Browse publications by year: 2021

  1. Paul BT, Hashi HA, Burhannuddin NN, Chung ELT, Jesse FFA, Lila MAM, et al.
    Trop Life Sci Res, 2021 Jun;32(2):83-96.
    PMID: 34367516 DOI: 10.21315/tlsr2021.32.2.6
    Caprine arthritis-encephalitis virus (CAEV) is a member of the genus lentivirus causing caprine arthritis-encephalitis (CAE), a chronic inflammatory condition affecting the lungs, joints, udder and central nervous system of small ruminants such as sheep and goats. CAE is distributed worldwide and is recognised as a significant cause of morbidity and decreased milk production in dairy goats. Earlier studies highlighted the clinicopathological features and supplied preliminary serological evidence for the existence of CAE among selected goat herds in Malaysia. Therefore, this study aims to provide further insights into the seroprevalence and contributing factors of CAE among sheep and goat herds in two states of Peninsular Malaysia. The blood samples and biodata were randomly collected from a total of 262 individual sheep (40) and goat (222) in seven smallholder farms. Blood sera were tested for specific anti-CAEV antibodies using Qayee-Bio CAEV sandwich-ELISA test kits according to standard procedures. Our results of the study revealed 21.4% (95% CI: 15.8-28.6) apparent and 20.6% (95% CI: 14.5-27.8) true seroprevalence with significant differences (p < 0.05) in seroconversion rates between the states, farms, production systems and breeds of small ruminants. The prevalence of CAE in the Malaysian Peninsular is a potential threat to the small ruminant industry and developing agricultural economy. Further studies are required to determine the genetic characteristics, distribution and risk factors of CAEV for effective prevention and control in Malaysia.
  2. Atmaja PSP, Bengen DG, Madduppa HH
    Trop Life Sci Res, 2021 Jun;32(2):97-119.
    PMID: 34367517 DOI: 10.21315/tlsr2021.32.2.7
    Epiphytes as the important features in the seagrass ecosystems have been studied widely, and their functions as a primary producer, influence rates of herbivory grazer, and prevent seagrass leaf from desiccation is well known. However, patterns and distribution among seagrasses especially in Indonesia, which was known as hotspot marine biodiversity is not well understood. Therefore, this study aimed to examined epiphytic assemblages on two seagrass species with different morphological and longevity, Enhalus acoroides and Cymodocea rotundata, in two different meadows (conservation area and non-conservation area) in Lesser Sunda Islands (Bali and Lombok). A total of 22 taxa of microalgae epiphytes species were identified from eight sites and 2 different species of seagrass. The highest number of collected species between class was from Bacillariophyceae (18), followed by Cyanophyceae (3) and Fragilariophyceae (1). Analysis of similarity (ANOSIM) revealed a significant difference of microalgae epiphytes assemblages between sites and seagrasses. Epiphytes assemblages in conservation area were more abundant than non-conservation area, both in Bali and Lombok. On seagrass comparison, Enhalus acoroides showed higher abundance of epiphytes assemblages than those on Cymodocea rotundata. Based on principal component analysis (PCA), this study highlights the microalgae epiphytic communities strongly influenced by seawater temperature, phosphate's concentration, and pH in sediment. This study also demonstrated that the assemblages of microalgae epiphytic communities affected by differences of seagrass morphological and longevity.
  3. Patano RR, Abales JM, Bajuyo EJ, Magtulis ABR, Mendez RA, Hinampas RT
    Trop Life Sci Res, 2021 Jun;32(2):121-132.
    PMID: 34367518 DOI: 10.21315/tlsr2021.32.2.8
    Scale structure and reflectance activity of a Mindanao endemic weevil from the genus Metapocyrtus has been studied for the first time. Specimens of Metapocyrtus apoensis Schultze, 1925 were collected through opportunistic sampling in Mount Calayo, Musuan, Mindanao, Philippines last February 2020. A total of three individuals of the species were collected all in lower dipterocarp forest with elevation of 500 masl-600 masl. Three specimens were then examined under Scanning Electron Microscopy with Energy Dispersive X-Ray (SEM_EDX) to analyse its scale structures and reflectance activity. The study provides new locality record of the Mindanao endemic species first in Bukidnon region and an updated distribution in Mindanao based on recent published articles and museum collections. The species inhabits wide ranges of habitat types that greatly differ in elevation and vegetation. Examination of scale's structure through SEM revealed that M. apoensis scales are 50 μm-70 μm in diameter which are almost circular in shape, slightly convex with rough like surface which is