Minor Subgroups Research Articles

Exploring Reasons and Perspectives Behind Decisions to Forego Hospital Births Among Remote Rural Populations in Bokeo Province, Lao PDR

Maternal mortality remains high among marginalized rural populations in Laos. Remote mountain villages in Bokeo Province typify persistent health access divides facing minor subgroups amidst infrastructure gaps and scattered habitation. This study explores complex drivers behind shunning hospital births using focused rural ethnography. Between October and November 2023, this qualitative study interviewed 40 participants including pregnant women, postpartum women, and their relatives across 5 villages in Bokeo Province regarding barriers to hospital births. Open-ended discussions aimed to elucidate motivations and barriers embedded in their decision to avoid formal delivery care, despite mortality awareness. Transcriptions from Lao were translated to Thai, maintaining cultural nuances. Thematic analysis identified patterns in women’s attitudes and barriers to hospital childbirth. A collaborative coding process revealed constraints on access, affordability, and autonomy, explaining why vulnerable groups often forego hospital births despite risks. The result founded that prohibitive transportation deficiencies including impassable roads, exorbitant driver fees and unreliable conveyance options were primary obstacles. Prohibitive direct and indirect costs compounded struggles for impoverished families. Restrictive traditions persisted among certain ethnicities. Discrimination fears and hospital foreignness also provoked wariness among a minority. Multidimensional geographical, financial and sociocultural barriers intersect to obstruct rural groups from accessible emergency obstetric care in Laos. Infrastructural strengthening, financial protection and public education can relieve these pronounced constraints denying the marginalized realization of maternal health rights.

No association between SARS-CoV-2 vaccination and ischaemic stroke or high-risk transient ischaemic attack

BackgroundInitiation of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) vaccinations aroused scepticism within the general-public about risks including stroke. Our aim was to explore temporal associations between vaccination and cerebrovascular events through an analysis of a prospective large-scale cohort of consecutive stroke and high-risk TIA (transitory ischaemic attack) patients. MethodsWe prospectively recruited a cohort of consecutive ischaemic stroke and high-risk TIA (ABCD2-Score ≥ 4) patients treated at the Innsbruck University Hospital (STROKE-CARD Registry Study, NCT04582825) from December 2020 until February 2022. SARS-CoV-2 vaccination status and the time of administration was ascertained by electronic health-data. A Cox model with vaccination status as time-dependent co-variable was employed to examine its association with ischaemic events. ResultsData on 572 participants were available with 355 (62.1%) vaccinated against SARS-CoV-2 before suffering cerebral ischaemia. In our cohort, no temporal association between vaccination and cerebrovascular event was detected (HR 1.06 [0.85–1.34; p = 0.60]) and this also applies to TIA (HR [0.82 0.37–1.85; p = 0.64]) or minor stroke (HR 1.18 [0.89–1.56; p = 0.26]) and subgroups defined by sex and age. Neither vector-based (HR 1.11 [0.79–1.56; p = 0.55]) nor mRNA-based (HR 1.06 [0.84–1.34; p = 0.61]) vaccinations were associated with the occurrence of cerebral ischaemia. ConclusionAmong patients with stroke or high-risk TIA, SARS-CoV-2 vaccination was not associated with cerebral ischaemia.

A fair consensus adjustment mechanism for large-scale group decision making in term of Gini coefficient

