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This retrospective cohort study of cancer decedents during 2004–2015 examined end-of-life cancer care quality indicators (QIs) in the provinces of British Columbia (BC), Ontario, and Nova Scotia (NS). These included: emergency department use, in-patient hospitalization, intensive care unit admissions, physician house calls, home care visits, and death experienced in hospital. Ontario saw the greatest 12-year decrease in in-hospital deaths from 52.8% to 41.1%. Hospitalization rates within 30 days of death decreased in Ontario, increased in NS, and remained the same in BC. Ontario’s usage of aggressive end-of-life measures changed very little, while BC increased their utilization rates. Supportive care use increased in both NS and Ontario. Those who were male or living in a lower income/smaller community (in Ontario) were associated with a decreased likelihood of receiving supportive care. Despite the shift in focus to providing hospice and home care services, approximately 50% of oncology patients are still dying in hospital and 11.7% of patients overall are subject to aggressive care measures that may be out of line with their desire for comfort care. Supportive care use is increasing, but providers must ensure that Canadians are connected to palliative services, as its utilization improves a wide variety of outcomes.

The President of The University of Texas at Austin discusses UTIMCO's investment strategy with its Chief Investment Officer.As the administrator of a perpetual endowment for the University of Texas and Texas AM(2) the health of the leveraged loan market;and (3) the search for new and better exit opportunities. All agreed that deal pricing was a perennial challenge, and that PE firms must work to develop a special “edge” in an intensely competitive market, where some firms consider a thousand deals a year to close on just two or three.The founder of Benchmark Capital begins by mentioning his firm's almost exclusive focus on early‐stage ventures and preference for being “the first money in.” He also notes Benchmark's different ownership structure;perhaps unique among venture firms, it is an equal partnership in which all partners have “the same economics,” the new as well as the oldest.The main investment advice offered is that, with interest rates so low, and some public company stocks trading at 30 to 50 times revenue, investors should remain as liquid as possibleThe recent popularity of SPACs is viewed as a response by issuers to “a broken IPO system” whose main symptom is runaway IPO underpricing and wealthy bankers. Noting that the amount of first‐day underpricing of IPOs has risen from $2 billion in 2016 to $30 billion in 2020, Gurley predicts that direct IPO listings, or DLs, will become much more common in the future.As for the recent frenzy of retail trading and the rise of Robinhood, Gurley says of the new trading firm's CEO,He tells the world that he's democratizing investing, but I don't think this is about investing at all. I think he's gamifying speculation… and I strongly suspect that the success rate of retail investors in options is really crappy. It should also scare the Biden administration that a lot of the money in Robinhood accounts came from stimulus checks this summer.

open access article The “Trust Building” initiative, launched in the United Kingdom in April 2016, aimed to dispel myths about Islam and build trust between Muslims and the wider community. This community-led initiative involved trained Trust Building “Ambassadors” delivering workshops at places of work and other community settings to talk about Islam and facilitate open dialogue. Previously, the project reported trust among participants had significantly improved, but the reasons for this were not explored. In this paper, we unpack how and why trust was being built. Providing a forum that permits open dialogue between Muslims and the wider community allowed opportunities for stories and experiences to be shared, enabling negative stereotypes to be uncovered and addressed, and for mutual values to be recognised. With negative media portrayal and rise in hate crime towards minorities, this research is a promising model that has important implications to address the trust deficit seen within our society.

Purpose: No one can deny the importance of education as it not only improves living standard but also promotes self-esteem as well as improves social development. The role of the government cannot be overlooked in the development of education. Therefore, the main purpose of this study is to analyses the role of government through national income and government expenditure on education through school enrolment in Pakistan. Design/Methodology/Approach: We have used secondary data over the period of 2000 to 2017 for empirical analysis. We used descriptive statistics analysis, and the method of least squares is used to obtain empirical results. Findings: The result shows that national income and government expenditures have positive effects on school enrollment, indicating when national and government expenditures increase, ultimately school enrolment also increases in the country. Implications/Originality/Value: Our results of this study suggest that national income needs to be increases and government spending also needs to be increases in order to improve education in the country.

This article aims to describe the impact of government policies on learning from home and the effects on student perspectives on learning Online learning. The method used is descriptive qualitative with observation instruments, online surveys, discussion group forums with the research subjects of students majoring in Arabic language education graduates of Islamic boarding schools in 2019 at UIN Maulana Malik Ibrahim Malang, Indonesia. Research results are utilized on campus e-learning, which is integrated with SIAKAD and other applications such as WhatsApp and Zoom as well as Google Meet for teleconference facilities during student presentations and discussions. Islamic boarding school graduate students can take online lectures well. The student's perspective on online lectures after the learning from home policy is not suitable due to internet connection constraints and lectures using the assignment method only. Keywords: Learning from Home; online; digital learning; students perspective, higher education Abstrak Artikel ini bertujuan untuk mendeskripsikan dampak kebijakan pemerintah pada pembelajaran dari rumah dan pengaruhnya terhadap perspektif mahasiswa dalam pembelajaran Online. Metode yang digunakan adalah deskriptif kualitatif dengan instrumen observasi, survei online, forum diskusi kelompok dengan subjek penelitian mahasiswa jurusan bahasa Arab lulusan pesantren tahun 2019 di UIN Maulana Malik Ibrahim Malang, Indonesia. Hasil penelitian menunjukkan kampus memanfaatkan e-learning kampus yang terintegrasi dengan SIAKAD dan aplikasi lain seperti WhatsApp dan Zoom serta fasilitas Google Meet untuk telekonferensi untuk presentasi dan diskusi. Mahasiswa alumni pondok pesantren bisa mengikuti perkuliahan online dengan baik. Perspektif mahasiswa terhadap perkuliahan online setelah kebijakan belajar dari rumah kurang baik. Hal ini karena kendala koneksi internet dan perkuliahan hanya menggunakan metode tugas. Kata Kunci: Belajar dari rumah; online; pembelajaran digital; perspektif mahasiswa, pendidikan tinggi

The purpose of this series with the title “Nuqta: An Emblem of Divinity” was to unveil the mystical connotations underlying a visual Nuqta (dot) in the genre of contemporary calligraphic art. Nuqta...