termed as non-ordered nipple-like structure. The scales' shape and surface structure clearly differ from other genera of curculionids based on published articles. Analysis of the particles on the weevil's elytra done by EDX reveals several elements that contribute to its iridescence. Major elements such as carbon (42.3%), oxygen (27.7%) and nitrogen (15.1%) come in relatively high atomic concentrations. Microspectrometer revealed a peak reflectance wavelength of about 569.7 nm. This explains the yellow-green iridescence observed on the dorsal side of the weevil. The concentration of the scale in pits serves for protection, intraspecific recognition and camouflage. Despite of widespread distribution and high abundance of this species in Mindanao, anthropogenic disturbances such as agricultural activities are on-going which extend towards their microhabitat. Monitoring to its population is recommended as the species is restricted only in Mindanao.
  4. Shaari AL, Che Sa SN, Surif M, Zolkarnain N, Ghazali R
    Trop Life Sci Res, 2021 Jun;32(2):133-146.
    PMID: 34367519 DOI: 10.21315/tlsr2021.32.2.9
    Leachate from landfill contains concentrated nutrients that may enter the terrestrial and aquatic environment, including nearby coastal areas. The nutrient contaminants eventually bring harm to marine organisms, including microalgae. This study was performed to investigate the growth of two green microalgal species, i.e. Chlorella sp. and Nannochloropsis sp. in diluted landfill leachate. Besides, the ability of nutrient removal by these microalgal was also explored from the changes of chemical oxygen demand (COD) and nutrients content. The initial and final concentrations of COD, NH3-N, and PO4 3- in the diluted leachate (5%, 10% and 15%) were measured and the growth patterns of these species were determined by counting the cell numbers for 12 days. Comparison of these microalgae showed that the growth rate of Nannochloropsis was significantly higher compared to Chlorella in all leachate concentrations. Leachate at 5% enhanced the growth of both microalgae, while leachates at 10% and 15% decreased their growth as early as at the beginning of the test. It is apparent that the less concentrated leachate discharged into seawater would not pose any toxicity to the environment and would not bear adverse effect to microalgae yet could promote their growth. This study also revealed that the microalgae could remediate leachate pollution by its ability of nutrient removal; thus, leading to the potential application in wastewater bioremediation, including industrial waste and palm oil mill effluent.
  5. Dela Rosa CJO, Lee AC, Rivera WL
    Trop Life Sci Res, 2021 Jun;32(2):147-161.
    PMID: 34367520 DOI: 10.21315/tlsr2021.32.2.10
    Pink pigmented facultative methylotrophic (PPFM) bacteria are ecologically distributed microorganisms. They have been isolated in many types of ecosystems like soil, water, air, in association with plants and even as pathogens in humans. However, a yet unexplored area for PPFM bacteria research is in food. Hence, the objective of this study was to establish the presence of PPFM bacteria in Philippine fermented food, in particular shrimp paste, and characterise them phenotypically and genotypically. A total of 13 PPFM bacteria were obtained from Philippine shrimp paste. Sequencing of the 16S rRNA gene revealed that the PPFM bacterial isolates belong to the genus Methylobacterium. A total of 35 phenotypic characterisations were performed that included morphological, biochemical and physiological tests. Phylogenetic tree was constructed to establish the genetic relatedness of the isolates. Morphological test results showed that all 13 isolates were consistent with the established phenotypic characters of the genus such as pink colony colour, Gram negative and rod-shaped. Biochemically, the use of API® 20 NE tests showed heterogeneity of results and physiological tests exhibited that the isolates are primarily mesophilic and halotolerant, being able to grow at 2% salt. Phylogenetic analysis showed that the isolates are Methylobacterium populi, M. dankookense, M. lusitanum, M. radiotolerans and M. zatmanii. This study confirmed the presence and diversity of PPFM bacteria in Philippine shrimp paste. Further studies are needed to show the functional activity of Methylobacterium in Philippine shrimp paste production.
  6. Saizul Z, Siti-Azrin AH, Zakaria AD, Hassan A, Abdul Rahman WFW, Jalil NAC
    Oman Med J, 2021 Jul;36(4):e284.
    PMID: 34367685 DOI: 10.5001/omj.2021.83
    Objectives: We sought to determine the immunohistochemistry expression of mismatch repair (MMR) and BRAF V600E proteins in sporadic young-onset colorectal cancer (CRC) and their association with clinicopathological features in the Kelantan population.

