Principal Author Research Articles

Update on the Penuma® an FDA-cleared penile implant for aesthetic enhancement of the flaccid penis.

The Penuma® implant is a medical-grade silicone implant surgically inserted subcutaneously to provide cosmetic improvement of the penile aesthetic. The principal author was invited to provide an update on the usage of the Penuma® implant for penile aesthetics. He collected as yet unpublished data, which is undergoing synchronous submission to Urologic meetings and peer-reviewed publications by a variety of authors for this communication. The objective of this article is to provide updated information regarding the Penuma® aesthetic penile implant. A new scrotal method of implantation named "concealed" is emerging. Through physician comparison of various factors prior to and after the scrotal method intervention, early findings suggest this approach seems to have less visible scar, is quicker and is followed by less seroma formation. As the device is now surgically implanted by surgeons other than its inventor, new developments have appeared authenticating the original published paper in 2018. Patients were contacted via phone and were asked five questions regarding satisfaction with the responses recorded. This new multicenter study shows findings of high patient and partner satisfaction coupled with acceptable adverse outcomes similar to the single-surgeon study. A new penile rehabilitation program has been developed with the aim for the penis appearance to be restored to its pre-operative state if the Penuma® is removed. 12 patients who underwent penile implant removal were followed for 6 months while participating in the penile rehabilitation program. The discipline worked in patients who desired removal for dissatisfaction and is currently under evaluation in patients who require device removal for medical reasons, e.g., infection or suture-related issues. Through new developments, the acceptance of Penuma® in the prosthetic community seems to be further solidified.

Decentralization Can Improve Equity, but Can It Be Sustained?

A major theoretical issue about health system reform involving decentralization has been whether it promotes equity of health system funding. An article by the principal author and others in 2003 showed that, under certain conditions and policies, decentralization improved the equity of allocation of financial resources to different income levels of municipalities in Colombia and Chile. Another recurring issue has been whether reforms can be sustained over time. In a follow-up study in 2015, we found that the equity of national allocations was sustained even though the allocation rules for intergovernmental transfers and insurance funding sources had changed, as long as per capita allocation rules were retained. Nevertheless, the wealthier municipalities in Chile were able to increase their own source funding contributing to a larger gap between wealthy and poor municipalities, suggesting that in order to assure continued equity some compensation for these funds be included in intergovernmental transfer rules or that local source funding be restricted by national policy. These reforms may be more likely to be sustained if they become embedded in existing financial systems and if they receive support of status quo constituencies.

Complications among Patients Undergoing Pancreaticoduodenectomy in Tertiary Care Centers of Nepal: A Descriptive Cross-sectional Study.

Pancreaticoduodenectomy (Whipple procedure), even after significant evolution, continues to be associated with a high morbidity. The study aimed to find out the prevalence of complications following pancreaticoduodenectomies performed by a single surgeon over a span of 20 years in tertiary care hospitals of Nepal. This was a descriptive cross-sectional study conducted from hospital records of patients who underwent pancreaticoduodenectomy between 1999 and 2019 at different institutions in Chitwan, where the principal author was involved. Ethical clearance was taken from the Institutional Review Committee. Convenience sampling was done. Patients' clinical characteristics and diagnoses were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Out of 327 patients who underwent pancreaticoduodenectomy, complications were found in 125 (38.2%) (32.9-43.7 at 95% Confidence Interval). Respiratory complications were the commonest 32 (9.8%), followed by septicemia 25 (7.6%) and cardiac complications 24 (7.3%). Delayed gastric emptying and postoperative pancreatic fistula were seen in 11 (6.8%) and 4 (2.5%) in the first decade respectively. In the second decade, delayed gastric emptying was noted in 2 (1.2%) and postoperative pancreatic fistula in 1 (0.6%) patient. The prevalence of complications in our study was comparable to other national and international studies. Surgery-specific complications such as delayed gastric emptying and postoperative pancreatic fistula showed a decline over the decade.

