Western Countries Research Articles

Inter-ethnic heterogeneity in valvular morphology and aortopathy of a worldwide bicuspid aortic valve cohort referred for TAVR

Abstract Background Bicuspid aortic valve (BAV) represents one of the most common congenital heart disease. BAV stenosis tipycally occurs in younger, low-surgical risk patients compared to tricuspid aortic valves (TAV). With the predicted expansion of trans-catheter aortic valve replacement (TAVR) into lower-risk patients, the proportion of BAV is expected to rise. Although some observational studies have investigated the characteristics of Asian versus European patients with BAV undergoing TAVR, little is known about the inter-ethnic differences within the large and diverse Asian, African, Russian, and Caucasian population. Purpose To evaluate the inter-ethnic differences of aortic valve morphology, annular size and associated aortopathy, in a worldwide population of patients with severe aortic stenosis referred for TAVR. Methods Cardiovascular multislice computed tomography data of patients with severe aortic valve stenosis referred for TAVR worldwide were obtained from the database of the Meril Life Core Lab. Inter-ethnic and epidemiological differences in terms of valvular phenotype, annular size and aortic morphology were evaluated with particular focus on patients with BAV. Results Among 12,712 patients (59% male), n=3,203 subjects (25%) exhibited a BAV morphology. According to the Siever’s BAV classification, type 1 (71%, n=2,284) was the most prevalent BAV morphology and particularly Type 1a was the most common in almost all population, with 26% exhibiting a type 0 BAV, while only 3% of the patients (n= 92) had a type 2 (Table 1). A significantly higher prevalence of severe calcium score (>1000 mm3) was found in patients with BAV compared with patients exhibiting a TAV morphology (51% vs. 32, p<0.01). Additionally, larger ascending aorta (AA) diameter (AA >40 mm) (BAV: 31% vs TAV 7%, p = 0.04), along with a higher prevalence of horizontal aorta (HA) (BAV: 20% vs TAV: 9%, p<0.01) was found in patients with BAV compared with TAV. As for inter-ethnic characteristics, there was a higher prevalence of BAV in Indian and Asian Pacific populations (respectively 43% and 28%), with the African population exhibiting the lowest prevalence (7%, n= 28, p=0.02) (Table 2). In Indian patients a higher prevalence of BAV was found in an earlier age (61-70 years old) compared to Western countries (p=0.05). Finally, smaller annular size (456±98 mm2 vs 584±99 mm2, p<0.01) and lower coronary ostia height (Asia and India: RCA 14.5±3 mm, LCA 14±2.9mm vs Caucasian and Russian: RCA 16±3.2 mm, LCA 16.9±3.3mm; p<0.01) were found in the Asian and Indian population when compared with Russian, African and Caucasian subjects. Conclusions BAV morphology, aortopathy and annular size resulted widely heterogenous according to the ethnicity and geographical origin of patients referred for TAVR worldwide. These features may lead different therapeutical decision making and outcomes following TAVR in patients with BAV.Table 1Table 2

Healthcare resource utilisation and cost of care of systemic inflammation in individuals with atherosclerotic cardiovascular disease and chronic kidney disease