AIMS To determine whether HbA1c mismatches (HbA1c levels that are higher or lower than expected for the average glucose levels in different individuals) could lead to errors if diagnostic classification is based only on HbA1c levels. METHODS In a cross-sectional study, 3106 participants without known diabetes underwent a 75-g oral glucose tolerance test (fasting glucose and 2-h glucose) and a 50-g glucose challenge test (1-h glucose) on separate days. They were classified by oral glucose tolerance test results as having: normal glucose metabolism; prediabetes; or diabetes. Predicted HbA1c was determined from the linear regression modelling the relationship between observed HbA1c and average glucose (mean of fasting glucose and 2-h glucose from the oral glucose tolerance test, and 1-h glucose from the glucose challenge test) within oral glucose tolerance test groups. The haemoglobin glycation index was calculated as [observed - predicted HbA1c ], and divided into low, intermediate and high haemoglobin glycation index mismatch tertiles. RESULTS Those participants with higher mismatches were more likely to be black, to be men, to be older, and to have higher BMI (all P

Highlights • BMI is used to characterize nutritional status but may not accurately depict body composition in CF. • DXA and bioelectrical impedance are the most commonly used methods for assessing BC. • Lower fat-free mass associates with worse pulmonary function and greater CF disease severity. • Fat-free mass associates with greater bone mineral density in individuals with CF., Because nutritional status is intimately linked with pulmonary function and survival, nutrition has been at the mainstay of cystic fibrosis (CF) care. Body Mass Index (BMI) is traditionally used to define nutritional status because of the ease with which it can be calculated, but it has a number of limitations including its inability to differentiate fat mass (FM) from lean body mass (LBM), the latter thought to confer health advantage. A number of tools are available to quantify body composition including dual-energy x-ray absorptiometry (DXA), bioelectrical impedance, MRI, CT, air displacement plethysmography, and stable isotopes, and these have been used to varying degrees in studies of CF. In CF, LBM tends to be lower for a given BMI, particularly at lower BMI. In adults, lower fat-free mass (FFM) correlates with greater CF disease severity, lower pulmonary function and higher inflammatory markers. FFM is also positively associated with greater bone mineral density, while greater FM is associated with greater loss of lumbar spine bone mineral density over 2 years. In youth, LBM is positively associated with pulmonary function. The predictive value of body composition for functional and clinical outcomes and the role of improving LBM on these outcomes remain undefined. With improvements in BMI accompanying highly-effective modulator therapy, closer evaluations of body composition may inform risk for more traditional, non-CF adult outcomes in CF.

ObjectivesWe aim to determine what threshold of compressive stress small bowel and colon tissues display evidence of significant tissue trauma during laparoscopic surgery.DesignThis study included 10 small bowel and 10 colon samples from patients undergoing routine gastrointestinal surgery. Each sample was compressed with pressures ranging from 100 kPa to 600 kPa. Two pathologists who were blinded to all study conditions, performed a histological analysis of the tissues. Experimentation: November 2018–February 2019. Analysis: March 2019–May 2020.SettingAn inner-city trauma and ambulatory hospital with a 40-bed inpatient general surgery unit with a diverse patient population.ParticipantsPatients were eligible if their surgery procured healthy tissue margins for experimentation (a convenience sample). 26 patient samples were procured; 6 samples were unusable. 10 colon and 10 small bowel samples were tested for a total of 120 experimental cases. No patients withdrew their consent.InterventionsA novel device was created to induce compressive “grasps” to simulate those of a laparoscopic grasper. Experimentation was performed ex-vivo, in-vitro. Grasp conditions of 0–600 kPa for a duration of 10 s were used.ResultsSmall bowel (10), M:F was 7:3, average age was 54.3 years. Colon (10), M:F was 1:1, average age was 65.2 years. All 20 patients experienced a significant difference (pConclusionsA threshold was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. This “force limit” could be used in novel sensorized laparoscopic tools to avoid intraoperative tissue injury.

Hispanic children are disproportionately affected by obesity, with this disparity starting at a young age, and there is a paucity of data comparing factors associated with excess weight in the first year of life in Hispanic vs. non-Hispanic populations. Excess weight was defined as weight-for-length ≥95th percentile. The associations of potential risk factors were compared by ethnicity stratification. Of the 1009 children, 302 (30.0%) were Hispanic and 707 (70.0%) were non-Hispanic White. The rate of excess weight was 30.1% and 13.6% among Hispanic and non-Hispanic White children, respectively. Factors associated with excess weight for non-Hispanic White children were higher than recommended weight gain during pregnancy (odds ratio (OR) 1.8 (1.2–3.1)), higher paternal body mass index (BMI) (OR 1.1 (1.02–1.15)), higher birth weight (OR 1.001 (1.001–1.002)), and lower breast milk feedings at 6 months (OR 0.98 (0.96–0.98)). Factors associated with excess weight for Hispanic children were lower maternal education (OR 2.37 (1.1–4.5)) and lower breast milk feedings at 6 months (OR 0.98 (0.96–0.99)). There are differential risk factors associated with excess weight at 12 months between Hispanic and non-Hispanic White children. Identification of differential factors in different ethnicities may allow for more targeted anticipatory guidance reduce obesity in at-risk populations.

