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"Rao, Sandhya"
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Navigating English language publishing: Challenges faced by Omani Arabic-speaking early career researchers
While English is now the most commonly used language for internationally recognized academic publications, its consequences for non-native English-speaking researchers have yet to be sufficiently documented in the Arabian Gulf. Using Flowerdew’s (2023) framework of ‘globalization of scholarship’ within ERPP (English for Research Publication Purposes), this paper explores the challenges and subsequent strategies used by Omani Arabic-speaking early-career scholars publishing in English language journals. This study is based on the analysis of qualitative data obtained from personal, unstructured interviews with eight Omani researchers in a publicly funded university in Oman to investigate the ways in which Arabic-speaking novice researchers negotiate the pressure to publish in well ranked English language publications by both conforming to established protocol, as well as by asserting their unique linguistic and discourse identity. The findings suggest that early-career scholars value English language publishing as a marker of institutional and professional achievement, but they want better support systems in terms of training and mentoring. Their recommendations to advance academic belonging consist of being involved with international organizations in specific disciplines to become familiar with academic discourse in English, engaging in collaborative writing, and using a journal’s in-house languages services. This study calls for inclusive publication opportunities as well as increased pedagogical support for scholars seeking to belong to the English language academic community.
Journal Article
Language and identity in the Arab world
\"Language and Identity in the Arab World explores the inextricable link between language and identity, referring particularly to the Arab world. Spanning from Indonesia to the United States, the Arab world is here imagined as a continually changing one, with the Arab diaspora asserting its linguistic identity across the world. Crucial questions on transforming linguistic landscapes, the role and implications of migration, the impact of technology on language use are explored by established and emerging scholars in the field of applied and socio-linguistics. The book asks such crucial questions as how language contact affects or transforms identity, how language reflects changing identities among migrant communities, and how language choices contribute to identity construction in social media. As well as appreciating the breadth and scope of the Arab world, this anthology focuses on the transformative role of language within indigenous and migrant communities as they negotiate between their heritage languages and those spoken by the wider society. Investigating the ways in which identify continues to be imagined and re-constructed in, and among Arab communities, this book is indispensable to students, teachers and anyone who is interested in language contact, linguistic landscapes, minority language retention as well as the intersections of language and technology\"-- Provided by publisher.
Book
The next step to reducing emergency department (ED) crowding: Engaging specialist physicians
Much work on reducing ED utilization has focused on primary care practices, but few studies have examined ED visits from patients followed by specialists, especially when the ED visit is related to the specialist's clinical practice.
To determine the proportion and characteristics of patients that utilized the ED for specialty-related diagnosis.
Retrospective, population-based, cohort study was conducted using information from electronic health records and billing database between January 2016 and December 2016. Patients who had seen a specialist during the last five years from the index ED visit date were included. The identification of ED visits attributable to specialists was based on the primary diagnosis of ED visits and the frequency of visit with specialists within a given timeframe.
Approximately 28% of ED visits analyzed were attributable to specialists. ED visits attributed specialists were represented by older patients and occurred more during working hours and early days of week. The most common diagnoses related to ED visits attributed to specialists were Circulatory, Musculoskeletal, Skin, Breast and Mental. Multiple departments, subdivisions and specialists were involved with each ED visit. The number of specialists following the patients who visited the ED ranged from one to six and the number of departments/subdivisions ranged from one to four. Patients that used the ED often were more likely to belong to departments (OR = 1.53) and specialists (OR = 1.18) associated with high ED utilization patterns.
Patients coming to the ED with specialty-related complaints are unique and require full engagement of the specialist and the specialty group. This study offers a new view of connections patients have with their specialists and engaging specialists both at department level and individual specialist level may be an important factor to reduce ED overcrowding.
Journal Article
Virtual Visits Partially Replaced In-Person Visits In An ACO-Based Medical Specialty Practice
Specialty care contributes significantly to total medical expenditures, for which accountable care organizations (ACOs) are responsible. AcOs have sought to replace costly in-person visits with lower-cost alternatives such as virtual visits (videoconferencing with physicians). In fee-for-service environments, virtual visits appear to add to in-person visits instead of replacing them. While this may be less of a problem within ACOs, whether virtual visits reduce in-person visits in an ACO is not known. Using data from over 35,000 patients in the period 2014-17 within a Massachusetts-based ACO, we found that the use of virtual visits reduced in-person visits by 33 percent but increased total visits (virtual plus in-person visits) by 80 percent over 1.5 years. While the use of virtual visits reduced in-person visits soon after registering with the program, the effect did not endure beyond a year. Whether and how virtual visits can substitute for in-person care in the long term are open questions.
Journal Article
Development of an electronic health record-based chronic kidney disease registry to promote population health management
Background
Electronic health record (EHR) based chronic kidney disease (CKD) registries are central to population health strategies to improve CKD care. In 2015, Partners Healthcare System (PHS), encompassing multiple academic and community hospitals and outpatient care facilities in Massachusetts, developed an EHR-based CKD registry to identify opportunities for quality improvement, defined as improvement on both process measures and outcomes measures associated with clinical care.