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is a chronic disease, progressed by localised or systemic inflammation (SI). Chronic kidney disease (CKD) facilitates the presence of SI and is associated with an increased risk of ASCVD. Previous studies have estimated that 1–2% of the population in Western countries suffer from both conditions. Purpose To investigates the healthcare costs and resource utilisation for individuals diagnosed with ASCVD and CKD, with or without SI. Method The study applied data from the Danish national health and administrative registries from 1994-2022. Patients with ASCVD were identified by ICD-10 codes. CKD was identified by eGFR [15-59mL/min/1.73m2], in the Register of Laboratory Results for Research (RLRR). The latter date of diagnosis of the two diseases were used as index date. CRP-test results were extracted from RLRR. Individuals with conditions associated with CRP-levels and tests observed in association with CVD events or antibiotic/antiviral drug use were excluded. Individuals with at least two valid CRP tests were included. If two CRP-test results ≥2mg/L to <20mg/L were observed less than six month apart, and within two years of index, the individuals were classified to have SI. Individuals diagnosed in the first year of available eGFR were excluded to ensure only incident individuals in the study. Outcomes included costs and use of inpatient (duration ≥12h) and outpatient (<12h) hospital care, cost of primary care and prescription drugs (adjusted to 2022 currency). Results were derived using linear regression models. Results A total of 19,162 individuals’ incident between 2012-2022 were identified – 68% had SI. SI individuals had higher healthcare costs from five years before to three years after index. Individuals generated a total healthcare cost of EUR 69,554 (SI) and EUR 39,540 (no SI) in the study period (difference EUR 30,014, p<0.001). In adjusted analysis, the attributable cost in the three years following index was 1.4 times higher for individuals with SI, compared to individuals with no SI (difference EUR 12,922, p<0.001). Inpatient care accounted for 85% of the cost. SI individuals had significantly more inpatient hospital contacts from four years before to five years after index (7 attributable contacts total, 4.7 attributable contacts after index, 1.2 times more, p<0.001), and more outpatient contacts from five years before to three years after index (6.2 attributable contacts total, 2.3 attributable contacts after index, 1.3 times more, p<0.001). The largest difference was found in the year following index, where the difference was EUR 7,666 (1.5 times higher, p<0.001) cost, 1.5 (1.3 times higher, p<0.001) inpatient hospital contacts, and 1.1 (1.3 times higher, p<0.001) outpatient hospital contacts (adjusted estimates). Conclusion Individuals with SI represent a significant burden to the healthcare system, both in terms of healthcare cost and healthcare resource utilisation.Total healthcare costsAttributable hospital contacts

Efficacy of Autologous Platelet Rich Plasma For Treatment of Diabetic Foot Ulcer

Background: Diabetic foot ulcer (DFU) is a common complication of long standing uncontrolled diabetes mellitus. There are different types of treatment commonly practiced among the clinicians to treat DFU. Among them, autologous platelet rich plasma (PRP) application is getting popularity day by day throughout the western world. Methodology: It was a prospective, randomized, controlled study that was carried out among 40 DFU patients in the Department of Surgery, Dhaka Medical College Hospital. Among them, 20 patients were treated by autologous PRP and another 20 patients were treated by conventional method. They were followed up for 12 weeks period. Data collected from the participants were analyzed to compare the healing rate among two groups. Result: In PRP treated ulcers, healing rate was significantly faster and better in comparison to conventionally treated ulcers. After 10th weeks follow up, in PRP group 14 ulcers were completely healed whereas in control group,4 ulcers were completely healed. On the contrary, 3 ulcers in control group showed further deterioration. At the end of 12th weeks follow up, 19 ulcers in PRP group were completely healed whereas 13 ulcers in control group were completely healed. In PRP group no patient showed any complication during treatment, whereas in control group 7 patients experienced local complications. Conclusion: Treatment of diabetic foot ulcer with autologous platelet rich plasma results in faster and better ulcer healing in comparison to conventional treatment. PRP accelerates the healing rate and keep the ulcer area safe from external pathogens. Hence, autologous PRP is a better selection for DFU treatment. J Dhaka Med Coll. 2023; 32(1) : 38-42

Netflix and the Transnationalisation of Teen Television

With the renewed popularity of teen television, SVOD services such as Netflix are increasingly investing in the production and distribution of teen series. Netflix is one of the first SVOD service to have adapted the genre outside of the western world. This transnationalisation of teen television is, we argue, infused with the streamer increasing emphasis on diversity. Based on a qualitative analysis of Netflix’s teen series trailers, this contribution explores how the streamer (a) challenges existing televisual conventions and (b) establishes its cultural authority through distinct negotiations of the global and the local. We highlight four dimensions of Netflix’s transnationalisation of teen television and conclude that, more than mere diversification of its catalog, Netflix managed to encapsulate different dimensions of diversity within the teen genre as part, on the one hand of its transnational strategy of expansion, and, on the other hand, its cultural politics.