Excessive magnitudes of compressive stress exerted on gastrointestinal tissues can lead to pathological scar tissue or adhesion formation, bleeding, inflammation or even death from bowel perforation and sepsis. It is currently unknown however, at exactly what magnitude of compressive stress that these pathologies occur. A novel simple compressive device was engineered to provide an objective means of producing discrete compressive stresses on human tissues. Samples of human large intestine (colon) were removed from consenting patients as a part of their standard surgical procedure. These samples were compressed with a range of loads normally produced by standard laparoscopic graspers in representative abdominal surgeries. After compression, specimens were processed for histological analysis and assessed. The two independent pathologists who were blinded to stress magnitudes were both able to quantify increasing tissue damage that corresponded to increasing amounts of compressive force. A threshold between 350–450 kPa was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. Whether the tissue injury quantified is pathologic is subject for future in-vivo longitudinal investigation but certainly based on literature, can be the basis of pathological adhesion formation or an area for hemorrhage and scar formation., This paper aimed to test a simple device that is capable of producing compressive stress in human tissues. As far as we know, we are one of the first groups to publish data based on the relationship between compressive stress and human gastrointestinal tissue trauma via a histological analysis. In these preliminary results, it is clear that tissue damage correlates to how much force is exerted on that tissue in compression.

Objective: To explore the effects of COVID 19 on reproductive and child health services and gender relations. Methods: This is a Qualitative Exploratory Research. Due to lockdown, setting was online interviews on Zoom. Sampling was purposive. Five in-depth interviews were conducted in June 2020 followed by compilation of results and manuscript writing in July and August 2020. Results: Maternal Neonatal morbidity and mortality will rise as part of collateral damage of C19. As all routine services of maternity care, family planning, post abortion care and vaccination were also in lockdown. Baby boom, unwanted pregnancies, unsafe abortions and violence against women will be the secondary consequences of C19. Conclusion: Some critical services should never stop which include maternal and neonatal essential services. MNCH service continuity has to be maintained to optimize maternal neonatal health, prevent unwanted pregnancy and abortion. With appropriate standard operating procedures, and protective equipments, health facilities need to open. LHWs and community mobilisers with PPEs should continue services. doi: https://doi.org/10.12669/pjms.37.4.3877 How to cite this:Shah N, Musharraf M, Khan F, Shah N. Exploring Reproductive Health Impact of COVID 19 pandemic: In Depth Interviews with key stakeholders in Pakistan. Pak J Med Sci. 2021;37(4):1069-1074. doi: https://doi.org/10.12669/pjms.37.4.3877 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gynecologic cancers, starting in the reproductive organs of females, include cancer of cervix, endometrium, ovary commonly and vagina and vulva rarely. The changes in the composition of microbiome in gut and vagina affect immune and metabolic signaling of the host cells resulting in chronic inflammation, angiogenesis, cellular proliferation, genome instability, epithelial barrier breach and metabolic dysregulation that may lead to the onset or aggravated progression of gynecologic cancers. While microbiome in gynecologic cancers is just at horizon, certain significant microbiome signature associations have been found. Cervical cancer is accompanied with high loads of human papillomavirus, Fusobacteria and Sneathia species; endometrial cancer is reported to have presence of Atopobium vaginae and Porphyromonas species and significantly elevated levels of Proteobacteria and Firmicutes phylum bacteria, with Chlamydia trachomatis, Lactobacillus and Mycobacterium reported in ovarian cancer. Balancing microbiome composition in gynecologic cancers has the potential to be used as a therapeutic target. For example, the Lactobacillus species may play an important role in blocking adhesions of incursive pathogens to vaginal epithelium by lowering the pH, producing bacteriocins and employing competitive exclusions. The optimum or personalized balance of the microbiota can be maintained using pre- and probiotics, and fecal microbiota transplantations loaded with specific bacteria. Current evidence strongly suggest that a healthy microbiome can train and trigger the body's immune response to attack various gynecologic cancers. Furthermore, microbiome modulations can potentially contribute to improvements in immuno-oncology therapies.

BackgroundInappropriate force in laparoscopic surgery can lead to inadvertent tissue injury. It is currently unknown however at what magnitude of compressive stress trauma occurs in gastrointestinal tissues.MethodsThis study included 10 small bowel and 10 colon samples. Each was compressed with pressures ranging from 100 kPa to 600 kPa by a novel device to induce compressive “grasps” to simulate those of a laparoscopic grasper. Experimentation was performed ex-vivo, in-vitro. Grasp conditions of 0 to 600 kPa for a duration of 10 seconds were utilized. Two pathologists who were blinded to all study conditions, performed a histological analysis of the tissues. Patients were eligible if their surgery procured healthy tissue margins for experimentation (a convenience sample). 26 patient samples were procured; six samples were unusable. 10 colon and 10 small bowel samples were tested for a total of 120 experimental cases. No patients withdrew their consent. Two metrics of damage were quantified: an intestinal layer thickness calculation where the serosa layer was measured in the area of compression and compared to a local control and a histological scoring scale for tissue trauma.ResultsSmall bowel (10), M:F was 7:3, average age was 54.3 years. Colon (10), M:F was 1:1, average age was 65.2 years. All 20 patients experienced a significant difference (pConclusionA threshold was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. This “force limit” could be used in novel sensorized laparoscopic tools to avoid intraoperative tissue injury.