基于形态学空间格局和空间主成分的贵阳市中心城区生态网络构建

PDF HTML阅读 XML下载 导出引用 引用提醒 基于形态学空间格局和空间主成分的贵阳市中心城区生态网络构建 DOI: 10.5846/stxb202012213241 作者: 作者单位: 作者简介: 通讯作者: 中图分类号: 基金项目: 国家自然科学基金项目（32060367）；贵州省科学技术基金重点项目（黔科合基础[2020]1Z011）；贵州省科技支撑计划项目（黔科合支撑[2021]一般458） Construction of ecological network in downtown of Guiyang city based on morphologically spatial pattern and spatially principal component analysis Author: Affiliation: Fund Project: 摘要 | 图/表 | 访问统计 | 参考文献 | 相似文献 | 引证文献 | 资源附件 | 文章评论 摘要:喀斯特多山地区，城市扩展过程中大量自然山体镶嵌入城，形成具有多种生态系统服务功能的城市遗存自然山体。但在城市内部致密化发展过程中，这些城市遗存山体常被城市建设用地孤立和包围，形成人工干扰场中的生态孤岛。生态网络的构建既有利于城市遗存自然山体自然资源保护，又有助于丰富城市绿色基础设施生态系统服务功能。以喀斯特地区典型的多山城市——贵阳市行政区为研究对象，综合利用形态学空间格局分析法和景观连通性识别中心城区生态源地，基于主成分分析确定研究区综合阻力面，通过最小累积阻力模型、重力模型和水文分析等方法，识别并优化关键衔接廊道及节点，在中心城区行政区和建成区两个尺度构建研究区生态网络。结果表明：（1）行政区生态源地分布整体呈现"南北相望"的格局，建成区生态源地集中在中部；（2）研究区综合生态阻力高值主要集中在研究区中部，呈放射状向外扩散，综合生态阻力低值主要分布在研究区周边，以大型林地斑块为主；（3）行政区极重要、重要、一般廊道数分别为15、21、69，极重要廊道集中分布在北部，建成区极重要、重要、一般廊道数分别为37、113、227条，极重要廊道主要分布在建成区中部；（4）行政区和建成区一类生态节点分别为29、25个，二类生态节点33、17个。最终通过叠加行政区和建成区生态网络要素，形成贵阳市中心城区生态网络，研究结果能为贵阳市中心城区在未来用地空间上协调生态保护与城市发展提供科学合理的参考。 Abstract:In the karst mountainous area, with the urban expansion, a large number of natural mountains have been embedded into the urban built-up area, forming the urban remnant natural mountains which have various ecosystem service functions. However, in the process of dense development within the urban area, these urban remnant mountains were often isolated and surrounded by the urban construction land, forming the ecological islands in the artificial interference field of urban built-up area. Construction of ecological network of the mountainous urban could be not only conducive to the protection of natural resources of urban remnant natural mountains, but also beneficial to enrich the service functions of urban green infrastructure ecosystem. Taking the downtown of Guiyang, a typical mountainous city in karst area, as research area, we comprehensively used morphologically spatial pattern analysis (MSPA) and landscape connectivity to identify ecological sources and determined the comprehensive resistance area based on the principal component analysis. We also identified and optimized the key connection corridors and nodes through the minimum cumulative resistance model (MCR), and constructed the ecological network at two scales of the administrative area and the built-up area of the research area. The results showed that:1) the overall distribution of ecological sources in the administrative region presented a pattern of "north and south facing each other", and the ecological sources in the built-up area were concentrated in the central part; 2) The high values of comprehensive ecological resistance were mainly concentrated in the middle of the study area and radially spread outwards, while the low values were mostly distributed in the periphery of the study area with large forest patches; 3) The number of essential, important and general corridors in the administrative region were 15, 21 and 69 respectively. The essential corridors were concentrated in the north of the study area, meanwhile, the number of essential, important and general corridors in the built-up area were 37, 113 and 227 respectively, and the essential corridors were mainly distributed in the middle of the built-up area; 4) There were 29 and 25 ecological nodes in the administrative and built-up areas, and 33 and 17 second-class ecological nodes, respectively. Finally, by superposition the ecological network elements of administrative region and built-up areas, the ecological network of the downtown of Guiyang City was constructed. This study could provide scientific and reasonable reference for coordinating ecological conservation and urban development in the central urban area of Guiyang city. 参考文献 相似文献 引证文献