    Methods: This was a cross-sectional study of sporadic young-onset CRC over 11 years from 1 January 2006 to 31 December 2017 in Kelantan. Formalin-fixed paraffin-embedded tissue blocks were immunohistochemically stained with antibodies for MMR (MLH1, MSH2, MSH6, and PMS2) and BRAF V600E. These expressions were correlated with clinicopathological parameters.

    Results: Our patient sample included 31 patients with a mean age of 31.5 years. More than half (61.3%) of the patients were women. The majority presented with abdominal pain (41.9%), and 71.0% had a tumor located on the right side of the colon, with 83.9% being moderately differentiated adenocarcinoma. The majority of patients presented at stage IV (54.8%). The most frequent pattern was all MMR protein expressions, which constituted patients in the microsatellite stable group (64.5%). Nine (29.0%) were microsatellite instability (MSI-high), and two (6.5%) were MSI-low. Positive BRAF V600E expression was observed in 83.9% of patients. Only histopathological subtypes revealed a significant association with BRAF V600E positive expression (p = 0.015).

    Conclusions: The majority of sporadic young-onset CRC presented with abdominal pain and advanced cancer stage. Most were microsatellite stable, and most cases showed positive expressions in all MMR markers and BRAF V600E by immunohistochemistry method. This finding will pave the way for further research on this disease.