The gut microbiome serves an important role in the human body. Reportedly, one of the benefits of these microflora is on mental health. Once established, food and other dietary sources that enhance quality microbiome content in our gastrointestinal system will be a significant consideration in individuals' day to day lives. This literature review conducted a PubMed search for studies about the gut microbiome and its relation to depression. In using several Medical Subject Heading (MeSH) keywords, relevant literature was selected. A total of 26 articles were selected after applying the inclusion and exclusion criteria, and after checking the articles' accessibility. This literature would like to establish the role of the gut microbiome in depression. This study's findings showed that there is a strong association of microbiome function to mental well-being.

Objectives There are several factors that may affect the length and height of the infant. Maternal factors include a wide array of factors (anthropometric, hematological, or genetic), which can affect newborn health determinants. The objective of this study was to evaluate the frequency of normal birth length and its determinants in newborns. Methods This retrospective cross-sectional study was carried out at the Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi, Pakistan, from March 1, 2019, to August 31, 2019. The relevant data were gathered by trained data collectors with the help of a structured questionnaire designed specifically for the study after taking written informed consent from all the participants. Data analysis was performed using Statistical Package for Social Sciences Version 20. Binary logistic regression was applied to develop a risk assessment model for the study outcome. Results Out of 195 pregnant mothers, 57 (29.2%) had low birth weight infants. Mean age of mothers was 29.29±5.22 years, 142 (72.8%) had BMI of 25.0 or more, 102 (52.3%) had hemoglobin between 10 to 11 mg/dL, 172 (88.2%) used to take vitamin C and iron during pregnancy, 136 (69.7%) consumed extra meals during pregnancy, and only 5 (2.6%) were tobacco smokers/chewers. Hundred (51.3%) newborns had normal birth length, i.e., >48 cm. The mother's mid-arm circumference > 22 cm (adjusted odds ratio [AOR]: 4.719; 95% CI: 2.337-9.527; p 11 mg/dL (AOR: 4.314; 95% CI: 1.779-10.463; p=0.001), and adequate rest during pregnancy (AOR: 3.798; 95% CI: 1.464-9.848; p=0.006) were significantly associated with normal birth length of the infants, i.e., >48 cm. Conclusions Mother's mid-arm circumference > 22 cm, consumption of extra meals during pregnancy, hemoglobin > 11 mg/dL, and adequate rest during pregnancy were found to be significant predictors of normal birth length of the infants.

The symptomatic overlap between borderline personality disorder (BPD) and bipolar disorder (BD) is a topic of scientific and academic debates. Emotional dysregulation and impulsivity are common features of both disorders. Several studies have shown that both BPD and BD lie on a spectrum; others have suggested that they are separate entities that coexist. BPD is characterized by impulsive and dangerous behaviors such as driving recklessly, inappropriate sexual behavior, eating disorders, and substance abuse. BD, during a manic episode, is known for their impulsive and risk-taking behavior like hypersexuality, excessive spending, and substance abuse. The current literature review aims to provide an overview of the impact of impulsivity and emotional dysregulation on comorbid bipolar disorder and borderline personality disorder. Our study results showed that patients with comorbid BPD and BD struggle with impulsive actions and have difficulty controlling their emotions. They are also highly susceptible to anxiety disorders like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and somatoform disorders. Patients with comorbid BPD and BD struggle with severe psychosocial morbidity and an increased risk of suicide. In patients with only one disease, misdiagnosis is a common phenomenon due to the overlapping symptoms of BPD and BD.

The study aims to search for syntax errors in machine translation. The study focuses on challenges in English Arabic Machine translation, types of errors in translation software, the most developed technologies in machine translation, and arbitrary Arabic text generating problems generally and in the Arabic language. This study use qualitative research design, qualitative data, drawn from our pragmatic analysis are presented, from perceptions of language learners and tutors in relation of Machine translation. The article discusses the disappointing fact that most intelligent machines are built to produce woodenly literal or paraphrased translations, but in Arabic, the errors are in high numbers. The paper results show an urgent need to build the machine language infrastructure in the Arabic language field to help people achieve accurate translation. To overcome the problems of machine translation, we recommend that we enter enough vocabulary and linguistic texts in the machine.

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and carries a significant risk of morbidity and mortality. Multiple trials have highlighted the benefit of catheter ablation over medical therapy in restoring sinus rhythm and improving quality of life. Whether it reduces long-term risk of stroke and mortality is still unclear. We performed a literature search using the PubMed database to review the current state of knowledge regarding the long-term outcomes of stroke and mortality in ablated patients compared to patients who receive medical therapy. Our review mainly consisted of recent randomized controlled trials and large observational studies. Results from large observational studies show that catheter ablation significantly reduces the risk of stroke in high-risk patients and mortality compared to medical therapy. However, randomized controlled trials have only demonstrated a mortality benefit in patients with comorbid systolic heart failure. In patients with paroxysmal AF, ablation therapy significantly limits the progression to persistent AF and has a higher efficacy in restoring sinus rhythm. Maintenance of sinus rhythm is the most important factor associated with lower long term risk of stroke and mortality. Large randomized controlled trials similar to the Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial are still needed to clarify whether catheter ablation is superior over medical therapy in improving the long-term outcomes of stroke and mortality.

Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that is characterized by obsessions and compulsions. Obsessions are uncontrollable distressful thoughts. Compulsions are recurrent behaviors or thoughts performed in an attempt to decrease the anxiety of the obsessions. Body dysmorphic disorder (BDD) is a mental disorder characterized by a distressful preoccupation with a perceived defect in appearance. The perceived flaw in appearance is minimal or unnoticed by others. BDD was considered an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). In the DSM-V, it was added to the obsessive-compulsive and related disorders category. The objective of this literature review was to explore the psychiatric comorbidities and the risk of suicide associated with OCD and BDD. Our study results showed OCD and BDD share common genetic and environmental risk factors, clinical features, and sociodemographic profiles. Both OCD and BDD are related disorders that commonly coexist. The suicide risk in OCD is increased as the intensity of the obsessions, trait perfectionism, and alexithymia increases. The suicide risk in BDD is increased by the presence of other disorders such as substance use disorder, major depressive disorder, eating and personality disorders. People with comorbid OCD-BDD have high morbidity, a decrease in insight and poor psychosocial functions. They have higher rates of anxiety, schizotypal features, and suicidal ideation compared to those with BDD or OCD alone.

