Diagnostic Performance of Ultrasonography Versus Magnetic Resonance Cholangiopancreatography in Biliary Obstruction.

Background In a suspected case of biliary obstruction with clinical and laboratory data suggesting obstructive jaundice, the major goal is to confirm the presence of obstruction, its nature and cause, location, and extent. Ultrasonography (USG) and magnetic resonance cholangiopancreatography (MRCP) are primarily used to diagnose suspected biliary tract illnesses. The aim of the study is to evaluate and compare the accuracy of MRCP and USG with endoscopic retrograde cholangiopancreatography (ERCP)/surgical/histopathological outcomes for finding the cause and level of obstruction in the case of clinically suspected biliary obstruction.

Scalable feature subset selection for big data using parallel hybrid evolutionary algorithm based wrapper under apache spark environment.

Extant sequential wrapper-based feature subset selection (FSS) algorithms are not scalable and yield poor performance when applied to big datasets. Hence, to circumvent these challenges, we propose parallel and distributed hybrid evolutionary algorithms (EAs) based wrappers under Apache Spark. We propose two hybrid EAs based on the Binary Differential Evolution (BDE), and Binary Threshold Accepting (BTA), namely, (i) Parallel Binary Differential Evolution and Threshold Accepting (PB-DETA), where BDE and BTA work in tandem in every iteration, and (ii) its ablation variant, Parallel Binary Threshold Accepting and Differential Evolution (PB-TADE).

GLP-1 Receptor Blockade Reduces Stimulated Insulin Secretion in Fasted Subjects With Low Circulating GLP-1.

Context: Glucagon-like peptide 1 (GLP-1), an insulinotropic peptide released into the circulation from intestinal enteroendocrine cells, is considered a hormonal mediator of insulin secretion. However, the physiological actions of circulating GLP-1 have been questioned because of the short half-life of the active peptide. Moreover, there is mounting evidence for localized, intra-islet mediation of GLP-1 receptor (GLP-1r) signaling including a role for islet dipeptidyl-peptidase 4 (DPP4).

Medical Student Portfolios: A Systematic Scoping Review.

Phenomenon: Medical Student Portfolios (MSP)s allow medical students to reflect and better appreciate their clinical, research and academic experiences which promotes their individual personal and professional development. However, differences in adoption rate, content design and practice setting create significant variability in their employ. With MSPs increasingly used to evaluate professional competencies and the student's professional identity formation (PIF), this has become an area of concern.

Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units.

It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician's concept of personhood, or "what makes you, 'you'", we adopt Radha Krishna's Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored.

A systematic scoping review of undergraduate medical ethics education programs from 1990 to 2020.

Introduction: Ensuring medical students are equipped with essential knowledge and portable skills to face complex ethical issues underlines the need for ethics education in medical school. Yet such training remains variable amidst evolving contextual, sociocultural, legal and financial considerations that inform training across different healthcare systems. This review aims to map how undergraduate medical schools teach and assess ethics.

Effect of supplemental nutrition in pregnancy on offspring's risk of cardiovascular disease in young adulthood: Long-term follow-up of a cluster trial from India.

Background: Undernutrition during intrauterine life and early childhood is hypothesised to increase the risk of cardiovascular disease (Developmental Origins of Health and Disease Hypothesis), but experimental evidence from humans is limited. This hypothesis has major implications for control of the cardiovascular disease epidemic in South Asia (home to a quarter of world's population), where a quarter of newborns have low birth weight. We investigated whether, in an area with prevalent undernutrition, supplemental nutrition offered to pregnant women and their offspring below the age of 6 years was associated with a lower risk of cardiovascular disease in the offspring when they were young adults.

Medical students' preference for returning to the clinical setting during the COVID-19 pandemic.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to widespread disruptions in the clinical education of medical students. In managing students' return to the clinical setting, medical schools face the challenge of balancing education, service and risk considerations. To compound this challenge, medical students may prefer not to re-enter during a period of great uncertainty, leading to substantive downstream sequelae on individual, institutional and national levels.

Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019.

Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed.

Educational roles as a continuum of mentoring's role in medicine - a systematic review and thematic analysis of educational studies from 2000 to 2018.

Background: Recent studies have gone to great lengths to differentiate mentoring from teaching, tutoring, role modelling, coaching and supervision in efforts to better understand mentoring processes. This review seeks to evaluate the notion that teaching, tutoring, role modelling, coaching and supervision may in fact all be part of the mentoring process. To evaluate this theory, this review scrutinizes current literature on teaching, tutoring, role modelling, coaching and supervision to evaluate their commonalities with prevailing concepts of novice mentoring.

A scoping review of mentor training programs in medicine between 1990 and 2017.

Effective mentoring enhances the personal and professional development of mentees and mentors, boosts the reputation of host organizations and improves patient outcomes. Much of this success hinges upon the mentor's ability to nurture personalized mentoring relationships and mentoring environments, provide effective feedback and render timely, responsive, appropriate, and personalized support. However, mentors are often untrained raising concerns about the quality and oversight of mentoring support.

Training clinical ethics committee members between 1992 and 2017: systematic scoping review.

Introduction: Clinical ethics committees (CECs) support and enhance communication and complex decision making, educate healthcare professionals and the public on ethical matters and maintain standards of care. However, a consistent approach to training members of CECs is lacking. A systematic scoping review was conducted to evaluate prevailing CEC training curricula to guide the design of an evidence-based approach.

Multi-dimensional approach to end-of-life care: The Welfare Model.

Appropriate and balanced decision-making is sentinel to goal setting and the provision of appropriate clinical care that are attuned to preserving the best interests of the patient. Current family-led decision-making in family-centric societies such as those in Singapore and other countries in East Asia are believed to compromise these objectives in favor of protecting familial interests. Redressing these skewed clinical practices employing autonomy-based patient-centric approaches however have been found wanting in their failure to contend with wider sociocultural considerations that impact care determinations.

Is increasing urbanicity associated with changes in breastfeeding duration in rural India? An analysis of cross-sectional household data from the Andhra Pradesh children and parents study.

Objective: To investigate whether village-level urbanicity and lower level socioeconomic factors are associated with breastfeeding practices in transitioning rural communities in India.

Setting: 29 villages in Ranga Reddy district, southern India between 2011 and 2014.

Participants: 7848 children under 6 years identified via a cross-sectional household survey conducted as part of the Andhra Pradesh Children and Parents Study.

Correlation between salivary cortisol levels and dental anxiety in children of smokers and nonsmokers.

Objectives: The present study was undertaken to evaluate salivary cortisol levels in children of smokers and nonsmokers and thereby establishing the relationship between cortisol levels in response to anxiety in children based on their father's habit of smoking.

Materials And Methods: The study population aged between 8 and 10 years includes two groups. Group 1 is comprised 20 children of cigarette smokers and Group 2 is comprised 20 children of nonsmokers.

Mentoring in Nursing: An Integrative Review of Commentaries, Editorials, and Perspectives Papers.

Although pivotal to mentoring success, scant data on mentoring relationships continue to hamper the application of mentoring programs in nursing education. To address this gap and circumnavigate mentoring's context-specific nature, this narrative review analyzes the perspectives and opinions of nurse mentors and mentees. The aim is to identify common themes in their mentoring experiences to better nurture effective mentoring relationships and programs in nursing.

Cultural influences upon advance care planning in a family-centric society.

Objective: Advanced care plans (ACPs) are designed to convey the wishes of patients with regards to their care in the event of incapacity. There are a number of prerequisites for creation of an effective ACP. First, the patient must be aware of their condition, their prognosis, the likely trajectory of the illness, and the potential treatment options available to them.

The practice of terminal discharge: Is it euthanasia by stealth?

'Terminal discharges' are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore.

