Physicians' personal attributes and training influence their likelihood of recommending herbal medicines.

Background Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping. Methods Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software. Results Mortality was found to be significantly higher in the endovascular coiling group (odds ratio (OR): 1.17; confidence interval (CI): 95%, 1.04, 1.32). Re-bleeding was significantly higher in endovascular coiling (OR: 2.87; CI: 95%, 1.67, 4.93). Post-procedure complications were significantly higher in neurosurgical clipping compared to endovascular coiling (OR: 0.36; CI: 95%, 0.24, 0.56). Neurosurgical clipping was a 3.82 times better surgical technique in terms of re-bleeding (Z = 3.82, p = 0.0001). Neurosurgical clipping is a better technique requiring fewer re-treatments compared to endovascular coiling (OR: 4.64; CI: 95%, 2.31, 9.29). Endovascular coiling was found to be a better technique as it requires less rehabilitation compared to neurosurgical clipping (OR: 0.75; CI: 95%, 0.64,0.87). Conclusion Neurosurgical clipping provides better results in terms of mortality, re-bleeding, and re-treatments. Endovascular coiling is a better surgical technique in terms of post-operative complications, favorable outcomes, and rehabilitation.

73 Background: Despite established screening guidelines, adherence to colonoscopy is approximately 60%. Blood-based screening tests, or Liquid Biopsies (LB), have the potential to close this screening gap. Our aim was to determine the cost-effectiveness of LB tests for CRC screening in the US. Methods: We developed a Markov model to compare four CRC screening strategies: no screening, or natural history (NH), colonoscopy (Colo) only, LB only, and colonoscopy to LB hybrid (C-LB). US SEER CRC incidence and mortality data were used to develop and validate the model. Many LB tests are in development awaiting validation; we used the preliminary performance characteristics for CRC screening of 82% sensitivity and 99.5% specificity (base case) from the Galleri multi-cancer early detection test (GRAIL). Screening ran from age 45 to 75; polyp surveillance ended at 85. We assumed 60.6% of the US population would undergo a screening colonoscopy, and 100% adherence for LB. In Colo, nonadherent patients were not offered other screening; in C-LB those who refused colonoscopy underwent LB. Primary outcomes were overall survival, total cost, incremental cost-effectiveness ratio (ICER), number of CRCs, and CRC deaths. Results: In the NH strategy, 5.2% of the population developed CRC and 1.8% died from CRC, with a cost of $7,802.15/individual. Compared to NH, in Colo, 40% of CRCs and 44% of CRC deaths were prevented, at a cost of $10,610.43/individual. In C-LB, 42% of CRCs and 50% of CRC deaths were prevented compared to NH, costing $13,762.61/individual. LB only prevented 2.0% of CRCs and 11% of CRC deaths compared to NH, and cost $34,339.85/individual. While LB showed an incremental benefit of 0.01 life years gained compared to NH, the ICER compared to NH is $2,653,770. Colo was most cost-effective with an ICER of $30,191.04. Although C-LB prevented the greatest number of CRCs, this strategy had an ICER of $457,057.64, above the accepted US willingness to pay threshold of $100,000/life year. We performed sensitivity analysis around base case estimates for LB. At both 70% and 90% test sensitivity, all outcomes remained largely constant. Conclusions: CRC screening with LB alone or with LB in conjunction with colonoscopy among nonadherent patients is not cost-effective in the US context. At this time, LB is unable to detect pre-cancerous colon polyps, which may limit its effectiveness as a CRC screening strategy. [Table: see text]

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Cellulose is the most abundant biopolymer which is a topic of extensive research work. In this study Fourier Transform Infrared Spectroscopy (FTIR) was utilized to assign the molecular structure of cellulose. B3LYP at 3-21g**, 6-31g** and LANL1DZ then MP2 at 6-31g* levels of theories were conducted to compare the calculated vibrational spectra with the FTIR spectrum. Model molecules of cellulose starting with monomer up to cellulose 18 units were studied with PM3 semiemperical method in order to follow up the effect of polymerization upon some selected physical parameters. Results indicate that final heat of formation and band gap energy have decreased with increasing cellulose units while total dipole moment has increased with increasing cellulose units. It is concluded that the reactivity of cellulose has increased with increasing the units also the unique hydrogen bonding dedicates cellulose to several applications.

This study evaluates health risks manifested by the exposure of welding fumes to the labourers working in welding environments. Welding fumes, are the complexes of fluorides, silicates and metal oxides, cause burns, eye damage, hormonal imbalance, organ damage and cataracts. In order to check the changes caused by fumes on thyroid gland, a study was planned to evaluate the variations in thyroid regulatory hormone levels in workers occupationally exposed to welding fumes. For this purpose, blood sampling of the welders (n=24) having exposure to welding fumes was done from different sites in city Lahore, whereas, blood samples of healthy controls (n=24) were collected from University of the Punjab, Lahore. Thyroid (T3 and T4) and its regulatory hormone (TSH) assessment was executed by ELISA. Independent student “t” test at confidence interval of 95% and P < 0.05 was applied. A non-significant decrease of both hormones i.e. T3 and T4 was found in the subjects under study as compared to controls. Levels of TSH in blood serum of workers showed a non-significant increase than healthy controls. Elevated TSH and reduced T3 and T4, although, statistically non-significant, predict chances of hypothyroidism due to chronic exposure to welding fumes. Welders are, therefore, recommended to adopt prophylactic measures and safer techniques in order to avoid direct hazardous exposure to welding fumes

Background: A better understanding of the mechanisms of recovery during rehabilitation could inform treatment decision-making. We tested two hypotheses: [1] a combination of neural function and injury measures is better than either measure alone for predicting motor gains during inpatient rehabilitation facility (IRF) admission; and [2] performance of prediction measures varies according to severity of baseline impairment. Methods: Fifteen patients with subacute stroke (56±12 yr, 16 days post-stroke) admitted to an IRF underwent EEG [3-min, resting-state, dense-array (256-lead)] and MRI [anatomical and diffusion tensor] at IRF admission; and serial behavioral testing. Neural function was assessed using EEG measures of coherence and power from electrodes overlying ipsilesional (M1 i ) and contralesional (M1 c ) primary motor cortex, in the Delta (1-3 Hz) and high Beta (20-30 Hz) frequency bands. Neural injury was assessed as integrity of white matter in corpus callosum (CC). Change in arm Fugl-Meyer (FM) and Functional Independent Measurement motor (FIM-m) scores served as primary and secondary behavioral recovery metrics, respectively. Results: In subjects with moderate or severe impairment (FM <55, N=11), neither neural function (M1 i -M1 c Delta coherence) nor neural injury (CC integrity) alone significantly predicted FIM-m score change. However, when combined into a single model, these measures did significantly predicted FIM-m score change (R 2 = 0.85, p=0.024); note that baseline behavior was not a significant predictor. An identical neural injury+function model approached significance at predicting FM score change (R 2 = 0.72 p=0.08). These models failed, however, when applied to all 15 patients (R 2 = 0.06, p=0.81). Conclusions: Results thus far in this ongoing study suggest that recovery during inpatient rehabilitation is best predicted by combining neural function and injury measures, and not by behavioral assessments. Performance of recovery predictors varies according to severity of baseline deficits, as adding mild strokes to moderate/severe strokes increased the sample size but diluted the model. These findings could potentially inform patient selection, treatment decisions, and discharge planning in an IRF setting.

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