Digital communication has revolutionized the way children interact and maintain social relations. However, not every tween (8-12 years) or teen (13-18 years) is able to take full advantage of digital media and may cross personal and social boundaries causing distress, mostly to their own friends at school and beyond. This results in adverse health effects for both the cyberbullying perpetrator and the victim. Articles reviewed on elementary school children and adolescents, collected from two different databases, showed that the number of elementary school kids using smartphones has more than doubled in the past few years. Given this rise, the risk of cyberbullying has also increased. Not all elementary school kids have the required media literacy to understand that their friends have equal rights in the virtual world as they do in the schoolyard. Regardless, they still carry a smartphone with data, use computers, and other electronic media to bully, embarrass, exclude, or humiliate others, often through social networking sites. Moving from tweens to teens seems to worsen the cyberbully behavior and choices, with middle school kids facing the highest cyberbullying incidents followed by high school kids and then the elementary school kids. The anonymity of cyberspace and the perceived lack of consequences seems to embolden the cyberbully. Identifying the mindset of a cyberbully and those at high risk of becoming a cyberbully can help target intervention efforts where they are needed the most and prevent cyberbullying.

Millions of children are on the run worldwide, with many unaccompanied children and adolescents undertaking risky journeys to flee war, adverse circumstances, and political persecution. The grueling journey and multiple stressors faced by the refugee children, both accompanied and unaccompanied during the pre-migration, migration, and in the country of destination, increase their risk for psychiatric disorders and other medical conditions. Unaccompanied refugee migrant children have higher prevalence of mental health disorders than accompanied refugee peers. Long after reaching the host country, the refugee, migrant, and asylum-seeking juveniles continue to face adversities in the form of acculturation. In assessing medical fitness and healthcare mediations for refugees and migrant children, special consideration should be given to certain areas such as their distinct history, whether they are with their family or separated or unaccompanied, and whether they have been peddled or have been left behind.

Over the last few years, bullying has been identified as one of the significant issues in the pediatric population. Reports also found that bullied youth have a higher risk of developing suicidality. Although preventable, suicide remains the leading cause of death in young people. This literature review aims to establish the association of bullying and the suicidality of the pediatric group (0-18 years of age). A PubMed search was conducted to find studies associating bullying and suicidality in the pediatric population. MeSH keyword strategy, along with subheadings, was used to retrieve appropriate literature. A total of 42 articles were included after the careful examination and application of exclusion and inclusion criteria. This study showed a strong association between bullying and suicidality, albeit the presence of some contradictory ideas.

Background: Low birth weight (LBW) is linked with fetal and neonatal mortality and morbidity; also it can slow down growth and cognitive development. Several factors contribute to pregnancy outcomes, including LBW deliveries, maternal nutrition, and additional dietary intake. Our study was aimed to identify the frequency and factors associated with LBW mothers in Karachi, Pakistan. Methods: A cross-sectional survey was carried out at the Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi. A total of 195 healthy pregnant females were enrolled. All the relevant data were collected from March 1st, 2019 to August 31st, 2019 with the help of a structured questionnaire designed specifically for the study where mothers were also asked about consumption of iron, vitamin, and extra meals since they became pregnant. Written, informed consent was taken from all of the participants before data collection. Data analysis was performed using a statistical package for the social sciences (SPSS) version 20.0. A Chi-square test was used for checking associations between the studied maternal factors and the weight of the children. Results: There was a total of 195 pregnant females selected for the study. The frequency of LBW infants was found to be 57 (29.2%) in these women. The mean age of the females was 29.29 ± 5.22 years, 142 (72.8%) of them had a body mass index (BMI) of 25.0 kg/m2 or more, 102 (52.3%) of them had hemoglobin (Hb) between 10 and 11 mg/dL. The study results further showed that maternal Hb (p=0.02), vitamin C intake (p=0.037), iron intake (p=0.01), and consumption of extra meals during pregnancy (p=0.021) were significantly associated with a LBW of the children. Mothers whose Hb

Background: Medicinal plants are used in anticancer therapies from ages. The very first time we have not only screened anticancer medicinal plants from Pakistan but also identified anticancer plant terpenes. This study will definitely pave the way towards anticancer drug development after animal trials. Materials and Methods | This study was based on ethanolic extraction of fruits/seed of 25 plants. The cytotoxic potential of extracts and plant terpenes was evaluated against mouse fibroblasts (NIH 3T3) cell line by using MTT (3- [4, 5-dimethylthiazole-2-yl]-2, 5-diphenyl-tetrazolium bromide) assay and compared with cyclohexamide. Results | Ethanolic extracts were nontoxic against NIH3T3 cell line. On the basis of the % inhibition plants were graded as B.lycium, 48% > T.bellerica, 47% > C.verum, 45% > Z.tenuior, 39% > H. adenophyllum, 38% > C. carandas, 31% > C.behen, 29% > P. juliflora, 28% & P.granatum, 28% W.somnifera, 27% > E.cheiri, 26% > S. potatorum, 24% & M.incana, 24% > D. peregrina, 21% & B.lanzan, 21% > L. maldivica, 20% > F. lyrata, 18% > F.arabica, 16% & R. indica, 16% > C.absus, 13% & C.paniculatus, 13%. > C. diurnum, 12% > J.mimosifolia, 11% > D.malabarica, 8% > C. speciosa, 3% as compared to the reference drug Cyclohexamide, 70%. Whereas the maximum % inhibition was exhibited by n-Hexadecanoic acid (88%), followed by Hexadecanoic acid, methyl ester (16%) and Methyl decanoate displayed 11%. C50 of n-Hexadecanoic acid and Cyclohexamide was 3.1±0.2 and 0.8±0.2 respectively. Conclusion| Plant extracts and terpenes was found to be inactive against 3T3 cell line.