With social media and e-democracy development, decision-making environments and problems have become increasingly complex. Traditional group decision-making, including a small number of decision makers, cannot deal with many practical decision-making problems. Large-scale group decision-making has received extensive attention as an efficient measure to address this issue. This paper proposes a two-stage optimization consensus mechanism for large-scale group decision-making by the Gini coefficient, which considers both the consensus among decision makers’ opinions and the fairness of consensus adjustment. First, we introduce an improved density peak clustering method to cluster decision makers into subgroups that can avoid different clustering centers being too close. Then, we define the subgroups' weights by the silhouette coefficient, the subgroup judgment distance, and their sizes. Respecting the importance of minority opinions, we design a new method to identify and adjust the weights of the minority opinions, which considers more aspects than previous ones. Further, we use the Gini coefficient to measure the equity of consensus adjustment of the group and subgroup. Moreover, we present a two-stage Gini coefficient-based consensus mechanism to obtain the adjusted consensus individual decision matrices, which can ensure the minimization and fairness of consensus adjustment and allocation under the set constraints. Based on these results, we give a new large-scale group decision-making method. Notably, it is the first method that fully considers the opinions of minor subgroups and the fairness of allocation results. These characteristics are essential in decision-making problems such as resource allocation and urban public construction. Finally, we show the utility and validity of the new method through a case study and make the comparative analysis from numerical and principle aspects.

Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy

AbstractAimsPatients with cirrhosis and clinically significant portal hypertension (CSPH) usually have concomitant secondary hypersplenism, and splenectomy (Spx) is an option for treating these patients in the Asia‐Pacific region. CSPH is the most important risk factor for postoperative liver dysfunction (PLD) in patients with hepatocellular carcinoma (HCC) and cirrhosis undergoing liver resection. However, the impact of simultaneous Spx and hepatectomy in patients with HCC and CSPH remains unclear. In this study, we aimed to determine the impact of simultaneous Spx on the posthepatectomy outcomes in these patients.MethodsThis study included 691 consecutive patients with hepatitis B virus‐related HCC, cirrhosis, and CSPH. These included 565 patients who underwent hepatectomy only (non‐Spx group) and 126 who underwent simultaneous hepatectomy and splenectomy (Spx group). We analyzed the effect of 25 preoperative and 5 intraoperative factors on postoperative outcomes using logistic regression. To overcome any possible selection bias, confounders were balanced by propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses, and subgroup analyses were performed within the PSM‐matched groups.ResultsLogistic regression analyses revealed that Spx was an independent protective factor for severe postoperative liver dysfunction (SPLD; odds ratio [OR] = 0.22, 95% confidence interval [CI]: 0.11–0.43, p < 0.001) and 90‐day SPLD‐related mortality (OR = 0.21, 95% CI: 0.06–0.55, p = 0.004), respectively. Spx was also independently associated with a higher overall survival rate (hazard ratio = 0.63, 95% CI = 0.47–0.85, p = 0.002) based on Cox regression analysis. PSM and IPTW models showed that the benefit of Spx was also consistent across the major and minor hepatectomy subgroups examined.ConclusionSimultaneous Spx improved the outcomes of patients with HCC, cirrhosis, and CSPH treated with hepatectomy, including patients who underwent major and minor hepatectomies.

Short Term Safety and Efficacy of Robotic Versus Laparoscopic Liver Resection: A Systematic Review and Meta Analysis

Introduction: Laparoscopic liver resection (LLR) remains technically challenging with its use limited to experienced surgeons. Robotic liver resection (RLR) may potentially produce favorable peri- and postoperative outcomes when compared to LLR. Methods: MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL databases were systematically reviewed to identify studies comparing robotic and laparoscopic partial hepatectomy (last search 5th August 2019). Quantitative comparative studies in English published since the introduction of RLR were identified for inclusion. Outcomes extracted include operative time (OT), estimated blood loss (EBL), conversion to open, perioperative transfusion requirement, post-operative complications, length of stay, R0 resection rate, and mortality. Sub-groups were defined as major, and minor resections. Meta-analysis and subgroup meta-analysis was carried out using a random effects model. Effect measures were odds ratio (OR) for dichotomous data and mean weighted difference (MWD) for continuous data. Results: Twenty-two non-randomised comparative studies with a total of 1890 patients (Robotic; n=836, Laparoscopic; n=1054) was included in analysis. Operative time was significantly longer for RLR [MWD=+39.8 minutes, 95% CI (21.1, 58.6), p< 0.001], but not significantly different in sub-group analysis. EBL, length of stay, conversion rate, transfusion, complication rate, R0 resection rate, and mortality was not significantly different between RLR and LLR nor in major or minor sub-groups [p>0.05]. Conclusion: RLR provides comparable peri- and postoperative outcomes to LLR, potentially being a preferable approach in complex and major liver resections due to the inherent advantages of the robotic platform. Further randomised controlled studies are required in establishing the role of robotics in liver resection.

