scholarly journals Immune Checkpoints Expression in Chronic Lung Allograft Rejection

2021 ◽  
Vol 12 ◽  
Author(s):  
Ilaria Righi ◽  
Valentina Vaira ◽  
Letizia Corinna Morlacchi ◽  
Giorgio Alberto Croci ◽  
Valeria Rossetti ◽  
...  
Keyword(s):  
T Lymphocytes ◽  
Bronchiolitis Obliterans Syndrome ◽  
Immune Checkpoints ◽  
Hla Antibodies ◽  
Restrictive Allograft Syndrome ◽  
And Function ◽  
Shed Light

Chronic lung allograft dysfunction (CLAD) is the main cause of poor survival and low quality of life of lung transplanted patients. Several studies have addressed the role of dendritic cells, macrophages, T cells, donor specific as well as anti-HLA antibodies, and interleukins in CLAD, but the expression and function of immune checkpoint molecules has not yet been analyzed, especially in the two CLAD subtypes: BOS (bronchiolitis obliterans syndrome) and RAS (restrictive allograft syndrome). To shed light on this topic, we conducted an observational study on eight consecutive grafts explanted from patients who received lung re-transplantation for CLAD. The expression of a panel of immune molecules (PD1/CD279, PDL1/CD274, CTLA4/CD152, CD4, CD8, hFoxp3, TIGIT, TOX, B-Cell-Specific Activator Protein) was analyzed by immunohistochemistry in these grafts and in six control lungs. Results showed that RAS compared to BOS grafts were characterized by 1) the inversion of the CD4/CD8 ratio; 2) a higher percentage of T lymphocytes expressing the PD-1, PD-L1, and CTLA4 checkpoint molecules; and 3) a significant reduction of exhausted PD-1-expressing T lymphocytes (PD-1pos/TOXpos) and of exhausted Treg (PD-1pos/FOXP3pos) T lymphocytes. Results herein, although being based on a limited number of cases, suggest a role for checkpoint molecules in the development of graft rejection and offer a possible immunological explanation for the worst prognosis of RAS. Our data, which will need to be validated in ampler cohorts of patients, raise the possibility that the evaluation of immune checkpoints during follow-up offers a prognostic advantage in monitoring the onset of rejection, and suggest that the use of compounds that modulate the function of checkpoint molecules could be evaluated in the management of chronic rejection in LTx patients.

scholarly journals The Role of Preoperative Computed Tomography on the Quality of Reduction and Outcomes in Intertrochanteric Fracture: A Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Tao Ma ◽  
Lin-Jie Hao ◽  
Peng-Fei Wen ◽  
Ya-Kang Wang ◽  
Hu Wang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Intertrochanteric Fracture ◽  
Controlled Trial ◽  
The Elderly ◽  
Ct Examination ◽  
Preoperative Ct ◽  
And Function

Purpose. The study is aimed at assessing the role of preoperative computerised tomography (CT) examination in the quality of reduction and outcomes in elderly patients with intertrochanteric fracture. Methods. The elderly patients with an intertrochanteric fracture who were treated with proximal femoral nail antirotation were included. The patients were divided into the CT group and the no-CT group according to the presence of preoperative CT examination. Patients’ baseline characteristics, quality of reduction, and function were recorded at follow-up. Functional outcomes were evaluated using the Harris hip scores (HHS). Results. Totally, the study included 182 patients with intertrochanteric fractures, with 85 in the CT group and 97 in the no-CT group, admitted between January 2018 and June 2019. There was no difference in the quality of reduction, HHS, the fracture healing, or postoperative complications between the CT group and the no-CT group. However, the CT group experienced the shorter mean operative time and blood transfusion, compared to the no-CT group. Conclusions. The preoperative CT examination seems to be excessive for elderly patients with an intertrochanteric fracture.

