Atrial Fibrillation and Hypertension: “Quo Vadis”

Hypertension is one of the most well-established risk factors for atrial fibrillation. Long-standing untreated hypertension leads to structural remodeling and electrophysiologic alterations causing an atrial myopathy that forms a vulnerable substrate for the development and maintenance of atrial fibrillation. Hypertension-induced hemodynamic, inflammatory, hormonal, and autonomic changes all appear to be important contributing factors. Furthermore, hypertension is also associated with several atrial fibrillation-related comorbidities. As such, hypertension may represent an important target for therapy in atrial fibrillation. Clinicians should be aware of pitfalls of the blood pressure measurement in atrial fibrillation. While the auscultatory method is preferred, the use of automated devices appears to be an acceptable method in the ambulatory setting. There are pathophysiologic bases and emerging clinical evidence suggesting the benefit of renin-angiotensin system inhibition in risk reduction of atrial fibrillation development particularly in patients with left ventricular hypertrophy or left ventricular dysfunction. A better understanding of hypertension’s pathophysiologic link to atrial fibrillation may lead to the development of novel therapies for the primary prevention of atrial fibrillation. Finally, future studies are needed to address optimal blood pressure goal to minimize the risk of atrial fibrillation-related complications.

The Effect of Geographic Distance on Earnings Management Decisions

Prior research has found evidence that country factors and management styles influence earnings management decisions in various geographic locations. Extending this research, we utilize an experimental setting to isolate the effect of geographic distance on the willingness to manage earnings in a near/distant location. In an initial experiment, we find less acceptable earnings management methods generate greater concerns about the method (ethicality and riskiness) leading to less willingness to manage earnings. Yet, greater geographic distance between the decisionmaker and reporting location attenuates these concerns, resulting in increased willingness to use a less acceptable method. In contrast, individuals are willing to use a more acceptable method to manage earnings regardless of geographic distance. These findings are consistent with construal level theory (CLT) and are corroborated in a second experiment where we find that greater geographic distance reduces managers’ focus on the means of earnings management, thereby reducing concerns about the method.

Does Telerehabilitation Help in Reducing Disability among People with Musculoskeletal Conditions? A Preliminary Study

Introduction: During the coronavirus pandemic, an initiative was launched in Saudi Arabia to provide telerehabilitation for people with musculoskeletal conditions who were unable to access in-person physiotherapy due to the associated lockdown. The purpose of this study was to explore the therapeutic impact and acceptability of telerehabilitation among the Saudi population. Methods: Ninety-five participants were recruited through an online advertisement and received a physiotherapy consultation and interventions via an online video conference platform (Google Meet). Following screening for red flags, participants received tailored education and conditioning exercises 2–3 times a week for 6 weeks. Outcome measures were recorded at baseline and 6 weeks and comprised the Pain Self-Efficacy Questionnaire, Patient-Specific Functional Scale, Musculoskeletal Health Questionnaire and a satisfaction survey. Results: The most frequent musculoskeletal conditions reported were lower back (37%), knee (14%) and neck (10%) pain and post-operative conditions (15%). Participants showed significant improvements in outcomes at the end of the program (p < 0.001) with effect sizes ranging from 0.6 to −1.9 and reported a high level of satisfaction with the telerehabilitation intervention. Conclusion: This study showed that telerehabilitation was an acceptable method of providing physiotherapy interventions for patients with musculoskeletal conditions in Saudi Arabia.

Preparation and Evaluation of Diclofenac Sodium Effervescent Tablet

The oral dosage forms are the most popular way of taking medicine although having some disadvantages like deliberate absorption and thus onset of action is extend. This can be overcome by administrating the drug in a liquid form i.e. effervescent tablet. The research is a formulation of diclofenac sodium as a effervescent tablet by wet granulation method. The bitter taste of the drug are masked by added sweetening agent (lactose, glucose etc.) In the present work we are prepared effervescent tablet in that we are used active drug diclofenac sodium and other active ingredient acid like tartaric acid and base sodium bicarbonate in different concentrations. The formulation of tablet was done by using wet granulation, wet granulation is found to be acceptable method of effervescent tablet formulation. The various pre-formulation studies was performed hardness, weight variation, disintegration, dissolution etc.