Psychometric properties of the Thai version of the Internalized sexual stigma scale for research on lesbian, gay, bisexual, and transgender (LGBT) populations

ABSTRACT Internalized sexual stigma is an important contributor to LGBT mental health disparities. In Thailand, the absence of validated instruments represents a research barrier. The study’s purpose was to translate and evaluate the psychometric properties of the Revised Internalized Homophobia (IHP-R) scale. Based on the cross-cultural principle, team translation was applied. The IHP-R was translated by the principal author and reviewed by bilingual Thai nurses, and clarifications were made. Multidisciplinary experts provided back translation and reconciled the finalized Thai version. The psychometric properties were established in 412 Thai LGBT individuals. Data was collected via online and paper-pencil surveys and analyzed using SPSS. Most participants were male, age ranged 18–53, with moderate levels of internalized homophobia (M = 2.3, SD = 1.04). The inter-item and item-total correlations were .38-.63 and .55-.68. The content validity index was high (I-CVI, S-CVI/UA/Ave = 1). The exploratory factor analysis confirmed one construct of internalized sexual self-stigma (factor loading = .702–.816). Scores on IHP-R were correlated with stress and experiences of discrimination (r = .14 and .12). Internal consistency reliability was also high (Cronbach’s alpha coefficient = .83). The IHP-R Thai version has high psychometric properties and is appropriate for LGBT research in Thailand.

Knowledge, Attitude, Practice of Iranian Physicians about COVID-19 in Iran

As a result of the global crisis caused by the coronavirus outbreak in late December 2019, Iran was also severely affected. The three provinces of Tehran, Mazandaran, and Gillan were high-risk cities exposed to infection and grievously damaged. Therefore, we decided to look at the level of knowledge, depth of attitude, and quality of physicians' practice in these three provinces. The most significant goal was to assess the level of KAP relative to the COVID-19 virus to provide comprehensive information to identify the strengths and weaknesses of the treatment staff to better cope and more effectively prevent and control critical situations.
 For research methodology, a cross-sectional study was performed on a sample of 300 people using a self-made questionnaire. An online questionnaire via virtual networks and a paper questionnaire were also distributed by the principal author in medical hospitals, which included four sections: demographic information, knowledge, attitude, and practice. Cronbach's alpha confirmed the validity and reliability of each component. The final results prove that the knowledge of physicians was acceptable and significant at the level of 0.05. Physicians' attitudes showed a level of fear and anxiety that was significant according to a one-sample t-test and chi-square (Sig <0.05). In order to rank the physicians' practice, a T-test was used, and the results of the Friedman test in the first stage of the Chi-square test showed that the significance level is 0.05. Looking at the research results, it can be said that the development of educational programs can have a beneficial effect in increasing physicians' knowledge and controlling the disease as effectively as possible. Also, due to the attitude associated with stress and fear, it can be seen that providing laboratory and treatment equipment has been one of the concerns of physicians.