Disinformation in the EU Law: Moral Theories and the Context

In recent years, there have been scandalous cases of information warfare acts in the Western world committed by hostile foreign governments. The effect of such acts is dramatically amplified by the widespread use of the internet media and ongoing military conflicts. Accordingly, the EU has taken steps in the battle against disinformation. The legal definition of disinformation contains attributes that need further explanation, particularly, lying and deception. Philosophical theories contain valuable insights on the morality of lying and deception, which can be adapted for interpretation of the disinformation concept.

The Role of Future Leader’s Entrepreneurial Orientation in Family Firm Internationalization Process – the Polish Context

Research background: In CEE countries, especially in Poland, research on family entrepreneurship has a shorter tradition than in western countries, mainly due to the fact that most family enterprises were established after 1989 when the political system changed. Among others, the main area of interest for researchers associated with family enterprises is succession, especially areas connected with preparation of the successor, future leader of the company. Purpose of the article: The research problem is to identify the conditions for the internationalization of family firms, which are associated with the person of a future leader (successor), in particular, those related to the entrepreneurial orientation of the leader. Therefore, the main research question is which and to what extent the dimensions of the leader’s entrepreneurial orientation influence the internationalization of family firms? Research methods: The complexity of the researched topic prompted the use of advanced statistical methods. Therefore, the quantitative analysis was carried out using the SEM-PLS method, i.e. structural equation modeling using the partial least squares method. Main findings: The dimensions that influence the internationalization are the pro-activity of the leader, the tendency of the leader to risk and the competitive aggression of the leader. Pro-activity of the leader in almost 20% affects the speed/pace of the internationalization of the family firm. This effect is enhanced by the presence of external managers. Future leader tendency towards risk and competitive aggression in almost 20% of every dimension affect the international achievements of a family firm.

Statistical analysis of total hip arthroplasty at rural hospital in Maharashtra under MJPJAY: a prospective study

Background: Total hip arthroplasty (THA) is one of the most common orthopedic surgeries globally, particularly in Western countries. In India, its prevalence has increased over the last two decades. However, most data on THA are from Europe and the United States. This study analyzes the clinical and demographic characteristics of patients undergoing uncemented THA at a rural hospital in Maharashtra, India, under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY). Methods: A prospective study was conducted in the Department of Orthopedics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, from January 2020 to October 2022. A total of 123 patients (130 hips) who underwent uncemented THA, were included. Patients were categorized by age, gender, and primary indication for surgery. Preoperative evaluations, radiographic analysis, and postoperative follow-ups assessment of pain, range of motion, and complications were done. Results: The mean age of patients was 40.32±12.53 years, with males (85.36%) outnumbering females (14.64%). Bilateral hip involvement was seen in 56.9% of cases and osteonecrosis of the femoral head was the most common indication (89.23%), with 57.6% idiopathic, 12.3% alcohol-related and 6.1% steroid-induced. The complication rate was 3.8%, with dislocation being the most frequent (2.1%). Revision surgeries performed in 2.1% of cases. Conclusions: THA under MJPJAY demonstrates comparable clinical outcomes to international standards. Idiopathic osteonecrosis remains the leading cause, with a male predominance. Standardized protocols for the Indian population are needed.