  7. Supahiah P, Bin Ahmad NA, Teh WM, Bt Abd Jalil NF, Md Din N
    Cureus, 2021 Jun;13(6):e16071.
    PMID: 34367742 DOI: 10.7759/cureus.16071
    Trichophyton species is a dermatophytic fungus commonly found in the skin, nails, hair, and other organic matters such as palm trees and soil. We report a rare case of a 23-year-old man who had a penetrating injury to the eye from the leaves of a palm tree and subsequently developed exogenous endophthalmitis. Culture from the vitreous tap revealed Trichophyton sp as the causative organism. Early vitrectomy and adequate intravitreal injection of amphotericin B resulted in good visual outcomes in an otherwise blinding condition. This is the first reported case of exogenous endophthalmitis secondary to Trichophyton species. Early diagnosis and prompt treatment may help improve visual outcomes.
  8. Raj JJ, Kow RY, Ramalingam S, Low CL
    Cureus, 2021 Jul;13(7):e16155.
    PMID: 34367767 DOI: 10.7759/cureus.16155
    Secondary hyperparathyroidism is a complication arising from untreated end-stage renal disease (ESRD). It can invariably lead to osteoporosis and subsequently cause pathological neck of femur (NOF) fracture. Despite being young, osteosynthesis in neck of femur fractures of these patients often leads to nonunion and implant failure due to severely osteoporotic bone. We present our experience in managing three young patients with ESRD and secondary hyperthyroidism who sustained NOF fractures. All three patients were successfully treated and showed no complication at one year post-operation. Based on our experience and literature review, we propose a simple algorithm to guide the management of these patients.
  9. Ghani UHM, Leong JF, Sani MH, Rosli N, Mohd-Haflah NH
    Cureus, 2021 Jul;13(7):e16182.
    PMID: 34367789 DOI: 10.7759/cureus.16182
    Vascular leiomyosarcoma is a rare malignant tumour of the smooth muscle connective tissue. Patients are usually asymptomatic in the early stages and only present when the lesion causes compressive or obstructive effects or has metastasized. We report a case of vascular pleomorphic leiomyosarcoma in a 70-year-old lady with a background history of squamous cell carcinoma of the cervix. She presented with a three-month history of low back pain, which radiated to the anterior bilateral thigh. Initial radiological findings revealed metastatic lesions involving the spine and lungs. Two spinal biopsies done were inconclusive. Increasing severity of pain over the right thigh prompted further imaging, which revealed bilateral femoral lesions. The patient underwent surgery which involved excision of the tumour in the right proximal femur with skeletal reconstruction using megaprosthesis. Proximal femoral nail was performed for the left femur. Intra-operatively, tumour was noted at the anteromedial aspect of the proximal right thigh surrounding the superficial femoral vein. Histopathological report of the right thigh mass finally confirmed a diagnosis of vascular pleomorphic leiomyosarcoma. The patient presented four months later with bilateral pulmonary embolism with deep vein thrombosis in addition to progression of the disease.
  10. Hamdan AM, Al-Chalabi MMM, Wan Sulaiman WA
    Cureus, 2021 Jul;13(7):e16223.
    PMID: 34367823 DOI: 10.7759/cureus.16223
    Extensive soft tissue injuries with exposed joints, bones, and tendons due to trauma of the hand -particularly fingers- necessitate soft tissue reconstruction and coverage. However, these injuries are challenging; therefore, various management options for traumatic skin loss over fingers are widely performed. These options comprise wound care permitting wound contracture without surgical intervention, full or split-thickness skin grafting, skeletal shortening and primary closure, and various types of flaps. We present a case of successfully placed Integra over the exposed phalangeal bones followed by split-thickness skin grafting a few weeks later, with a good outcome. We conclude that Integra is an alternative, safe and effective method for reconstructing severely traumatized fingers with exposed bone, tendon, or joint without sacrificing outcome.
  11. Abd Hamid MR, Wan Hitam WH, Abd Halim S
    Cureus, 2021 Jul;13(7):e16224.
    PMID: 34367824 DOI: 10.7759/cureus.16224
    OBJECTIVE: This study aimed to evaluate the retinal nerve fiber layer (RNFL) thickness and macular thickness in Parkinson's disease (PD) patients.

    METHODS: The present study is a comparative cross-sectional, hospital-based study. A total number of 64 PD patients and 64 controls were recruited. Candidates that fulfilled the criteria with normal ocular examinations were undergone optical coherent tomography (OCT) examinations of the right eye. RNFL and macular thickness were evaluated.

    RESULTS: There was a statistically significant reduction in RNFL thickness in average (adjusted mean 84.32 vs 95.93, p ≤ 0.001), superior (adjusted mean 105.15 vs 118.13, p ≤ 0.010), and inferior (adjusted mean 104.95 vs 126.55, p ≤ 0.001) PD group compared to the control group. The macula thickness also was significantly reduced in average (adjusted mean 266.51 vs 281.34, p = 0.015), central (adjusted mean 236.37 vs 255.55, p = 0.001), outer superior (adjusted mean 269.16 vs 278.19, p = 0.014), outer inferior (adjusted mean 256.34 vs 272.24, p ≤ 0.001), and outer nasal (adjusted mean 287.64 vs 302.84, p = 0.001) PD group compared to the control group. There was a significant positive correlation between RNFL thickness and visual acuity among PD patients in the inferior segment with p = 0.020 and nasal segment with p ≤ 0.001. There was also a significant positive correlation between macular thickness and visual acuity among PD patients in the inner temporal segment with p = 0.006, outer superior segment with p = 0.003, and outer temporal segment with p ≤ 0.001.

    CONCLUSION: The mean of the average, superior, and inferior RNFL thickness was significantly lower in the PD group compared to the control. The mean of the average, central, outer superior, outer inferior, and outer nasal macular thickness was significantly lower in the PD group compared to the control.