A-195 Reliability of Scores Obtained on the WAIS-IV and WISC-V in a Largely Pacific Islander Sample

Abstract Objective With the emergence of Covid-19, the field of assessment had to adapt immediately to telehealth administration without the typical rigorous standardization procedures neuropsychologists are accustomed to. This study will provide some support for reliability of scores obtained on the Wechsler Adult Intelligence Scale (WAIS-IV) and Wechsler Intelligence Scale for Children (WISC-V) utilizing telehealth in a largely Pacific Islander sample. Method Participants were all individuals who had completed a psychological evaluation with the principal author in either a community health care clinic or a nearby independent assessment practice. Testing had to have taken place a minimum to one year prior and participant’s had to be within the age range to repeat the same test that was previously administered. Thus far, there are 16 total participants. Results Paired samples t-tests indicated that there were no significant differences between the Verbal Comprehension Index (VCI), Fluid Reasoning Index (FRI), and Working Memory Index (WMI) on the WISC-V for those administered in person and through telehealth VCI (t(4) = 2.08, p = 0.106) FRI (t(4) = −0.86, p = 0.439); and WMI (t(3) = −0.104, p = 0.924). Findings were similar for the WAIS-IV with non-significant scores on the VCI (t(5) = −0.1.3, p = 0.903) or WMI (t(5) = −0.1.3, p = 0.903). Conclusion Although telehealth is not the gold-standard for psychological assessment, telehealth administration can provide reliable scores and important information for diagnostic clarity. As such, telehealth administration remains a valuable tool for psychologists to generate diagnoses and provide recommendations for treatment.

Corrigendum to "Simulation and Optimization of Lead-Based Perovskite Solar Cells with Cuprous Oxide as a P-type Inorganic Layer [J. Nig. Soc. Phys. Sci. 1 (2019) 72–81, https://doi.org/10.46481/jnsps.2019.13

The version in the original Article has an error in the name of the principal author Eli Danladi which was given incorrectly as D. Eli. We highly regret this.

Comparison of Modified Mathieu versus Standard Tubularised Incised-Plate Urethroplasty for Distal Hypospadias Repair

Objective: To compare the outcomes of modified Mathieu versus standard tubularised incised-plate urethroplasty for distal hypospadias repair. Materials and Methods: This prospective comparative study was conducted on 54 cases affected by distal hypospadias presenting to Institute of Kidney Disease, Hayatabad, Peshawar form February 2015 to June 2020. The inclusion criteria was patients with distal hypospadias (coronal, sub-coronal, or distal penile), age range of 15 to 60 months. Cases with severe chordee/ventral curvature, history of previous hypospadias repair, and poorly developed urethral plate were excluded. The patients with distal hypospadias were divided into two equal groups: in-group I repair done with Mathieu procedure plus incision of the urethral plate (modified Mathieu) and in-group II repair was performed with Tubularized Incised Plate (TIP). The principal author performed functional and cosmetic assessment at follow up visits which includes; denvo meatus; size and pressure of the stream; and complications like meatal stenosis, urethral cutaneous fistula. Fisher Exact test was used to compare categorical variables between the two groups and student t test for continuous variables. Results: The mean age of the study was 38.13±12.55 months. The operating time was less in TIP than modified Mathieu procedure statistically (P=0.036, 95% CI=0.315, 9.02). In modified Mathieu procedure the sprayed stream of micturition was higher (n=4, 14.8%) while in TIP procedure the frequency of narrow stream was higher (n=4, 14.8%). The difference was statistically significant (P=0.054). Only in modified Mathieu procedure the meatus shape was round in 4 (14.8%) cases and the results were statistically different (P=0.038). Post-operative fistula was higher TIP (n=6, 22.2%) than modified Mathieu (n=1, 3.7%) statistically (P=0.043). Only in TIP procedure postoperative meatal stenosis was found in 5 (18.5%) and the difference was statistically significant (P=0.019). Conclusion: The modified Mathieu technique can improve the cosmetic outcome through creation of slit-like meatus, low incidence of fistula and meatal stenosis than tubularized incised plate urethroplasty in the repair of distal hypospadias.