Intramolecular oxyacetoxylation of N-allylamides: an expeditious synthesis of oxazolines and oxazines by using a PhI(OAc)/hydrogen fluoride-pyridine system.

The synthesis of oxazolines and oxazines from N-allylamides was accomplished via an unprecedented reaction set. This reaction involved an intramolecular cyclization of N-allylamides resulting from nucleophilic attack of the allylamine on the benzoxazin-4-one. Unlike the previous literature, the isolable N-allylamide could readily be subjected to exo and endo fashion ring-closure under conditions to afford the title compounds.

Prevalence and severity of depressive symptoms in relation to rural-to-urban migration in India: a cross-sectional study.

Background: Migration is a major life event, which may also be a risk factor for depression. However, little is known regarding the relationship between these phenomena in low and middle income settings. This study explores the frequency and severity of depressive symptoms among rural-to-urban migrants compared to permanent rural and to urban residents in India.

Fibroblast growth factor 21 is required for beneficial effects of exercise during chronic high-fat feeding.

Exercise is an effective therapy against the metabolic syndrome. However, the molecular pathways underlying the advantageous effects of exercise are elusive. Glucagon receptor signaling is essential for exercise benefits, and recent evidence indicates that a downstream effector of glucagon, fibroblast growth factor 21 (FGF21), is implicated in this response.

Role of the Nasogastric Tube and Lingzhi (Ganoderma lucidum) in Palliative Care.

Decision-making on behalf of an incapacitated patient at the end of life is a complex process, particularly in family-centric societies. The situation is more complex when attempts are made to accommodate Eastern concepts of end-of-life care with more conventional Western approaches. In this case report of an incapacitated 74-year-old Singaporean man of Malay descent with relapsed Stage 4 diffuse large B cell lymphoma who was without an established lasting power of attorney, we highlight the difficult deliberations that ensue when the patient's family, acting as his proxy, elected to administer lingzhi through his nasogastric tube (NGT).

Ruthenium Catalyzed Stereo/Chemo/Regioselective One-Pot Synthesis of C(2)-C(3) Unsaturated and α-D-Mannopyranosyl Sulfones.

An efficient and divergent approach to C(2)-C(3) unsaturated glycosyl and α-D-mannopyranosyl sulfones has been developed via ruthenium-promoted direct glycosylation, oxidation, and dihydroxylation from glycal in one-pot. The presence of stoichiometric amounts of NaIO4 and in situ generation of RuO4 from a RuCl3-NaIO4 reagent system were crucial for chemoselective oxidation of sulfide in the presence of an olefin moiety. The dual-role of ruthenium in sequential glycosylation-oxidation-dihydroxylation is amenable to a wide range of thio acceptors to access α-D-mannopyranosyl sulfones in good yields with high regioselectivity.

Understanding the fluid nature of personhood - the ring theory of personhood.

Familial determination, replete with its frequent usurping of patient autonomy, propagation of collusion, and circumnavigation of direct patient involvement in their own care deliberations, continues to impact clinical practice in many Asian nations. Suggestions that underpinning this practice, in Confucian-inspired societies, is the adherence of the populace to the familial centric ideas of personhood espoused by Confucian ethics, provide a novel means of understanding and improving patient-centred care at the end of life. Clinical experience in Confucian-inspired Singapore, however, suggests that personhood is conceived in broader terms.

Automated IMT estimation and BMI correlation using a low-quality carotid ultrasound image database from India.

This paper presents AtheroEdgeLowRes (AELR), an extention of AtheroEdge™ from AtheroPoint™, and a solution to carotid ultrasound IMT measurement in low-resolution and overall low quality images. The images were collected using a low-end ultrasound machine during a screening study in India. We aim to demonstrate the accuracy and reproducibility of the AELR system by benchmarking it against an expert Reader's manual tracing and to show the correlation between the automatically measured intima media thickness (IMT) and the subjects' cardiovascular risk factors (i.