Tax evasion in the medical profession An Empirical Study in the General Tax Authority in Iraq

2019 ◽  
Vol 118 (11) ◽  
pp. 80-88
Author(s):  
Ramyar Rzgar Ahmed ◽  
Hawkar Qasim Birdawod ◽  
S. Rabiyathul Basariya
Keyword(s):  
Tax Evasion ◽  
Income Tax ◽  
Medical Profession ◽  
Great Influence ◽  
Tax Law ◽  
Degree Of Confidence ◽  
Medical Professions ◽  
Shed Light

The study dealt with tax evasion in the medical profession, where the problem was the existence of many cases of tax evasion, especially tax evasion in the income tax of medical professions. The aim of the study is to try to shed light on the phenomenon of tax evasion and the role of the tax authority in the development of controls and means that reduce the phenomenon of tax evasion. The most important results of the low level of tax awareness and lack of knowledge of the tax law and the unwillingness to read it and the sense of taxpayers unfairness of the tax all lead to an increase in cases of tax evasion and in suggested tightening control and follow-up on the offices of auditors, through the investigation and auditing The reports of certified accountants and the use of computers for this purpose in order to raise the degree of confidence in these reports and bring them closer to the required truth and coordination and cooperation with the Union of Accountants and Auditors and inform them about each case of violations of the auditors and accountants N because of its great influence in the rejection of the organization of the accounts and not to ratify fake accounts lead to show taxpayers accounts on a non-truth in order to tax evasion.

The Baluch, Sunnism and the State in Iran

2017 ◽  
Author(s):  
Stéphane A. Dudoignon
Keyword(s):  
South Asia ◽  
South Asian ◽  
Social Life ◽  
The State ◽  
First Century ◽  
Local Democracy ◽  
Oasis Area ◽  
Shed Light

Since 2002, Sunni jihadi groups have been active in Iranian Baluchistan without managing to plunge the region into chaos. This book suggests that a reason for this, besides Tehran’s military responses, has been the quality of Khomeini and Khamenei’s relationship with a network of South-Asia-educated Sunni ulama (mawlawis) originating from the Sarbaz oasis area, in the south of Baluchistan. Educated in the religiously reformist, socially conservative South Asian Deoband School, which puts the madrasa at the centre of social life, the Sarbazi ulama had taken advantage, in Iranian territory, of the eclipse of Baluch tribal might under the Pahlavi monarchy (1925-79). They emerged then as a bulwark against Soviet influence and progressive ideologies, before rallying to Khomeini in 1979. Since the turn of the twenty-first century, they have been playing the role of a rampart against Salafi propaganda and Saudi intrigues. The book shows that, through their alliance with an Iranian Kurdish-born Muslim-Brother movement and through the promotion of a distinct ‘Sunni vote’, they have since the early 2000s contributed towards – and benefitted from – the defence by the Reformist presidents Khatami (1997-2005) and Ruhani (since 2013) of local democracy and of the minorities’ rights. They endeavoured to help, at the same time, preventing the propagation of jihadism and Sunni radicalisation to Iran – at least until the ISIS/Daesh-claimed attacks of June 2017, in Tehran, shed light on the limits of the Islamic Republic’s strategy of reliance on Deobandi ulama and Muslim-Brother preachers in the country’s Sunni-peopled peripheries.

scholarly journals Peran Supervisi Kepala Madrasah dalam Meningkatkan Mutu Pendidikan di MTs Negeri Kulon Progo

2020 ◽  
Vol 4 (2) ◽  
pp. 211-220
Author(s):  
Legiman
Keyword(s):  
Quality Improvement ◽  
Learning Objectives ◽  
Learning Activities ◽  
Quality Of Education ◽  
Factors Affecting ◽  
Qualitative Descriptive ◽  
Education Personnel

This research aims to determine the role of the head of Madrasah in improving the quality of education in MTs Negeri 4 Kulon Progo, and to help improve the competency of teachers in the learning activities with a real, measurable, controlled, directional program to achieve learning objectives. This research uses qualitative descriptive methods with data collection through observation, interviews and documentation. The results of this research are: 1) supervision of the head of the district of the state of the principal of the school 4 Kulon Progo includes education, managerial, administrator, supervisor, leader, innovator, and motivator; 2) The role of quality improvement is done by increasing the professionalism of teachers by giving opportunities to teachers; 3) Factors affecting the implementation of the head of the Madrasah include: the planning, implementation and follow-up that is carried out continuously to the teachers and education personnel.