Understanding the influence of children’s mental health, cognitive development, and environmental factors on learning outcomes in Chile

Mental health, cognitive development, and social background are related to educational success. While growing evidence is available in cultural settings other than Western countries, more knowledge is needed, especially regarding interactions among these dimensions. Rather than studying isolated factors, we propose an integrated approach to consider the diverse interrelated dimensions influencing children’s learning. Life course theory supports this approach underlying the role of early events in subsequent life paths and the multidisciplinary nature of these events. The sample consisted of 610 children (49.1% male) attending first grade. The children completed reading, mathematics, and visuospatial working memory (VWM) assessments. Parents completed the Strengths and Difficulties Questionnaire (SDQ-P) and reported their demographic information. A multilevel path model was estimated, including direct relationships between (i) children’s socioemotional behavior (SEB) and learning, (ii) VWM and learning, and (iii) SEB and VWM. The effects of sex and maternal education were also controlled. School and student level variances were modeled. At the school level, VWM, reading, and mathematics have variance, whereas SEB does not. At the student level, VWM, SEB, and maternal education have significant and differential effects on learning. Hyperactivity and peer problems were negatively related to reading and mathematics, while emotional problems were not, and conduct problems exhibited mixed results. These results reinforce developmental life course approaches, that is, from the beginning of schooling, promoting positive mental health can improve children’s learning outcomes.

The Impact of the Russia-Ukraine Conflict on Global Economic Stability and Political Security

The conflict between Russia and Ukraine has emerged as a significant geopolitical tension, with far-reaching implications for global stability and security. This paper intends to study the impact of the war on the worlds and regional economic development and political stability, and achieve some findings that may trigger further policy considerations in mitigating challenges and issues imposed by the war. Through literature reviews and comparison analysis, the findings reveal economic, political, and security consequences of the conflict. The disruption of trade flows, economic sanctions, and uncertainty have impacted both Russia and Ukraine, as well as the wider region and the world. Energy security concerns and shifts in military alliances have added to the complexity of the conflict. The expansion of NATO and increased rivalries between Russia and Western countries have further heightened tensions. Based on the findings, the paper concludes that the Russia-Ukraine conflict poses a significant threat to global economic stability and political security. It emphasizes the need for a multilateral approach to address the conflict and promote peace and stability in the region. Ceasefire agreements, humanitarian assistance, and reconstruction efforts are crucial steps towards long-term peace and development. The paper highlights the importance of prioritizing diplomatic solutions over short-term gains from the conflict. In summary, this paper intends to explore the implications of the Russia-Ukraine conflict on global stability and security, with findings that underscore the need for international cooperation and concerted efforts to mitigate the consequences of the conflict and foster a peaceful resolution.

A retrospective analysis of syphilis cases with a focus on otolaryngology at a university hospital

ObjectivesIn recent years, there has been a notable increase in syphilis cases in Japan and Western countries. Syphilis, a classic sexually transmitted disease caused by treponemas, presents diagnostic challenges due to its diverse clinical manifestations. This study explores the diagnosis of syphilis in patients treated at our hospital. MethodsWe retrospectively reviewed patients who visited our hospital between April 2015 and March 2024. The review focused on the patients' clinical backgrounds, onset times, symptoms, diagnostic processes, and clinical courses. ResultsOur hospital had 45 cases of syphilis. Forty-five cases of syphilis were diagnosed as syphilis in our hospital (13 cases were diagnosed in the Otolaryngology: ENT department). The median age was 40 years, with a significant male predominance (male-to-female ratio of 34:11). The median duration from the onset of subjective symptoms to syphilis diagnosis was 54 days. The timeframe from the initial clinic visit to diagnosis ranged from 1 to 57 days, with a median of nine days. Notably, 47.5% of the patients reported a history of employment or patronage in the sex industry. 73.3% of patients presented to local clinics with any kind of subjective symptoms, but syphilis was often missed in the differential diagnosis. Patients visiting the ENT department were referred to our hospital with a diagnosis of persistent oral ulcer, oropharyngeal carcinoma and neck lymphadenopathy. Histological and cytological evaluation was performed in 33% of patients, but the diagnosis was often difficult to make. Additionally, some patients initially denied using sex services at their first visit but later disclosed this during subsequent visits to the Department of Infectious Diseases, highlighting the critical role of thorough medical history assessments. ConclusionDiagnosing syphilis can be challenging unless the physician specifically suspects it. It is crucial to consider syphilis in cases of pharyngeal mucosal inflammation and neck lymphadenopathy. This study highlights the need for heightened awareness and education regarding the signs and symptoms of syphilis, particularly oropharyngeal and skin findings, to ensure timely diagnosis and treatment.