Methods
Patients are included in the registry based on the following criteria: 1) two estimated glomerular filtration rate (eGFR) results < 60 ml/min/1.73m
2
separated by 90 days, including the most recent eGFR being < 60 ml/min/1.73m
2
; or 2) the most recent two urine protein values > 300 mg protein/g creatinine on either urine total protein/creatinine ratio or urine albumin/creatinine ratio; or 3) an EHR problem list diagnosis of end stage renal disease (ESRD). The registry categorizes patients by CKD stage and includes rates of annual testing for eGFR and proteinuria, blood pressure control, use of angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), nephrotoxic medication use, hepatitis B virus (HBV) immunization, vascular access placement, transplant status, CKD progression risk; number of outpatient nephrology visits, and hospitalizations.
Results
The CKD registry includes 60,503 patients and has revealed several opportunities for care improvement including 1) annual proteinuria testing performed for 17% (stage 3) and 31% (stage 4) of patients; 2) ACE-I/ARB used in 41% (stage 3) and 46% (stage 4) of patients; 3) nephrotoxic medications used among 23% of stage 4 patients; and 4) 89% of stage 4 patients lack HBV immunity. For advanced CKD patients there are opportunities to improve vascular access placement, transplant referrals and outpatient nephrology contact.
Conclusions
A CKD registry can identify modifiable care gaps across the spectrum of CKD care and enable population health strategy implementation. No linkage to Social Security Death Master File or US Renal Data System (USRDS) databases limits our ability to track mortality and progression to ESRD.
Journal Article
Longer-term impact of cardiology e-consults
Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown.
We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P < .001). After the introduction of cardiac e-consults, the increase in traditional cardiac visit requests was less than the increase in traditional visit requests for control specialties (4.5% vs 10.1%, P < .001). For e-consults with at least 6 months of follow-up, 75.6% patients did not have any type of traditional cardiology visit during the follow-up period.
E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists.
Journal Article
Echoes of the Coast: Decoding Ecotourism Narratives in Online Reviews
This study aims to investigate how tourists articulate their ecotourism experiences through online reviews of coastal Karnataka. As one of India’s most favored domestic destinations since the 1960s, coastal Karnataka is renowned for its scenic shoreline, unique biodiversity, and diverse ecotourism experiences along a 320 km stretch of the Arabian-Sea rim spanning across the Uttara Kannada, Udupi, and Dakshina Kannada districts. Despite the growing popularity of ecotourism and sustainable travel, limited research has examined how tourists share ecotourism concepts via online reviews. Employing content analysis through the Leximancer tool, this study examines 1843 online reviews from 80 eco-resorts and homestays listed on TripAdvisor® to identify emerging themes from interconnected concepts and assess the extent to which ecotourism values are reflected. The findings highlight several themes out of which “place”, “food”, “resort”, and “rooms” were the dominant ones. Notably, this study also revealed minimal references to coastal conservation or sustainability. The analysis offers several theoretical contributions to the ecotourism literature by demonstrating the implication of construal level theory (CLT) and the use of Leximancer in analyzing large-scale travel data. This study also provides meaningful insights for the tourism service providers to use online review data to enrich tourist experiences and outlines actionable strategies for strengthening the visibility of coastal conservation efforts and promote ecotourism advocacy.
Journal Article
Array of prediction tools for understanding extent of wall effects on DBP formation in drinking water distribution systems
The Stage 2 Disinfectant and Disinfection By-Product (D/DBP) regulations of the United States force water utilities to be more concerned with their distributed water quality. Improved compliance requires understanding of reaction kinetics and wall effects of different distribution materials used on DBP formation. To validate results in a full-scale system, effect of different materials, wall effects, bulk reactions, and water movement is analyzed using simulated distribution system (SDS) tests, material specific simulated distribution system (MS-SDS) tests, pipe loop, and pipe section reactor (PSR); all built using materials from the city of Columbia, Missouri's distribution system. On average, the choice of polyvinyl chloride (PVC) and ductile iron can account for as much as 36% difference in trihalomethane (TTHM) formation and 60% difference in chlorine residual decay over time irrespective of the prediction model and operational strategy used. In the case of ductile iron, pipe effect (PE) is1. In PVC systems there is an overall increase in TTHM formation as a result of pipe wall surface reactions.
Journal Article
Mycobacterium tuberculosis Calcium Pump CtpF Modulates the Autophagosome in an mTOR-Dependent Manner
Calcium is a very important second messenger, whose concentration in various cellular compartments is under tight regulation. A disturbance in the levels of calcium in these compartments can play havoc in the cell, as it regulates various cellular processes by direct or indirect mechanisms. Here, we have investigated the functional importance of a calcium transporting P2A ATPase, CtpF of
(Mtb) in the pathogen's interaction with the host. Among its uncanny ways of dealing with the host with umpteen strategies for survival and persistence in humans, CtpF is identified as a new player. The levels of
are upregulated in macrophage stresses like hypoxia, high nitric oxide levels and acidic pH. Using confocal microscopy and fluorimetry, we show that CtpF effluxes calcium in macrophages in early stages of Mtb infection. Downregulation of
expression by conditional knockdown resulted in perturbation of host calcium levels and consequent decreased activation of mTOR. We present a mechanism how calcium efflux by the pathogen inhibits mTOR-dependent autophagy and enhances bacterial survival. Our work highlights how Mtb engages its metal efflux pumps to exploit host autophagic process for its proliferation.
Journal Article