Using Forest Plots to Present the Performance Sheets Provided to OSCE Examinees Using Rasch Analysis (Preprint)

BACKGROUND Objective structured clinical examination (OSCE) has become an acceptable method for evaluating clinical skills in healthcare settings. However, none of the current literature has used visualization plots to compare individual OSCE performances. OBJECTIVE This study uses the Rasch model to (1) compare two other scenarios composed of binary scores and mixed binary and percentage responses; (2) draw a forest plot to visualize students’ performance; and (3) observe the comparison of OCSE scores among subgroups (e.g., schools) using real data.. METHODS We obtained data from 29 medical students who participated in OSCE examinations at 12 stations in 2018. The continuous Rasch model (CRM) was applied to estimate person measures and standard errors (SEs). The characteristics of the percentage CRM were interpreted in comparison to the other two counterparts (i.e., binary and mixed scenarios). Forest plots frequently used in meta-analysis were drawn to display those 29 examinees and five subgroups. RESULTS We used online CRM to draw forest plots and observed that (1) the binary scenario had a wider range of measures, followed by the mixed scenario. The percentage mode as expected has narrower ranges in person abilities(from -0.42 to 0.38) and item difficulties(from -0.48 to 0.41) owing to smaller total raw scores when compared to the other two counterparts;(2) all OSCE performances of medical students do not deviate from the middle line with zero logits; (3) The students in Taipei Medical University outperformed other schools among the five subgroups. CONCLUSIONS We designed two online computer modules for (1) estimating person measures and SEs and (2) drawing forest plots to display the OSCE performance sheets for Taiwanese medical students, which helps hospitals evaluate OSCE performances for students efficiently and objectively, but such results are not limited to medical students in the future.

Evaluation of Different WQI Methods for Drinking Water Assessment with a Case Study of Groundwater from Vizianagaram District, AP, India

Application of Water Quality Index (WQI) to assess the water quality for drinking water suitability and intensity of contamination is in practice worldwide. Many WQI methods have been in use since their conceptualization, and some are country-specific or use-specific. A generalized and widely acceptable method that can project ground truths in non-dimensional numerical form to evaluate the water quality, especially for drinking uses, is lacking. Complexity and disagreement among different methods are adding to incongruence among the scientists. The concept and a simple calculation method of WQI are deliberated. Five different WQI methods using water chemistry results of Vizianagarm District are discussed. The WQI output obtained from these methods displays discrepancies in the proper projection of water quality. Some samples show similarities in WQI values obtained from two to four methods. However, the suitability status of water for drinking purposes could not be precisely ascertained from these indices. Since the water chemistry results and WQI values are incompatible, the output from these methods could be red herring. Few issues are identified among the studied methods which need improvisation. The use of ideal value in the weighted arithmetic index method and arbitration in assigning Weight for each parameter gives scope for speculation. Non-uniformity in the categorization of water and the suitability statuses of drinking water are discouraging factors. The WQI is an effective tool in screening the vast database for identifying and addressing the issues in water quality. Since drinking water standards and water supply are government-sponsored, an institutional intervention is required to standardize the WQI computation procedure. Such an initiative is necessary for the practical application of water quality data to contain water-borne diseases.

Easing of Regulatory Barriers to Telemedicine Abortion in Response to COVID-19

For many people seeking abortion during the continuing COVID-19 pandemic, telemedicine abortion is the safest and most acceptable method, posing lower risk of exposure to the virus. In addition, by reducing in-person visits with health care providers, increased use of telemedicine for abortion can reduce pressure on overburdened health systems. Given the benefits of telemedicine during the pandemic, government agencies in several countries took measures to temporarily allow telemedicine abortion. We conducted key-word English-language searches to identify examples of government action to remove regulatory barriers to the practice of telemedicine abortion in response to the pandemic. We found instances of government agencies in eight countries taking steps to ease regulatory barriers to telemedicine abortion. Telemedicine abortion is safe, cost-effective, and may be the preferred method of abortion during acute periods of COVID-19 transmission, as well as after the pandemic has abated. As one step to expanding access to abortion with medicine where abortion is legal, health agencies and other regulatory bodies can take steps to remove barriers specific to telemedicine abortion.