The Trend of Scientific Productions on the Use of Herbal Medicines in Metabolic Disorders in the Middle East Countries

Context: Prevalence of metabolic disorders, type 2 diabetes mellitus (T2DM), dyslipidemia, obesity, metabolic syndrome (MetS), and osteoporosis has been increased. Herbal medicine is an accessible, safe, and low-cost option in managing and caring for metabolic disorders. We conducted a bibliometric analysis of global scientific productions in herbal medications and metabolic disorders in the Middle East countries. Study Selection: Our search terms were “diabetes”, “dyslipidemia”, “obesity”, “osteoporosis”, “metabolic syndrome”, “herb”, and “herbal medicine” in Middle East countries through the Scopus database until January 2020. We analyzed the data regarding publication year, main journal, geographical distribution, document type, subject area, co-authorship network, the h-index of citations by Scopus analysis tools, Visualizing Scientific Landscapes (VOSviewer) version 1.6.4, and SPSS version 15. Results: Among 6408 global publications, most of the papers (> 85%) were original articles, and mostly (44.26%) were about dyslipidemia. A significant time-trend was shown in the number of documents (P < 0.001), mostly in 2019. Medicine and pharmacology were subject areas in > 80% of papers. The top country in the global publication number was Iran. The highest cited papers in dyslipidemia, obesity and osteoporosis were original articles from Turkey and Egypt, but in T2DM and MetS the highest cited paper was a review article from Iran. The top sources were “Phytotherapy Research” and “the Journal of Ethnopharmacology”. The top institutes were from Egypt, Iran, and Saudi Arabia and the principal author in the co-authorship network assessment was from Iran. Conclusions: The time-trend growth in producing scholarly papers in the studied disorders is appreciated, but more evidence-based articles are still needed.

Underdiagnosed Delirium on Elderly Patients in the Emergency Room Principal Author

Delirium is a fluctuant, transitional and acute affection of cognition and attention, with multifactorial aetiologies. It is a medical emergency and requires an integral evaluation to identify the underlying causes. In elderly people, over 65 years old, the incidence of Delirium oscillates greatly between 14% to 24% at the moment of hospitalization and 6% to 56% during the time of hospitalization. The prevalence of Delirium acquired in the community oscillates from 1% to 2%. However, this prevalence increases as high as 10% when entering the emergency department.

The Question of Sharing: Thomas Jefferson and the Idea of Communal Property

Drawing from archival research, this article explores Thomas Jefferson’s understanding of property and his embrace of a political community defined by communal sharing. Tracing the evolution of Jefferson’s view on property holdings from the Anglo-Saxons to the American colonies to his speculative vision of ward republics, this paper argues that fears concerning economic and property inequities in the early republic compelled the principal author of the Declaration of Independence to endorse small, communal experiments. Importantly, this reading of Jefferson problematizes strict liberal or republican interpretations of his thought, further calling into question the philosophical heritage of the American republic. By evaluating personal letters from 1804 to 1824, this article offers an alternative reading of Jefferson, one that carefully showcases his wholly original, compelling, and radical democratic thinking. The significance of this heterodox interpretation has far-reaching implications on our understanding of the foundational principles of the early republic as well as how we address the issue of economic inequality in the modern-day United States.

ASSESSMENT OF TRIGLYCERIDE TO HIGH-DENSITY LIPOPROTEIN RATIO AS AN INDICATOR OF CORONARY ARTERY DISEASE AND ITS SEVERITY

Objectives: To evaluate the TG/HDL ratio test as a diagnostic tool for assessing the severity of CAD.
 Methodology: This was a validation study conducted at the Indus Hospital, Karachi between March 2019 and March 2020. All patients irrespective of gender, aged above 18 years of age, who had chest pain or tightness radiating to the arms or shoulders, had shortness of breath, sweating or dizziness underwent an electrocardiogram (ECG) followed by coronary angiography in a catheterization lab were recruited in the study. Patients with a congenital heart disease or familial hyperlipidemia were excluded from the study. Lipid profiles were assessed by the principal author and were recorded in a predefined pro forma.
 Results: The mean (SD) age of the subjects was 55.12 ± 9.93 years. A significant association of increasing TG/HDL ratio was observed with the severity of the illness (p<0.0001). The mean TG/HDL ratio was considerably varied in patients with mild to moderate, moderate to severe, and very severe disease from the control group and in the mean TG/HDL ratio of patients with mild to moderate from very severe disease patients (p<0.05).
 Conclusion: The current study indicates a strong association of triglyceride to HDL-c ratio with severity of CAD. We recommend that TG/HDL ratio should be determined for CAD patients to assess the severity of CAD in addition to other lipoprotein products.