A particle swarm model of socio-psychological dynamics based on Heider’s balance theory

The emergence of collective behavior has been extensively studied in the field of artificial life. We propose a self-driven particle system with the dynamics of both social preferences and social relationships in the socio-psychological space to computationally understand the dynamics of human social relationships. Social preferences, represented as a matrix with the values of how much a person prefers another, is updated according to Heider’s balance theory. In addition, social relationships, represented as the distribution of particle agents in the two-dimensional space, is updated based on Kano’s model. Our experimental results show that if we assume the loop dynamics caused by the social preferences and social relationships, the community tends to converge to a state with two major subgroups accompanied by a few minor subgroups as a locally optimal solution.

Molecular diversity analysis in rice (Oryza sativa L.) using SSR markers

Rice is the most important staple food crop among the cereals and feeds more than half of the world’s population. Assessment of genetic diversity is of utmost importance in rice breeding from the perspective of selection, conservation and proper utilization. The present study was undertaken with an objective to assess the genetic diversity among 27 rice cultivars with 12 SSR markers. The results revealed a total of 40 alleles were detected across 27 rice cultivars tested. PIC values varied widely among SSR loci tested and it ranged from 0.38 to 0.65, with an average of 0.56 per marker. The 27 rice cultivars were grouped into two major clusters i.e., cluster I and II with similarity coefficient 0.13. Cluster I was sub divided into two minor sub-groups IA and IB having 5 and 8 genotypes respectively. These subgroups were further subdivided into minor groups. In similar way, the second main cluster i.e. Cluster II was also sub divided into two minor sub-groups that is IIA and IIB having 5 and 9 genotypes respectively. These subgroups were further divided into minor groups. This indicated presence of considerable diversity in the genotypes studied and the most diverse cultivars were IR 98846-2-1-2-3 and IR 14D201.

ECPGR recommended SSR loci for analyses of European plum (Prunus domestica) collections

A set of nine Simple Sequence Repeat (SSR) loci, approved by the ECPGR Prunus working group, are proposed as a standard set for genotyping European plum accessions. These loci show sufficient reliability in spite of problems caused by hexaploidy. Polymorphism in the loci is high and enables differentiation between unique plum accessions as well as analyses of genetic grouping and overall genetic structure. A set of seven reference accessions are described. A compiled dataset with allelic information for 165 accessions is presented. Genetic structure reveals three different K-values (2, 4 and 9) demonstrating a major dichotomy between Prunus insititia-related accessions and cultivars belonging to Prunus domestica sensu stricto, as well as differentiation among minor subgroups defined by pomological traits and geographical origin.

High-resolution computed tomography evaluation of congenital aural atresia - how useful is this?

To depict various temporal bone abnormalities on high-resolution computed tomography in congenital aural atresia patients, and correlate these findings with auditory function test results and microtia subgroup. Forty patients (56 ears) with congenital malformation of the auricle and/or external auditory canal were evaluated. Auricles were graded according to Marx's classification, divided into subgroups of minor (grades I and II) and major (III and IV) microtia. Other associated anomalies of the external auditory canal, tympanic cavity, ossicular status, oval and round windows, facial nerve, and inner ear were evaluated. Minor and major microtia were observed in 53.6 and 46.4 per cent of ears respectively. Mean hearing levels were 62.47 and 62.37 dB respectively (p = 0.98). The malleus was the most commonly dysplastic ossicle (73.3 vs 80.8 per cent of ears respectively, p = 0.53). Facial nerve (mastoid segment) abnormalities were associated (p = 0.04) with microtia subgroup (80 vs 100 per cent in minor vs major subgroups). Microtia grade was not significantly associated with mean hearing levels or other ear malformations, except for external auditory canal and facial nerve (mastoid segment) anomalies. High-resolution computed tomography is essential in congenital aural atresia, before management strategy is decided.