Cisplatin (cis-diamminedichloroplatinum [II], CP) is most widely prescribed in chemotherapy and efficaciously treats diverse human cancers, with remission rates > 90% in testicular cancers. However, clinical use of CP is associated with numerous untoward side effects, in particular, at the gastrointestinal level that reduces the therapeutic efficacy of CP and often results in withdrawal of its clinical usage in long term cancer chemotherapy. Substantial strides have been made to identify effective protective strategies against CP-induced nephrotoxicity, hepatotoxicity and ototoxicity. Unfortunately, very limited studies have focused on CP-induced gastrointestinal toxicity and advances in developing potent gastroprotective strategies/agents are still lacking. The current article reviews the metabolism and pharmacokinetics of CP, mechanisms underlying CP-induced gastrointestinal toxicity and lastly displays the potential approaches including plant-derived agents (phytochemicals) utilized to counteract CP-induced gastrointestinal dysfunction. Furthermore, the gastroprotective agents described in the experimental literature have shown partial protection against CP-induced intestinal damage. This stresses the need to ascertain new information on the underlying mechanism and to discover novel combinatorial strategies for the abrogation of CP-induced gastrointestinal toxicity.

Highlights • Poor nutritional status and decreased lean body mass. • Decline in pulmonary function. • Increased mortality from lung disease. • Microvascular complications. • Macrovascular complications (not currently a significant complication but this may change with modulators)., Cystic fibrosis related diabetes (CFRD) occurs in at least 40–50% of adults with CF. With other forms of diabetes, microvascular and macrovascular disease are the major causes of morbidity and mortality. Macrovascular disease is rare in CF. While microvascular disease does occur in this population, there are CF-specific diabetes complications that have a more important impact on prognosis. The additional diagnosis of diabetes in CF is associated with decreased lung function, poor nutritional status, and an overall increase in mortality from lung disease. These negative findings start even before the clinical diagnosis of CFRD, during the period when patients experience abnormal glucose tolerance related to insulin insufficiency. The main mechanisms by which CFRD negatively affects prognosis are thought to be a combination of 1) protein catabolism, decreased lean body mass and undernutrition resulting from insulin insufficiency, and 2) an increased pro-inflammatory and pro-infectious state related to intermittent hyperglycemia. With the introduction of CFTR modulators, the care of CF patients has been revolutionized and many aspects of CF health such as BMI and lung function are improving. The impact of these drugs on the adverse prognosis related to the diagnosis of diabetes in CF, as well as the potential to delay or prevent onset of CFRD remain to be determined.

Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

Either because of high demand or seasonality in supply, various food products and/or drinks can be adulterated in diverse situations. According to different authors like El-loly et al. (2013) and Asrat and Yilma (2014), there are intentional/deliberately/knowingly and unintentional/unknowingly/incidental adulterations. So it is very important to see them separately.

Although superficially similar, herbal medicine and conventional pharmacotherapy have three important differences

Adulteration is a legal term meaning that a food or herbal product fails to meet legal standards. Adulteration is basically found in two major fundamentals of life.

Enormous phenotypic plasticity makes macrophages the target cells in obesity-associated inflammatory diseases. Thus, nutritional components that polarize macrophages toward antiinflammatory phenotype can partially reverse inflammatory diseases like insulin resistance. In the present study, macrophage-polarizing and insulin-sensitizing properties of fish oil (FO) were evaluated in obese insulin-resistant c57bl/6 mice fed high-fat diet (HFD-IR) after oral supplementation with FO (4, 8 or 16mg/kg body weight) and compared to lean and HFD-IR mice. FO-supplemented HFD-IR mice exhibited reduced adiposity index, serum cholesterol and triglycerides and increased insulin sensitization and showed improved adipose tissue physiology under light and transmission electron microscopy. NF-κB/P65 expression showed a downward shift on FO supplementation. The surface marker of M1 macrophages (CD-86) and the TLR-4 expression reduced with the increased supplementation of FO. Expression of arginase 1, an important marker of M2 macrophages, increased in a dose-dependent manner in response to FO dosage, which was observed at protein level by the western blotting and at mRNA level by real-time PCR. The cytokine profile of adipose tissue macrophages showed a steep shift toward antiinflammatory ones (IL-4 and IL-10) from the inflammatory TNF-α, IFN-γ, IL-2 and IL-1β. Thus, macrophage polarization seems to be the plausible mechanism via which FO alleviates obesity-induced inflammation and insulin resistance.