Kuwaiti Teachers’ Classroom Behavior Management Practices, Experiences, and Beliefs

Recent statistics suggest that student externalizing behaviors are increasing in Western and Asian countries; however, there is a paucity of research on teachers’ perspectives of these behaviors in Middle Eastern countries. A mixed-methods research design was used to investigate Kuwaiti public elementary and middle school teachers’ perceptions of their classroom behavior management (CBM) experiences, including their (a) academic preparation; (b) use of CBM practices to support students with externalizing behaviors; (c) observations of student externalizing behaviors; and (d) perceptions on administrative support and family involvement. Participants included 2,140 general and special education teachers randomly recruited from 45 schools. Results indicated that fewer than half of the teachers surveyed had prior instruction in CBM, reported using a wide variety of CBM practices in response to student behavior problems, and perceived higher levels of administrative support than family involvement. Implications of the study’s findings and suggestions for further research were discussed

Application of the One Health Surveillance (OHS) Matrix to Evaluate the Disease Surveillance Systems in Gujarat, India: A Policy Content Analysis.

An effective disease surveillance system can detect outbreaks of emerging zoonotic diseases early and allow the system to respond immediately and control the epidemic. Gujarat is a western Indian state with a population of more than 65million humans and 26million livestock, and it has the respective surveillance systems under the Department of Health & Family Welfare for humans and the Department of Animal Husbandry for animals. A veterinarian is placed on establishing cross-sectoral collaborations between these systems, but the joint collaborative activities and their effect on the early warning response are least understood. This provides an opportunity to conduct a secondary policy content analysis study using the One Health Surveillance Matrix (OHSM). The aim of this study was to evaluate the level of collaboration among human-animal disease surveillance systems for zoonotic disease in Gujarat, India. This study findings highlight a few gaps in the human health surveillance system, such as data sharing, sampling, outreach to decision-makers, and external communication, while the animal health surveillance system exhibits deficiencies in the data dissemination to decision-makers, management and storage of data analysis, interpretation of data, and external communication as per the OHSM evaluation. Despite major differences, there is a possibility of developing the One Health Surveillance system in Gujarat, India which is profoundly documented in this study.

“You forgot Poland?” Polish involvement in the Iraq war and its aftermath through a postcolonial lens

ABSTRACT This article examines Polish participation in the Iraq war (2003–2008) and its aftermath through a postcolonial lens within the context of Warsaw’s foreign policy choices in the post-Cold War era. After the fall of communism, Poland attempted to join “core” Western countries and institutions, while simultaneously distancing itself from the countries of the “periphery”. The article argues that Poland has operated in a liminal space during the Iraq war and its aftermath as it has been treated as an “internal other” of the West, and at the same time has “othered” the Iraqi periphery. The article does this by applying three key postcolonial theories to the case study: Said’s concept of orientalism, Coronil’s concept of occidentalism and Spivak’s ideas related to the subaltern. The article finds the following to be true: (a) Poland has been orientalised by core Western states while it has also orientalised the Iraqi and Middle Eastern periphery, (b) Poland has generally been a willing participant of occidentalist strategies concerning Iraq and the Middle East and (c) Western core states have attempted to speak for/silence Poland while Poland has spoken for/silenced the Iraqi/Middle Eastern periphery.