ТРАНС-ГЕРМАНСЬКІ ОСОБЛИВОСТІ ПРЕТЕРИТО-ПРЕЗЕНТНИХ ДІЄСЛІВ

This article contains systematic and detailed analysis of morphological and semantic parameters of Germanic preterite-present verbs, dividing them into major and minor subgroups. The development of both preterite-present subgroups and their steady transformation into the modal verbs is a specific feature of all Germanic languages. Since the modal verbs of the Modern Germanic languages are morphologically defective, it is commonly assumed that preterite-present verbs of the old Germanic languages lost some of their morphological features in the process of turning into modal verbs. The semantic aspects of this process are rather obscure. All Germanic languages were losing some preterite-present verbs in the process of transformation from the Gothic language, which had fourteen preterite-present verbs. In OE there were twelve preterite-present verbs. Six of them survived in NE. The morphological description focuses on the finite and non-finite forms of the preterite-present verbs, which belong to the minor subgroup. The detailed description helps to see the origin and development of the minor subgroup in the new light. The description encompasses the data of classical Indo-European languages and Old Germanic languages. The authors emphasize the expediency of turning to the theory of preterite/strong verb origin, the verbs in question may be regarded as inter-group, hybrid units. In order to gain insight into the origin of the Germanic languages it is necessary to look into the history of the Gothic and West Germanic and North Germanic languages. The authors find it useful to compare common and different phenomena, highlighting individual specific processes taking place in the process of development of the Germanic languages. These languages are analyzed on different stages of their development, but inline with the view that the languages co-operated and coexisted in the same area. The data given in the article are used to analyze the problem implementing comparative grammar tools. The authors were particularly careful to take all grammatical forms into consideration while working with the lexical units from the ancient sources. Some additional information was taken from Greek, Latin and Sanskrit to produce reliable and consistent comparison of the German language with the rest of Indo-European languages.

Micro-computed tomographic evaluation of the apical seal of endodontically treated teeth by two obturating techniques and two post space preparation techniques

Aim: This study evaluated apical seal of teeth obturated by two techniques and gutta-percha (GP) removed by two methods for post space preparation, using micro-computed tomography (micro-CT). Materials and Methods: Fifty-six single rooted teeth were decapitated at 15mm from the apex and prepared using ProTaper Universal System. Specimens were divided into two main groups of 28 each according to technique of GP Removal and post space preparation: Group A1, GP removed by a penetrating drill and Group A2, GP removed by hot plugger. Each main group was divided into two subgroups according to obturation technique: single cone (SC) and System B. Each subgroup was further divided into two minor subgroups according to storage time—immediately and one-week post-obturation. Approximately 9mm of GP was removed for post space preparation. All specimens were scanned three times by micro-CT: post-preparation, post-obturation, and after post space preparation. Total mean percentage of voids/gaps in the apical portion was calculated at 1, 3, and 5mm from the apex. Data were explored for normality using Kolmogorov–Smirnov and Shapiro–Wilk tests. Paired sample t-test was used to compare between two groups. Independent sample t-test was used to compare between two groups in non-related samples (significant P ≤ 0.05). Results: It showed that group A2 recorded significantly lower voids than group A1 at the two investigation periods. Voids associated with System B technique were lower than those with SC. Conclusion: An immediate removal of GP by hot plugger would not affect the apical seal.