Background: The pathways that are involved for the duration of pregnancy and type of parturition are extremely complex, involving maternal as well as fetal systems. The objective of this study was to determine the frequency of types of parturition and their relationship with maternal characteristics among pregnant female patients.Methods: A cross-sectional survey using a non-probability convenient sampling technique was conducted among 195 healthy pregnant females at Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi, from 1st March 2019 to 31st August 2019. After taking written informed consent from the participants, the relevant data were gathered with the help of a structured questionnaire designed specifically for the study. Statistical package for social sciences was used for data entry while the chi-square test was applied for inferential analysis. The duration of the study was six months. Data were entered and analyzed using Statistical Package for Social Sciences version 20.0. Descriptive analysis was performed by generating means and standard deviations for continuous variables while frequencies and percentages for categorical variables. A Chi-square test was applied to perform the inferential analysis while the significance level was set at 0.05.Results: A total of 195 pregnant females were included in the study, whose mean age was 29.29±5.22 years. The study results showed that BMI before pregnancy (p=0.021), rest is taken during pregnancy (p=0.034) and gravida status (p=0.047) were all significantly associated with the type of parturition among the study participants, but spacing in pregnancies and parity were not.Conclusions: Maternal characteristics were found to be significantly associated with the type of parturition among pregnant females. For gynecologists the maternal characteristics identified in this study may serve as a useful indicator of the type of parturition expected in their patients.

30 dentures selected for the study were disinfected using effervescent denture tablets. Then the dentures were trimmed 1.5mm from fitting surface and relined with NBR soft lining material. Sample was scraped from denture fitting surface after one month and two months duration and the changes in colony forming units per mm after each month's time were measured and marked. After one month's duration, 24 samples were reported sterile and 6 showed colonies of Candida albicans & Staphylococcus aureus. After 2 months duration, 28 out of 30 samples became positive with C. albicans & S. aureus colonies and aerobic spore bearing units. NBR soft liner material was sterile till one month of clinical usage so it can be prescribed as a safe soft lining material till one month of clinical usage in a controlled environment of oral hygiene

Metastatic melanoma is a least common form of cancer as it accounts only for 1% of all cancer cases. But, it is most deadly in nature and is haunting mankind for long emotionally as well as economically. The sites for the onset of the disease are pigment-producing cells of the skin, mucosa, eye etc. It has the potential to spread other sites like subcutaneous tissue, lymph nodes, lungs, liver, bone and brain. The United States Food & Drug Administration has approved various drug molecules from time to time. The molecules (Dabrafenib-BRAF inhibitor and Trametinib-MEK inhibitor) have proved their credentials alone and in combination as well. These molecules have demonstrated good results for various end points like median progression free survival, overall survival, objective response etc. The median progression free survival for patients using dabrafenib and trametinib were 5.1 and 4.8 months, respectively (administered singly). It has increased to 11.4 months in the combination treatment “dabrafenib + trametinib”, which is approximately 104% and 138% greater than dabrafenib and trametinib treated groups alone. Similarly, the overall survival rate and objective response rate for the patients administered with “dabrafenib + trametinib” have been increased by 72% 64%, respectively. All these increments in these parameters were for a short period of time as the molecules were unable to withstand the pressure of resistance developed in the patients. So, the current review suggests the use of BRAF and MEK inhibitors as intermittent therapy along with heat shock protein 90 (HSP90) molecules.

Background Traditional knowledge of indigenous plants is pivotal in developing strategies to feed livestock sustainably in low input systems. Likewise, in Pakistan the indigenous people of Central Punjab have been using their regional grasses as a ruminant fodder for centuries. This study evaluated the indigenous traditional knowledge to ascertain the value of various fodder grasses to optimise their use to feed livestock in Central Punjab. Methods The snowball technique was employed to identify key informants who had relevant knowledge about different grasses in the study area. Semi-structured questionnaires, face-to-face interviews and site visits were used for describing the fodder grasses. The data were then analysed by using relative frequency citation and pairwise comparison methods to determine the order of priority among the listed fodder grasses. Furthermore, SPSS 22 software was used for descriptive statistics and interpretation of associations among studied parameters. Microsoft Excel was used to present data as % values and graphs. Results Overall, 53 grasses were described with ethnobotanical information regarding their uses for fodder, ethnoveterinary and other purposes. All these grasses belonged to the family Poaceae where the subfamily Panicoideae had the maximum number of 30 grasses. We categorized these grasses into high (A), medium (B) and low priority (C) groups where the group A grasses were reported as not only the most abundant but also the most palatable forages to all ruminants. Their higher demand was reflected by the feeding systems of both ad libitum grazing and feeding after cutting and mixing with other feeds. The study also revealed 37 previously unreported ethnoveterinary uses of these grasses. Conclusions The results have reinforced the value of conserving ethnobotanical knowledge, being poorly documented previously, in developing strategies to feed livestock. It indicated the preferred fodder grasses as well as the possible reasons of their preference. The reported data need to be validated for nutritional and health benefits. This information could help the smallholder farmers in association with regional governments to propagate suitable fodder grasses for their use in sustainable livestock feeding to produce safe and healthy food for indigenous communities.

Cisplatin (CP) is an effective anti-cancer drug which causes remarkable toxicity to the kidney, particularly to proximal tubules, by generating reactive oxygen species. Nigella sativa (NS), commonly known as "black cumin" reduces the progression of various kidney disorders. Thymoquinone (TQ), the major bioactive constituent of NS seeds, has been credited for various pharmacological effects of NS. Since, a typical clinical CP dosing regimen involves CP administration in multiple cycles over a long time duration, hence the present study aimed to evaluate the renoprotective efficacy of NS oil and TQ against multiple dose CP treatment induced deleterious biochemical and histological alterations in rat kidney. Adult male Wistar rats were divided into six groups viz. control, CP, CPNSO, CPTQ, NSO and TQ. Animals in CPNSO and CPTQ groups were pre-administered NSO (2ml/kg bwt, orally) and TQ (1.5mg/kg bwt, orally) respectively for 14 days and were then treated with CP (3mg/kg bwt, i.p), every fourth day for 20 days while still receiving NSO/TQ. NSO and TQ administration, prior to and along with CP treatment, attenuated CP induced renal functional impairment as evident by significantly restored serum creatinine and blood urea nitrogen levels. CP treatment alone led to significant decline in the specific activities of brush border membrane (BBM) marker enzymes viz. ALP (-46.64%), GGTase (-50.24%) and LAP (-42.15%), while NSO or TQ administration to CP treated rats significantly prevented the decline in the activities of these enzymes in isolated BBM vesicles (BBMVs) as well as in the homogenates of renal cortex and medulla. Furthermore, both NSO and TQ administration also mitigated the CP induced perturbations in renal metabolic and redox status. Histological studies supported these biochemical results showing significant attenuation of CP induced kidney damage in CPNSO and CPTQ cotreated groups. Thus, NSO and TQ have excellent scope for use as functional food or combinatorial nutraceuticals in CP chemotherapy to ameliorate the accompanying nephropathy in long term cancer chemotherapy.