Keeping Connected With School: Implementing Telepresence Robots to Improve the Wellbeing of Adolescent Cancer Patients

Background: Adolescent cancer patients experience considerable absence from their education, contributing to poorer academic attainment and isolation from peers, and impacting wellbeing. Telepresence robots have been used to support the educational and social needs of young people with chronic illness. This article presents the results of the development and pilot-testing of a telepresence robot service in schools for adolescent cancer patients – the TRECA (Telepresence Robots to Engage CAncer patients in education) service.Methods: Phase I used semi-structured interviews (n = 25) to assess the views of patients, parents, schools and clinicians on the benefits, acceptability, barriers, and enablers of utilizing robots in schools for adolescent cancer patients. Results from Phase I informed the development of the TRECA service. Phase II used semi-structured interviews (n = 22) to assess the implementation experiences of adolescent cancer patients, and their families, schools, and keyworkers who pilot-tested the TRECA service.Results: Phase I demonstrated the need for telepresence technology in connecting adolescent cancer patients to school. Given the variable support during treatment, a telepresence robot service was considered an acceptable method of facilitating a school-patient connection. The recommendations provided in Phase I, such as the need for provision of ongoing education, training, and support to the patient and school, informed the development of the TRECA service. In Phase II, the themes of The necessity of stakeholder buy-in, A facilitator of meaningful connection, and One size does not fit all were generated. The TRECA service’s flexibility in meeting the needs of its users helped facilitate meaningful connections. Participants reported that these connections provided patients an enhanced sense of agency and wellbeing. The importance of stakeholder buy-in and taking an individualized approach to service delivery were also highlighted. Stakeholder miscommunication and lack of knowledge were key aspects of implementation needing improvement as the service is rolled out on a larger scale.Conclusion: Using telepresence robots to connect adolescents to school during cancer treatment was regarded as highly acceptable, facilitating peer and academic connection. By making stakeholder-recommended improvements to the TRECA service’s existing processes, the service will continue to grow in effectiveness and capacity.

Development and Relative Validity of the Chronic Kidney Disease Short Food Frequency Questionnaire (CKD SFFQ) to Determine Diet Quality and Dietary Habits among Adults with Chronic Kidney Disease

Limited instruments are available to determine diet quality among US adults with chronic kidney disease (CKD). The purpose of this study was two-fold: (1) to develop a food frequency questionnaire, CKD SFFQ, for adults with CKD and (2) to validate the CKD SFFQ against two 24-h recalls in determining diet quality (DQ). A 57-item CKD SFFQ was developed through a content validation method. Adults with CKD (n = 46) completed the CKD SFFQ and 2–24-h recalls. Statistical analyses included descriptive statistics, frequencies, t-tests, Pearson correlations, and Bland–Altman plots. All data were analyzed using JMP SAS v15 with statistical significance detected at p < 0.05. Results showed no differences for the overall DQ (p = 0.11) and the nine whole-food components (p = 0.07 to p = 0.44) when comparing the CKD SFFQ to the 2–24-h recalls. Pearson correlation coefficients ranged from −0.39 (refined grains) to 0.60 (greens and beans). Bland–Altman plots showed overall good agreement and there was a systematic trend towards higher estimates with the CKD SFFQ, particularly for overall DQ, total proteins, and dairy. The majority of participants rarely or never consumed grains, fruits, vegetables, seafood, and plant proteins. The CKD SFFQ was demonstrated to be an acceptable method to determine DQ for adults with CKD.