reserved.