Developing Sidewalk Assessment Tool: Towards Evaluation of Pedestrian Environment in Urban Areas

Streets are one of the important means of transportation where sidewalks are one of their integral parts of which pedestrians are prime users. To plan for qualitative environment for pedestrians, existing sidewalk situations need to be assessed. In western countries several tools and models are developed for evaluation of sidewalks. However, most of these tools have neglected the importance of considering pedestrians’ perception in assessing Pedestrian Level of Service (PLOS) of sidewalks. A more accurate and sensitive tool would incorporate and account for the planning or improving of existing pedestrian environments in any city. The aim is to develop sidewalk assessment tool for evaluation of existing sidewalk environment from level of pedestrians’ satisfaction. This tool will help the municipal authorities to identify the sidewalk attributes that need to be measured, how to measure them and, finally, incorporating them into an appropriate assessment framework. The result of the study is interpreted in terms of Pedestrian Satisfaction Index defining PLOS and it contributes in identifying shortcomings of sidewalk attributes from pedestrians’ perspective.

Can Religious Modest Dress be Included in the Feminist Project

In 2009, Nicolas Sarkozy, the former French president, claimed that the burqa was not a symbol of faith but rather a sign of enslavement, and was therefore unwelcome in French society (La Fornara, 2018). Feminism aims to free women from any such ‘enslavement’ that would act as a barrier to gender equality. Nevertheless, the intersectional injustices that impact religious women make this debate more complicated than what Sarkozy suggested. This essay will therefore explore the ethical significance of religious modest dress, and advocate for its compatibility with the feminist project. This will be achieved through focusing on Jewish and Muslim women, living as minoritised groups in Western countries. While religious patriarchal structures seem to contradict the strive for gender equality through dictating how women present themselves, this should not permit the Western world to act as ‘saviours’ and reduce these women to victims. Instead, they should be included in the feminist cause and an effort should be made to truly understand their perspectives in order to strive for a modern world that treats men and women from all backgrounds more equally than it does currently.

Detrimental Industries' Sponsorship in Football Clubs Across Ten Major Leagues from 2000-2022: A Retrospective Study.

Sponsorship of football teams by detrimental industries may negatively impact fans' dietary and behavioral choices. The study aimed to determine the proportion of sponsors on the jerseys of teams in the top ten football leagues that comprise companies producing alcohol or unhealthy food, or engaging in gambling. We conducted a retrospective study, incorporating data from first-division football teams in 10 countries (Argentina, Brazil, England, France, Germany, Italy, Poland, the Netherlands, Spain, and the United States) playing from 2000-2022. Data were collected on the primary sponsors displayed on team jerseys and categorized into alcohol, unhealthy food (defined as producers of ultra-processed food according to the NOVA classification), gambling, or other, based on the nature of the products or services offered by the sponsors. We performed descriptive statistical analyses and multivariate linear regression analyses. A total of 4452 sponsorship records were analyzed. The majority were classified as "other" (81.8%), followed by gambling (6.9%), alcohol (2.6%), and unhealthy food (2.6%). We did not identify any sponsor representing the tobacco industry. The prevalence of gambling sponsors surged from 1.7% in 2000 to 16.3% in 2022. Conversely, alcohol-related sponsorships dwindled from 6.2% in 2000 to 1.0% in 2022. In the multivariate linear regression model, these trends were statistically significant. The alcohol industry remained visible in the Spanish league. A significant proportion of sponsorships on the jerseys of top football teams across the world represents alcohol, ultra-processed food, or the gambling industry. Trends in the types of sponsors on the jerseys of leading football clubs across the Western world are diverse. Particularly concerning is the recent increase in the percentage of clubs sponsored by the gambling industry. To limit the detrimental effects of the promotion of unhealthy products, novel policies should be considered.