ASSESSMENT OF TRIGLYCERIDE TO HIGH-DENSITY LIPOPROTEIN RATIO AS AN INDICATOR OF CORONARY ARTERY DISEASE AND ITS SEVERITY

Objectives: To evaluate the TG/HDL ratio test as a diagnostic tool for assessing the severity of CAD. Methodology: This was a validation study conducted at the Indus Hospital, Karachi between March 2019 and March 2020. All patients irrespective of gender, aged above 18 years of age, who had chest pain or tightness radiating to the arms or shoulders, had shortness of breath, sweating or dizziness underwent an electrocardiogram (ECG) followed by coronary angiography in a catheterization lab were recruited in the study. Patients with a congenital heart disease or familial hyperlipidemia were excluded from the study. Lipid profiles were assessed by the principal author and were recorded in a predefined pro forma. Results: The mean (SD) age of the subjects was 55.12 ± 9.93 years. A significant association of increasing TG/HDL ratio was observed with the severity of the illness (p<0.0001). The mean TG/HDL ratio was considerably varied in patients with mild to moderate, moderate to severe, and very severe disease from the control group and in the mean TG/HDL ratio of patients with mild to moderate from very severe disease patients (p<0.05). Conclusion: The current study indicates a strong association of triglyceride to HDL-c ratio with severity of CAD. We recommend that TG/HDL ratio should be determined for CAD patients to assess the severity of CAD in addition to other lipoprotein products.

Corrigendum to: A Review on Lung Cancer Diagnosis Using Data Mining Algorithms.

Due to an oversight of the author, the principal author's name was published incorrectly in the author list and in the Fig. (3): Shakeel et al. (2019) have been changed to Shakeel et al. (2020) and Palani and Venkata-lakshmi (2019) have been changed to Palani and Venkatalakshmi (2018) in the article entitled "A Review on Lung Cancer Diagnosis Using Data Mining Algorithms" in "Current Medical Imaging", 2021; 17(1), [1]. The original article can be found online at https://www.eurekaselect.com/183148/article.

Why Orthopedic Surgery for Elderly Indicates that the Maryland Total Cost of Care Model should be Universally Adopted

Arthritis is the disease that kills the fewest but cripples the most. With the aging of the population in the United States and the antiquated DRG reimbursement system for hospital surgical intervention, it is inevitable that the Medicare assistant will bankrupt itself prior to the proposed bankruptcy date of 2026 if changes are not made. It may change would be to insist that the system in Maryland for reimbursement to hospitals for essential joint replacement surgery of the elderly be adapted nationwide.

State of the art: a forty-year reflection on the Spanish language preparation of Spanish-English bilingual-dual language teachers in the U.S.

ABSTRACT This state-of-the-art paper is centered on bilingual education teachers’ linguistic qualifications with special reference to Spanish competencies needed to meet the needs of emergent bilingual education learners in the U.S. The paper spans over a forty-year period drawing on the experiences and related publications of the principal author beginning in the mid 1980s and up to the present. In doing so, key themes, questions and challenges related to the special issue are highlighted based on the series of publications from 1993 to 2020. Insights into the ways language ideologies and politics of bilingual education teacher preparation entities undermine this need are addressed. Drawing on language education policy planning, the author then offers three paths forward given that not much progress has been made since the inception of bilingual education in the U.S. with regard to the preparation of linguistically qualified bilingual education teachers with specific reference to their Spanish competency.