© 2017 Elsevier Ltd Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [

AIMS: There is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emergency hospitalization and to identify variations based on diabetes type and glycemic control. METHODS: We conducted retrospective analysis of 273 YA admitted to an inner-city hospital with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHS). T-tests, Chi-Square tests, and ANOVA identified differences in demographics, diabetes history, clinical indicators, complications/comorbidities, and hospital admission stratified separately by diabetes type (1 vs 2) and admission HbA1c

Fecal calprotectin is commonly used as a quantitative marker for intestinal inflammation, predominantly in inflammatory bowel disease; however, the role of this laboratory value has not been well established for patients with juvenile polyps. We present 2 cases illustrating high fecal calprotectin levels caused by very large juvenile polyps.

Medical simulation has become an integral component of many surgical trainees' residency programs. In fact, the American College of Surgeons (ACS) has adopted simulation as a prerequisite for board certification in the United States. Simulation offers learners a means of gaining both important technical and non-technical skills (like communication), in a safe, repeatable, and, most importantly, standardized learning environment. Simulation is especially important for laparoscopic skill acquisition for two reasons: the novel psychomotor and perceptual obstacles faced by new learners take many trials of repeat practice to master and the fact that the operating room (OR) is a dangerous and expensive facility for the training of basic skills. The rise in the popularity of simulation also comes from a number of other factors such as: a decrease in daily work hours for residents, an overall shortening of training programs, growing demand for structured and criterion-based curricula (rather than relying on a traditional apprenticeship model), the need to protect patients from unnecessary harm, and an ethical push to stop the use of animals as surgical models. A range of simulation methods have been developed and validated for learners, including: physical phantoms, box trainers, virtual reality tower simulators, and full-OR procedure and crises simulators. Simulation training can be measured both subjectively and objectively. Objective measurements include operative time, path length, smoothness and number of movements (economy of motion), and operative hand dominance. A number of procedure-specific objective global assessment scales have been developed and validated, such as the Global Operative Assessment of Laparoscopic Skills (GOALS) and the Objective Structured Assessment of Technical Skills (OSATS).

Background Studies assessing patch testing (PT) in allergy practices are limited. Objectives To determine whether PT results using a limited panel of allergens such as in the Thin-Layer Rapid-Use Epicutaneous Test (TT) as compared with an expanded panel, such as the addition of supplemental allergens (North American Contact Dermatitis [NACD] Panel, Dormer Cosmetics, hairdressing series, corticosteroid series, and personal products) will miss a significant number of positive PTs. To compare our PT results with published data from dermatology practices. Methods This is a 5-year multicenter retrospective chart review of PT at 3 separate allergy practices. Results Four hundred twenty-seven patients (mean age, 49.8 years) were patch tested. Eighty-two percent were female; 54% reported an atopic history. Of the standardized allergens, the 5 most common positives were nickel sulfate, fragrance mix I, p-phenylenediamine (PPD), thimerosal, and cobalt chloride. Two hundred eighteen (56.9%; 95% CI=51.9–61.8%) patients were positive to at least 1 TT allergen. Ninety-eight (25.6%; 95% CI=21.5–30.2%) patients were positive to both a TT and a supplemental allergen. Forty-eight (12.5%; 95% CI=9.6–16.2%) patients were negative to a TT allergen but positive to a supplemental allergen. Conclusion Positive allergens would have been missed in 12.5% of patients when evaluating with TT allergens alone, whereas 25.6% would be partially evaluated. Patch test performance characteristics for these allergy practices appear to parallel that seen for dermatology. The TT remains an adequate screening tool in an allergy practice, but a more comprehensive panel may be needed to fully evaluate contact dermatitis.

Aim: To assess and validate the best model for fetal weight estimation in the Pakistani population. Material and Methods: The cohort included 178 women with singleton pregnancies at term (37–41 weeks) who had an ultrasound scan within 7 days of delivery. A proportionality formula was used to compensate for the fetal weight gain between the scan and the delivery. Data points from 119 pregnancies were used to derive the fetal weight formula, which was subsequently tested on the remaining 59 pregnancies. The best model for fetal weight estimation from ultrasound biometric parameters was selected. Results: The selected model showed an interclass correlation coefficient with birthweight of 0.89. The systematic and random errors were −10 and 250 g, respectively. This validity assessment compared favorably with the performance of the more commonly used formulae when applied to our population. Conclusions: We describe a new model for fetal weight estimation in a Pakistani population which produces more valid and reliable estimates than currently used models derived from other populations.

Item does not contain fulltext BACKGROUND: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture. METHODS: Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older. RESULTS: The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%). CONCLUSIONS: The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations. CLINICAL RELEVANCE: The results are based on two clinical trials. The questionnaires used concern pure, clinically relevant issues (ability to walk, climb stairs, etc.). Moreover, the results can be used for future research comparing clinical outcomes (or treatments) for populations with a femoral neck fracture.