  12. Goodson M, McLellan E, Rosli R, Tan MP, Kamaruzzaman S, Robinson L, et al.
    Front Public Health, 2021;9:637484.
    PMID: 34368037 DOI: 10.3389/fpubh.2021.637484
    Background: The number of people living with dementia worldwide is increasing, particularly in low- and middle-income countries (LMICs) where little is known about existing post-diagnostic care and support. This study aimed to better understand healthcare provision for people living with dementia in Malaysia, and to identify priorities for providing timely, quality, and accessible care and support to all. Methods: This is a qualitative interview study on care providers and facilitators (health and community care professionals, paid carers, traditional medicine practitioners, faith healers, community leaders, non-governmental organisations). A topic guide, piloted in Malaysia and peer reviewed by all LMIC partners, elicited the understanding of dementia and dementia care and barriers and facilitators to care for people living with dementia and carers, and perceptions of key priorities for developing efficient, feasible, and sustainable dementia care pathways. Verbatim transcription of audio-recorded interviews was followed by iterative, thematic data analysis. Results: Twenty interviews were conducted (11 healthcare professionals, 4 traditional medicine practitioners, and 5 social support providers). The findings indicate that dementia care and support services exist in Malaysia, but that they are not fully utilised because of variations in infrastructure and facilities across the country. Despite a locally recognised pathway of care being available in an urban area, people with dementia still present to the healthcare system with advanced disease. The interviewees linked this to a public perception that symptoms of dementia, in particular, are normal sequelae of ageing. Earlier detection of dementia is commonly opportunistic when patients present to GPs, government clinic staff, and general physicians with other ailments. Dementia may only be identified by practitioners who have some specialist interest or expertise in it. Workforce factors that hindered early identification and management of dementia included lack of specialists, overburdened clinics, and limited knowledge of dementia and training in guideline use. Post-diagnostic social care was reported to be largely the domain of families, but additional community-based support was reported to be available in some areas. Raising awareness for both the public and medical professionals, prevention, and more support from the government are seen as key priorities to improve dementia management. Conclusions: This qualitative study provides novel insight into the availability, delivery, and use of post-diagnostic care and support in Malaysia from the perspective of care providers. The respondents in this study perceived that while there was a provision for dementia care in the hospital and community settings, the different care sectors are largely unaware of the services each provides. Future work should explore how care provision across different service sectors and providers can be supported to better facilitate patient access and referral between primary, secondary, and social care. The importance of supporting families to understand dementia and its progression, and strategies to help them care for relatives was emphasised. There is also a need for broad workforce training and development, at both the postgraduate and undergraduate levels, as well as improved general awareness in the community to encourage earlier help-seeking for symptoms of dementia. This will enable the use of preventive strategies and access to specialist services to optimise care and quality of life for people living with dementia in Malaysia.
    MeSH terms: Humans; Malaysia; Perception; Quality of Life; Caregivers; General Practitioners*
  13. Dalawi I, Chen XW, Isa MR, Azhar ZI, Mohd Nor F
    Front Public Health, 2021;9:704115.
    PMID: 34368066 DOI: 10.3389/fpubh.2021.704115
    MeSH terms: Humans; Health Knowledge, Attitudes, Practice; Malaysia/epidemiology; Health Literacy*
  14. Syed Annuar SN, Kamaludin NF, Awang N, Chan KM
    Front Chem, 2021;9:657599.
    PMID: 34368075 DOI: 10.3389/fchem.2021.657599