Effect of Condensation Techniques on Fracture Resistance of Endodontically Treated Teeth Restored with Different Post Systems

The purpose of this study was to evaluate the fracture resistance of endodontically treated teeth with two obturating techniques supported with different post systems.A total of 90 sounds freshly extracted sound human single rooted teeth were included in the present study. The teeth were prepared by using the crown-down technique. The prepared specimens were divided randomly into three main groups (30 specimens each) .Group A1 used Titanium post),Group A2 used Glass fiber post), and Group A3 used Cast post. Each main group was divided into two subgroups (15 specimens each ) according to the obturation techniques .Subgroup B1 used lateral condensation technique, and Subgroup B2 used Thermo plasticized injectable technique. Each subgroup was further subdivided into three minor subgroups each composed of5 specimens .Subdivision S1 Post immediately placed after obturation, S2 (One month), and S3 (Three months). Failure loads were measured under a static loading. The results of fracture resistance of this study showed that at Immediate, 1 month, and 3 months; no statistical significant difference between vertical and lateral obturation technique. Post types showed that there were statistically significant differences in both obturation techniques. Conclusions: The Glass fiber post was more fracture resistance followed by Titanium post, then Cast post.

Factors associated with functional outcome in patients having limb salvage surgery for primary malignant bone sarcoma using TESS

Introduction: Achieving maximum functional outcome in primary malignant bone sarcoma surgery (PMBS) patients, is challenging for both patients and clinicians. This study, aimed to evaluate different factors that affect postoperative functional outcome of the primary malignant bone sarcoma patients following upper limb (UL) and lower limb (LL) salvage surgery using Toronto Extremity Salvage Score (TESS).Methods: 136 PMBS adult patients were identified and were grouped as lower limb (LL) and upper limb (UL). Each group then sub-grouped to major and minor surgeries. Their functional outcome was compared using TESS by demographic variables(gender and age), neoadjuvant/adjuvant therapy and tumour variables (anatomical sites). In the UL groups, TESS was also compared for major and minor surgery subgroups based on their dominant or non-dominant limb.Results: The result of TESS has revealed that chemotherapy, radiotherapy, and gender have no effect on the functional outcome in PMBS patients. Functional outcome however was significantly affected by age in both LL and UL groups. The TESS was significantly different between major and minor subgroups in UL group with p= 0.0001. In patients with upper LSS on their dominant limb, no significant difference between major/ minor surgery subgroups was observed with p=0.077.Conclusion: Our findings using TESS revealed that factors such as patient’s age, and type of surgery (major or minor) in PMBS patients will affect the patients’ functional outcome after LSS especially in those PMBS patients with upper LSS.

A Comparative Study of Albumin-Bilirubin Score with Child-Pugh Score, Model for End-Stage Liver Disease Score and Indocyanine Green R15 in Predicting Posthepatectomy Liver Failure for Hepatocellular Carcinoma Patients

Background: The albumin-bilirubin (ALBI) grade is a newly proposed model for assessing the hepatic function. This study aimed to compare the value of the ALBI score with Child-Pugh score, model for end-stage liver disease (MELD) score and indocyanine green (ICG) R15 in predicting posthepatectomy liver failure (PHLF). Methods: Patients undergoing curative resection for hepatocellular carcinoma (HCC) between January 2014 and June 2017 were enrolled. The values of the Child-Pugh score, MELD score, ICG R15 and ALBI score in predicting PHLF were evaluated. Results: A total of 473 HCC patients were enrolled. The ALBI score was identified as an independent predictor of PHLF. The AUCs for the Child-Pugh score, MELD score, ICG R15 and ALBI score in predicting PHLF were 0.665, 0.649, 0.668, and 0.745 respectively. Multivariable analyses revealed that the ALBI score was an independent predictor of PHLF regardless of the hepatectomy subgroups, but the Child-Pugh score and MELD score were not significant predictors of PHLF both in major and minor hepatectomy subgroups, and ICG R15 was only a significant predictor of PHLF in minor hepatectomy subgroup. Conclusion: The ALBI score showed superior predictive value of PHLF over Child-Pugh score, MELD score and ICG R15. We propose to use the ALBI score to evaluate surgical risk for HCC patients undergoing hepatic resection.