scholarly journals Understanding coaching efficacy in education through activity systems: privileging the nuances of provision

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rachel M. Lofthouse ◽  
Anthea Rose ◽  
Ruth Whiteside
Keyword(s):  
Activity Systems ◽  
Content Type ◽  
Coaching Efficacy ◽  
Range Of Functions ◽  
Cultural Historical Activity ◽  
The Individual ◽  
Specific Challenge

PurposeThe research demonstrates the role of activity systems based in Cultural Historical Activity Theory as a means of analysing characteristics and efficacy of specific provisions of coaching in education.Design/methodology/approachThree examples of coaching in education were selected, involving 51 schools in England. The three examples were re-analysed using activity systems. This drew on existing evaluation evidence, gathered through interviews, questionnaires, focus groups and recordings of coaching.FindingsIn each example, the object of the coaching was to address a specific challenge to secure the desired quality of education. Using activity systems it is possible to demonstrate that coaching has a range of functions (both intended and consequential). The individual examples illustrate the potential of coaching to support change in complex and diverse education settings.Research limitations/implicationsThe use of existing data from evaluations means that direct comparisons between examples are not made. While data were collected throughout the duration of each coaching programme no follow-up data was available.Practical implicationsThe analysis of the examples of coaching using activity systems provides evidence of the efficacy of specific coaching provision in achieving individually defined objectives related to sustaining and improving specific educational practices.Originality/valueThe research offers insights into how coaching in education might be better tuned to the specific needs of contexts and the challenges experienced by the individuals working in them. In addition, it demonstrates the value of activity systems as an analytical tool to make sense of coaching efficacy.

Glioma patient-reported outcomes: patients and clinicians

2021 ◽  
pp. bmjspcare-2020-002699
Author(s):  
Marthe Peeters ◽  
Germaine Ottenheijm ◽  
Paul Bienfait ◽  
Daniëlle Eekers ◽  
Anja Gijtenbeek ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Successful Implementation ◽  
Nurse Specialist ◽  
Patient Reported ◽  
Semistructured Interviews ◽  
Routine Assessment

IntroductionRoutine assessment of patient-reported outcomes (PROs) in oncology has shown to improve the quality of the delivered care and to prolong survival. However, for successful implementation of routine assessment of PROs, more knowledge on their usability in clinical practice is needed.ObjectiveThis study aimed to cross-sectionally assess the perspective of patients and clinicians on the practicality of routinely measuring PROs in clinical practice for glioma patients.MethodsSemistructured interviews were conducted evaluating the role of healthcare professionals (HCP) in discussing results of PRO measures (PROMs), and the preferred topics, methods and frequency of PRO assessment. Glioma patients, their proxies and HCPs involved in the treatment of glioma patients from eight centres in the Netherlands were included.ResultsTwenty-four patients, 16 proxies and 35 HCPs were interviewed. The majority of patients, proxies and HCPs (92%, 81% and 80%, respectively) were willing to discuss PRO results during consultations. Although HCPs prefer that results are discussed with the nurse specialist, only one-third of patients/proxies agreed. Functioning of daily life was considered important in all three groups. Most participants indicated that discussion of PROM results should take place during standard follow-up visits, and completed at home about 1 week in advance. On group level, there was no preference for administration of questionnaires on paper or digitally. Lastly, all centres had staff available to send questionnaires on paper.ConclusionThis study shows that routine assessment of PROs is desired by patients, proxies and HCP’s in neuro-oncological care in Dutch hospitals.