    Organotin(IV) compounds have wide applications in industrial and agricultural fields owing to their ability to act as poly(vinyl chloride) stabilizers and catalytic agents as well as their medicinal properties. Moreover, organotin(IV) compounds may have applications as antitumor, anti-inflammatory, antifungal, or antimicrobial agents based on the observation of synergistic effects following the binding of their respective ligands, resulting in the enhancement of their biological activities. In this review, we describe the antiproliferative activities of organotin(IV) compounds in various human cancer cell lines based on different types of ligands. We also discuss the molecular mechanisms through which organotin(IV) compounds induce cell death via apoptosis through the mitochondrial intrinsic pathway. Finally, we present the mechanisms of cell cycle arrest induced by organotin(IV) compounds. Our report provides a basis for studies of the antitumor activities of organotin(IV) compounds and highlights the potential applications of these compounds as anticancer metallodrugs with low toxicity and few side effects.
  15. Rajiah K, Maharajan MK, Ramaya H, Wan Ab Rahman WNA
    Front Med (Lausanne), 2021;8:617147.
    PMID: 34368172 DOI: 10.3389/fmed.2021.617147
    Introduction: Administration of psychotropic pro re nata (PRN) medications is influenced by diverse factors such as legal use of PRN medications, the attitude of patients, personal bias, and stigma toward such medication use. While PRN prescriptions increase the efficiency of care and encourage patients to participate in self-care, the use of psychotropic PRN medications by outpatients has raised concerns about its risks of harm, especially for the outpatients. This study explored the use of psychotropic PRN medications by patients attending the outpatient clinic in a hospital. Methods: Qualitative in-depth interviews were conducted. Purposeful sampling was done to achieve cases with enriched information. Participants were chosen regardless of their ethnicity and were selected using the database and patient records in the clinic. Patients 18 years of age prescribed PRN psychotropic medications attending outpatient clinics in a hospital were included. Vulnerable patients (e.g., pregnant ladies, prisoners, cognitively impaired individual, AIDS/HIV subjects, and terminally ill subjects) were excluded. Results: This study revealed the patients' perspectives and experiences on self-management of psychotropic PRN medications. The themes that emerged were clustered as education and background, knowledge on psychotropic medications, frequency of medication intake, underuse of medication, the overdose of medication, side effects concern, source of information, and personal experience. Conclusions: Patients' understanding of medication, inappropriate medication use, cues to action, and use of alternatives are the factors that affected the self-management of psychotropic PRN medications by the patients.
  16. C Thambiah S, Lai LC
    Pract Lab Med, 2021 Aug;26:e00248.
    PMID: 34368411 DOI: 10.1016/j.plabm.2021.e00248
    Diabetes mellitus (DM) is an escalating pandemic and an established cardiovascular risk factor. An important aspect of the interaction between DM and atherosclerotic cardiovascular disease (ASCVD) is diabetic dyslipidaemia, an atherogenic dyslipidaemia encompassing quantitative [hypertriglyceridaemia (hyperTG) and decreased high density lipoprotein cholesterol (HDL)] and qualitative [increased small dense low density lipoprotein cholesterol (sdLDL) particles, large very low density lipoprotein cholesterol (VLDL) subfraction (VLDL1) and dysfunctional HDL] modifications in lipoproteins. Much of the pathophysiology linking DM and dyslipidaemia has been elucidated. This paper aims to review the pathophysiology and management of diabetic dyslipidaemia with respect to ASCVD. Briefly, the influence of diabetic kidney disease on lipid profile and lipid changes causing type 2 diabetes mellitus are highlighted. Biomarkers of diabetic dyslipidaemia, including novel markers and clinical trials that have demonstrated that non-lipid and lipid lowering therapies can lower cardiovascular risk in diabetics are discussed. The stands of various international guidelines on lipid management in DM are emphasised. It is important to understand the underlying mechanisms of diabetic dyslipidaemia in order to develop new therapeutic strategies against dyslipidaemia and diabetes. The various international guidelines on lipid management can be used to tailor a holistic approach specific to each patient with diabetic dyslipidaemia.
  17. Dahlan M, Bustami MR, Makmur, Mas'ulah S
    Heliyon, 2021 Jul;7(7):e07541.
    PMID: 34368475 DOI: 10.1016/j.heliyon.2021.e07541
    BACKGROUND: The act of worshipping in mosque is often not only considered to be one of the factors causing the transmission of coronavirus disease 2019 (covid-19), but also a contributing factor to health protocol violations. Against this backdrop, the purpose of this paper is to examine the application of the Islamic principle of ḥifẓ al-nafs (protection of life) in the practice of worshipping at the Nurul Iman mosque as it relates to the prevention of transmission of covid-19.