Risk factors for lower extremity amputation in patients with diabetic foot

Objective: To explore the risk factors for lower extremity amputation in patients with diabetic foot. Methods: The clinical data of 1 771 patients with diabetic foot at the Air Force General Hospital of PLA from November 2001 to April 2015 were retrospectively analyzed. The patients were divided into the non-amputation and amputation groups. Within the amputation group, subjects were further divided into the minor and major amputation subgroups. Binary logistic regression analyses were used to assess the association between risk factors and lower extremity amputation. Results: Among 1 771 patients with diabetic foot, 323 of them (18.24%) were in the amputation group (major amputation: 41; minor amputation: 282) and 1 448 (81.76%) in the non-amputation group. Compared with non-amputation patients, those in the amputation group had a longer hospital stay and higher estimated glomerular filtration rate(eGFR)levels. Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), C-reaction protein (CRP), ESR, ferritin, fibrinogen and WBC levels of the amputation group were higher, while hemoglobin albumin, transferrin, TC, TG, HDL-C and LDL-C were lower than those of the non-amputation group (all P<0.05). The proportion of hypertension(52.48% vs 59.98%), peripheral vascular disease (PAD)(68.11% vs 25.04%), and coronary heart disease(21.33% vs 28.71%)were different between the amputation and non-amputation groups (all P<0.05). Multivariable logistic regression analyses showed that Wagner's grade, PAD and CRP were the independent risk factors associated with lower extremity amputation in hospitalized patients with diabetic foot. Conclusion: Wagner's grade, ischemia of lower limbs and infection are closely associated with amputation of diabetic foot patients.

Work injury trends during the last three decades in the construction industry

ObjectivesThe aim was to analyze injury trends according to age, severity, work activity and business cycle in the construction sector. MethodsFrom 1980 to 2010 a total of 23.464 work related injuries were treated at the emergency department at Odense University Hospital. The annual incidences were calculated. Employment levels in the construction sector were used as an indicator of fluctuations in the business cycle since 1980. ResultsThrough the last three decades the overall trend of work-related injuries was unchanged. For some subgroups of injuries, such as major injuries and injuries due to young workers use of small powered tools significant downward trends were seen, but trends within different age groups of workers were unchanged and young workers have at least twice the risk compared to older workers. The fluctuations in work injury trends among workers under 30years of age were significantly related to the business cycle, where the risk of injuries was higher during economic booms than during recessions. Further, periods with economic booms are positively related to the rate of minor injuries and injuries due to all other work activities than the use of power tools. ConclusionOverall the number of injuries in the construction sector have not changed significantly during the recent three decades, except for minor subgroups related to ‘major injuries’ and ‘injuries due to use of small power tools’. Re-evaluation of safety prevention programs is needed in order to break the high injury level among young workers compared to older workers, especially during economic booms.

Molecular marker based genetic diversity analysis in rice (Oryza sativaL.) using SSR markers

Assessment of genetic diversity is very important in rice breeding from the standpoint of selection, conservation and proper utilization. The role of a broad genetic base and systematically characterized germplasm in the crop improvement of cultivated plants has been well recognized. To meet the continuously expanding needs of varietal improvements, the evaluation and characterization of all existing germplasm are required. Genetic variability studies are important in selection of parents for hybridization as sound crop improvement depends upon the magnitude of variability in the base population. In the present investigation 36 rice genotypes were studied for diversity studies using polymorphic SSR markers. These rice genotypes were grouped into two main clusters that is cluster I and II with similarity coefficient (0.00). Cluster I can be sub divided into two minor sub-groups IA, IB, and with similarity coefficient (0.15). Cluster IA consisted of 12 genotypes, whereas cluster IB consisted of 13 genotypes. The second main cluster can be also sub divided into two minor sub-groups that is IIA and IIB (0.25). This indicated presence of considerable diversity in the genotypes studied. Through diversity analysis, highest similarity was observed between cultivar URG-5 and URG-8 followed by NDR-359 and Pusa-6-B. The most diverse cultivars were Akshaya dhan and URG-24.