Exploring the scope of homoeopathy in combating the unfortunate consequences of post-COVID-19 survivors based on non-COVID conditions: a narrative review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ashish Kumar Dixit ◽  
Nibha Giri ◽  
Shishir Singh
Keyword(s):  
Chronic Fatigue ◽  
Cardiac Insufficiency ◽  
Medical Database ◽  
Fatigue Syndrome ◽  
Tract Infections ◽  
The Impact

Abstract Objectives The long-term consequences of COVID-19 survivors care and post-coronavirus infection are not yet well understood. The review aims to see whether homoeopathy can help COVID-19 survivors recover from its consequences and improve their quality of life. Content A systematic search of published articles for post-COVID sequelae and the impact of Homoeopathy were conducted. For the literature search, the major electronic bio-medical database PubMed/MEDLINE was used. In addition, supplementary searches were conducted through the references of those published articles. Summary A total of 113 records were identified of which 61 studies included for this review. Homoeopathy is effective in the treatment of mental disorders including anxiety and depressive disorder (ADD), some research studies have found, although systematic reviews disagree. Likewise, some medical societies denounce homoeopathy for pain management; other literature shows that it can be used to treat pain effectively. Homoeopathy can aid in the treatment of cardiovascular diseases, as Crataegus, a homoeopathic medication, was found to be just as effective as a standard angiotensin-converting enzyme (ACE) inhibitor and diuretic treatment for minor cardiac insufficiency. The outcomes for Chronic Fatigue Syndrome (CFS), Influenza, and Acute Respiratory Tract Infections (ARTIs) are also promising. Outlook Based on the results of homoeopathy in non-COVID conditions, it can be thought of in the management of post-COVID-19 outcomes. Consequently, we propose that while investigating post-COVID-19 patient rehabilitation, homoeopathic management may be included as part of the follow-up route and as much data as possible in the context of homoeopathy should be collected, so that in future, the role of homoeopathy in dealing with it can be better demonstrated.

The Irresponsible Expert Witness: A Failure of Biomedical Graduate Education and Professional Accountability

PEDIATRICS ◽  
1982 ◽  
Vol 70 (5) ◽  
pp. 754-762 ◽  
Author(s):  
Robert L. Brent
Keyword(s):  
Expert Witness ◽  
Expert Witnesses ◽  
Contributing Factors ◽  
Witness Testimony ◽  
Expert Witness Testimony ◽  
Professional Accountability ◽  
Proper Role ◽  
And Function

Many forces have created the epidemic of negligence and malpractice litigation. One of the contributing factors to the rising rate of nonmeritorious litigation is the increasing number of unqualified and irresponsible expert witnesses. The high remuneration has attracted physican-scientists who are unaware of the proper role of an expert witness. They are frequently manipulated by the attorneys and function as partisans rather than scholars. The role of the expert witness should be taught in medical and graduate school. Testimony should be treated as a scholarly endeavor and experts should be encouraged to seek peer review of their opinions and not to testify secretly and in isolation. It is suggested that greater visibility of experts and their testimony (light of day phenomenon) should raise the quality of expert witness testimony and encourage more qualified experts to participate as expert witnesses, thus removing the stigmata usually associated with unqualified expert witnesses.

Psychiatry’s ethical involvement in gender-affirming care

2018 ◽  
Vol 26 (5) ◽  
pp. 460-463 ◽  
Author(s):  
Roberto D’Angelo
Keyword(s):  
Gender Dysphoria ◽  
Poor Quality ◽  
Medline Search ◽  
Gender Reassignment ◽  
The Subject ◽  
Poor Outcomes ◽  
Physical Treatments

Objective: To reflect on the role of psychiatry in authorising physical treatments for Gender Dysphoria and to examine the quality of evidence for gender-reassignment. Method: A Medline search was performed with the subject term “transsexualism” or “gender dysphoria” and “outcome” or “follow-up” in the title. Studies published from 2005 onwards reporting psychosocial outcomes were selected for review. Results: Most available evidence indicating positive outcomes for gender reassignment is of poor quality. The few studies with robust methodology suggest that some patients have poor outcomes and may be at risk of suicide. Conclusion: The author raises questions about the implications for ethical treatment of transgender individuals.

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