    METHODS: This research uses a sociology of law perspective to the connection and the dynamics between the adoption of the principle of ḥifẓ al-nafs and the implementation of worship at the Nurul Iman mosque. As a case study, the data collection technique used includes interviews, observation, documentation reviews, and triangulation techniques, while the analysis technique used content analysis techniques.

    RESULTS: The application of the principle of ḥifẓ al-nafs (protection of life) in the practices of worship at the Nurul Iman mosque have proven to be in accordance with health protocols and at the same time all members of the mosque congregation have been free from the transmission of covid-19. From an Islamic needs framework perspective, in the context of Covid-19 pandemic, the application of the ḥifẓ al-nafs principle at this mosque is a considered primary necessity (ḍarūriyyāt) in that it protects life while providing spiritual continuity of collective religious worshipping, hence integrating the community together within a health and sanctity of life paradigm during this challenging time. Equally important, this research also challenges the thesis of the direct linkage between worshipping in mosque and Covid-19 transmission.

    CONCLUSION: the application of the principle of ḥifẓ al-nafs in the practices of worship in mosque has demonstrably shown that the congragants levels of health consciousness has increased and that they have also been kept safe. In essence, the effective contextualization of Islamic principle is able to provide the twin benefits of health and spirituality.

  18. Nazir MU, Yasin I, Tat HH
    Heliyon, 2021 Jul;7(7):e07613.
    PMID: 34368481 DOI: 10.1016/j.heliyon.2021.e07613
    This study aims to examine the effect of destination image, perceived risk, and perceived constraints on the behavioral intention of international tourists to revisit Pakistan. The study also seeks to assess the destination image's mediating role in the relationship between perceived risks, perceived constraints, and behavioral intention. A quantitative study with Partial least square structural equation modeling was used to investigate the research Hypothesis. The data was collected from international tourists who were in Pakistan or who had visited Pakistan. The findings revealed that perceived risks and perceived constraints negatively impact destination image and behavioral intention. On the other hand, destination image has a positive impact on behavior. Moreover, the study also proved the mediating effect of destination image among the relations of perceived risks, perceived constraints, and behavioral intention. These findings indicate that sometimes it is difficult for destinations to overcome constraints, so destination managers should provide value-added services for substitutes. A positive destination image can overcome risks and constraints, so destination managers should also promote destinations besides mitigating risks. Literature has discussed the mediating effect of destination image in different contexts. However, studies are scarce investigating destination image's effect in alleviating perceived constraints and perceived risks through negotiation mechanisms.
  19. Dodd S, Fish R, Gorst S, Hall D, Jacobsen P, Kirkham J, et al.
    HRB Open Res, 2021;4:45.
    PMID: 34368618 DOI: 10.12688/hrbopenres.13139.3
    Background: The COMET Initiative promotes the development and use of 'core outcome sets' (COS), agreed standardised sets of outcomes that should be measured and reported in all studies in a particular clinical condition. COS are determined by consensus amongst key stakeholders, including health professionals, policymakers and patients, ensuring that the priorities and expertise of these representatives inform the choice of the most important outcomes to measure for a given condition. There is increased recognition of the need to integrate COS across the healthcare system and with existing regulatory apparatus, to ensure that outcomes being recorded are those of key relevance to important stakeholders. The aim of this study is to assess the degree of concordance between outcomes recommended in COS for research and in guidance provided by two key regulators: US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Methods: COS for research published during 2015-2019 with patient involvement and covering drug or device interventions will be compared against relevant regulatory guidelines, matched by condition. Guidance documents matching in scope (relating to intervention and population) to a COS for research will be scrutinised to identify all suggested outcomes for comparison against the core outcomes in the corresponding COS. Discussion: This study will identify variation between outcomes suggested in FDA and EMA regulatory guidance relative to outcomes included in published COS for research, thus demonstrating the degree of representation of COS in regulatory guidance and vice versa. We will share the study findings (in particular, highlighting any lack of concordance between COS and regulatory guidance overall or for particular disease areas) and will invite feedback from FDA and EMA; we will seek to highlight where findings support the recommendations towards using well-developed COS or will make recommendations to COS developers on outcomes of importance to these key regulators.
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