Book Review

Haematologica Atlas of Hematologic Cytology. Invernizzi, R. (Principal Author) and Balduini, CL. (Editor). Pavia: Ferrata-Storti Foundation, 2020. The Ferrata-Storti Foundation has celebrated 100 years of the journal Haematologica with the publication of this atlas. In addition to the principal author, Rosangela Invernizzi, there are 16 contributing authors. Most authors are from Italy, specifically from Pavia and Milan, with two from Sweden, one from the USA and one from Brazil. The atlas celebrates not only this significant anniversary, but also the continuing relevance of microscopy in the age of molecular medicine. It also shows the strength of morphological diagnosis in Lombardy. The Atlas is, of course, very well illustrated (800 colour illustrations) and, apart from some typographical errors, the text is accurate and comprehensive. Bone marrow aspirates are covered as well as the peripheral blood, but trephine biopsy sections are not included. Do I have any reservations? Not with regard to the content, which is excellent, but I think a hardback version would be better than softback for a book that will be used in laboratories. Such books rapidly become quite battered. I also have a personal prejudice against the use of American spelling and terminology in a European publication. This seems a very good way to celebrate the anniversary of a journal. The Atlas is available electronically free of charge (http://digital.haematologica.org/wp-content/uploads/flipbook/48/book.html), but laboratories would benefit from purchasing the printed version and having it on their shelves for ready reference. It is available at a remarkably reasonable cost.

László Gozmány’s annotated essay on the history of Hungarian lepidopterology published in 1949

In 1949, the American Lepidopterists’ Society published an essay of nine entries on the history of Hungarian lepidopterology. The principal author of the short paper was the young, 28 years old Dr. László Gozmány. Access of the essay is difficult as early volumes of the News of the Lepidopterists’ Society are rare in libraries and not available on the world-wide-web. The original essay is reproduced here with 38 supplementary annotations giving more historical clarity. The article is a tribute to Dr. László Gozmány on the occasion of the 100th anniversary of his birth. With one figure.

Emergence and Development of Wh-questions in Jordanian Arabic-speaking Children: A Longitudinal Study

The main objective of this paper is to examine the emergence and development of wh-questions in two Jordanian Arabic-speaking pre-school children. Specifically, it investigates (1) how these children interact with wh-questions; which questions they find easier and thus earlier to acquire and why, and finally (2) what symptoms one can identify as characteristics of the intra-stage development of such questions. The data of the study are a subset of a large body of a longitudinal audio-taped corpus collected by the principal author, who happened to be a psycholinguist and the children’s grandparent, on the basis of three-day, weekly sessions over a period of five years. The recordings were made in the family home environment during routine activities, mainly after dinner, and mostly in the presence of family members. The findings reveal the acquisition of wh-questions is a complex process that supports a general cognitive maturity model interpretation. The acquisition of wh-questions that ask about concrete objects/entities, that is mi:n ‘who’, we:n ‘where’ and ʔe:ʃ/ʃu: ‘what’ are produced and developed at an earlier stage than those questions which ask about abstract objects/entities, that is le:ʃ ‘why’, ke:f ‘how’, ɡadde:ʃ/kam ‘how many/much’ and wakte:ʃ/ʔe:mta ‘when’. However, the subjects do not find the questions within each of the two sets equally easy/difficult. Put differently, in the first category, mi:n ranked first on the easy/difficult scale while ʔe:ʃ/ʃu: ranked third. Moreover, the order of acquisition in the second category suggested that it is easier for Jordanian Arabic-speaking children to ask about reason (le:ʃ-why) than about time (wakte:ʃ-when) and that to ask about quantity (ɡadde:ʃ/kam-how many/much) is more difficult than to ask about manner (ke:f-how). The study argues that the emergence of wh-words does not mark but the onset of an accumulative process which includes a host of symptoms on the way to adult-like acquisition.