Genome-wide identification and characterization of Xylanase Inhibitor Protein (XIP) genes in cereals

Xylanase inhibitor proteins (XIPs) have been reported to be involved in plant defense mechanisms, more predominantly against fungal pathogens. XIPs have mostly been well characterized in model plant species, and very little is known about their distribution, organization and evolution in cereals. In the present study, we have identified XIPs in four cereal plant species, including three major crops sorghum, maize, rice and a model species Brachypodium. The genome-wide analysis identified 10, 20, 13 and 31 XIP genes respectively for Brachypodium, sorghum, maize and rice. The number of identified genes is in well accordance with the genome size except for maize. Interestingly, most of the XIP genes were observed to be intron-less, and clustered together on the chromosomes. The XIP genes organization is much similar to the lower eukaryotes and fungi suggesting the possibility of horizontal gene transfer from the pathogen. The phylogenetic analysis of XIP revealed two major groups, and minor subgroups mostly representing gene clusters. Gene expression evaluation using publically available data suggested LOC_Os11g47500 and LOC_Os11g47510are candidate genes for resistance against Magnaporthe grisea pathogen in rice. The information provided here would be helpful for the identification of candidate resistance genes in other cereals.

Abstract W P280: Predictors of Hospitalization in Patients with Minor Stroke and TIA

Background: Although current guidelines recommend urgent treatment for patients with TIA and minor stroke, it is unclear if hospitalization is required, and little is known about the factors that influence decisions to admit such patients. The objective of this study was to identify patient and system-level predictors of admission in patients with minor stroke and TIA. Methods: The Ontario Stroke Registry (OSR) was used to identify a cohort of patients with acute minor stroke or TIA who presented to any one of Ontario’s 150 acute care hospitals between April 1, 2008 and March 31, 2011. Multivariable analysis using hierarchical logistic regression modeling was performed to identify predictors of hospitalization, including patient characteristics, risk factors, presenting symptoms, features of the care encounter and hospital and system-level factors. Results: The final study cohort consisted of 10,890 patients with minor stroke or TIA. Overall, 48% were women and the median age was 75 years. The overall admission rate was 57% (31% for TIA and 83% for minor stroke). In the multivariable analysis, significant predictors of hospital admission included disability prior to admission, risk factors including hyperlipidemia, atrial fibrillation and smoking, presenting with weakness or symptoms persisting for more than 60 minutes and arriving to hospital by ambulance (all p&lt;0.01). Approximately 88% of the model’s variance was attributable to patient-level factors. Stroke center designation, hospital volume, having a stroke unit on site and having access to a stroke prevention clinic were not significant predictors of hospitalization. Similar results were found when the minor stroke and TIA subgroups were analyzed separately. Conclusions: These results suggest that patient-level characteristics rather than system-level factors have a greater influence on the decision to admit patients with minor stroke or TIA. Given that these patients are hospitalized solely for rapid completion of investigations and initiation of secondary prevention therapies, a system change providing access to specialized urgent TIA clinics is required to avoid the unnecessary costs of hospitalization.

Role of circulating tumor cells in future diagnosis and therapy of cancer

Circulating tumor cells (CTCs) have become a blistering topic of discussion for oncologists because of their tremendous potential in the diagnosis and treatment of cancer. Over the past few years, they have been doled with quite an amount of research in this area understanding that CTCs are shed from tumors and circulate in the bloodstream. This process can also occur at an early stage of cancer. The major limitation in isolation of CTCs is their availability in limited numbers. Hence, many techniques have been developed and are under continuous improvement to enhance their efficacy of CTC isolation and enumeration. They have shown their potentiality to not just indicate the presence of a tumor but also to provide us with its core information. They have also proven to be useful in detecting minor subgroups of cells present in the primary tissue which might eventually be the cause of treatment resistance or relapse of the disease. Hence, detecting and characterizing CTCs can definitely become an inevitable step in treating solid tumor malignancies. In this review, we have tried to comprehend the basics of CTCs including isolation, detection, characterization, and molecular mechanism of their circulation in the blood stream. We have mostly focused on the significance of CTCs in diagnosis and therapies of four most common types of cancers, namely, breast, prostate, lung, and colorectal. This review provides the coverage of most of the advancements with regards to different tumor malignancies and their probable use in predicting outcomes of the disease to realize the concept of personalized medicine.