Analysing inter-state communication dynamics and roles in the networks of the International Institute of Intellectual Cooperation

The International Institute of Intellectual Cooperation (IIIC) was an international organisation established post-World War I, aimed to foster intellectual relations for global peace. As this institution becomes centenary, the digitisation of archival records has democratised access, sparking renewed scholar interest and eventually enabling new research avenues. Here, we examine two letter collections from IIIC’s digitised funds, focusing on administrative and artistic/literary matters. By analysing recognisable sender-receiver pairs and their geographical origins, we construct networks revealing intricate international relationships. Notably, the community structures and roles differ between administrative and literary exchanges, suggesting distinct communication dynamics. Administrative matters depict a more egalitarian distribution. In contrast, relevant literary correspondents include Western European countries exclusively, reflecting the prominence of certain geocultural areas as well as potential geopolitical influence attempts, challenging the established historical narratives on centres and peripheries, inviting a revaluation of the IIIC’s geographical organisation and intellectual cooperation during the interwar period.

The potential for a union default to convert nonunion workers into union members: The effects of beliefs about unions' consequences, free‐riding and social customs

AbstractUnion density has fallen dramatically in many western European countries over recent decades, with grave implications for unions' strength and legitimacy regarding collective bargaining. Free‐riding remains an ongoing challenge in maintaining union membership levels, as covered nonunion workers generally receive the same collectively bargained terms as union members. To help resolve this problem, we propose a union default that would, as a legal requirement, automatically enrol all workers under coverage as union members in the first instance, but with a subsequent right to opt‐out. We use survey evidence from New Zealand to suggest that nearly half these nonunion workers working for unionised employers would retain membership if defaulted. A default would be effective at converting nonunion workers into union members partly because it would shift the norms of the workplace from nonunion to union, as per social custom theory.

Examining the Relationship Between Student Online Learning Readiness and Their Satisfaction on Distance Learning.

Assessing Student's Online Learning Readiness is among the critical factors that help higher education institutions to achieve their goals. However, majority of these studies were conducted in western countries. Thus, the current research aimed to examine the relationship between Student's Online Learning Readiness (SOLR) constructs and their satisfaction on distance learning in the higher education institutions in the United Arab Emirates (UAE) context. A quantitative research methodology was used to answer the research question. The questionnaire was distributed among 621 students. SPSS software was used to examine the preliminary data, while SmartPLS software was used for the measurement model and hypotheses. Statistical analysis indicated that there was a positive relationship between satisfaction on distance learning and the following constructs of Student Online Learning Readiness: 1) Technical competencies, 2) Communication competencies, and 3) Social competencies with instructor. While there was no relationship between satisfaction and the following constructs of Student Online Learning Readiness: 1) Social competencies with classmates, and 2) Self-directed learning. The findings extended both student e-learning readiness and satisfaction literature, and supported the applicability of western models such as the Student Online Learning Readiness model developed in the United States in higher education institutions in not often examined contexts such as the UAE. Furthermore, the achieved result extended Yu and Richardson’s (2015) model by examining the impact of self-directed learning as additional construct to overcome the limitation of the used model. Concerning contextual contribution, this research is among the first studies to examine this relationship in the UAE context, which can help decision-makers to understand the significance of investment in student experience and the overall role of student's different competencies on achieving outputs such as their satisfaction with distance learning. With regards to managerial implications, this study confirms the need for implementing national level strategy to identify and enhance human capital required competencies and skills which could help students in the short and long term to achieve the required objectives.

Pulmonary arterial hypertension: updates and perspective with newer therapies.

Pulmonary arterial hypertension (PAH) is a rare condition for which a remarkable change has been witnessed in the epidemiology, assessment and treatment landscape over the last three decades. Well-established registries from the Western world have not only highlighted the shift in the epidemiology to an older, more comorbid cohort but have also identified markers of prognosis that have been validated as part of risk stratification scores in multiple cohorts. The emphasis on early identification through a systematic assessment pathway and the option of upfront combination therapy with serial risk stratification assessment has laid the foundation for the standard of care and improved prognosis. This review provides an update on the assessment and newer therapies for PAH.