Impact of Rising Energy Prices on Consumer’s Welfare: A Case Study of Pakistan

This work investigated the impact of higher energy prices on consumer’s welfare for the Pakistan from 1987 to 2012. The central objective of the study is to quantify the consumer welfare through Compensating Variation (CV) after estimating the demand elasticities by applying the Linear Almost Ideal Demand System (LA/AIDS) for main energy sources. Welfare change is also measured in four scenarios (two price shocks) for Pakistan in order to analyse the impact of energy price change in different time period. Coal, gasoline and High Speed Diesel (HSD) oil are relatively less elastic, where High Octane Blended Component (HOBC), kerosene and Compressed Natural Gas (CNG) are relatively more elastic, while electricity and natural gas is unit elastic. Additionally, the results of Compensating Variation suggest that due to higher energy prices, more income compensation is required to pay for consumer in order to achieve the initial energy utility. So mixture of price controlling and income policies should be adopted for each energy source. JEL Classification: D6, Q4 Keywords: Rising Energy Prices, Consumer Welfare, LA/AIDS, CV, Time Series Dat

Paradigm shift in medical education due to the COVID-19 pandemic:guidelines for developing a blended learning curriculum in medical education

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the world's economy, health and education in a blink of an eye. Almost 1 billion learners have been affected across the globe. This has resulted in a paradigm shift to blended learning. Therefore, it was felt necessary to provide practical guidelines for the development of blended curriculum in medical education. It would help to overcome the challenges faced due to unprecedented transformation of medical education on account of pandemic. Methods: Guidelines based on personal experience of the authors and literature search were developed using the complex adapted blended learning system (CALBS) framework. Seven experts developed these guidelines using the nominal group technique. The consent form and literature for CABLS framework was shared with experts. The experts developed the guidelines independently during phase one of the technique. After a given time, phase 2 started with moderator mediated discussion about the individual guidelines developed by the experts. After discussion and mutual consensus four types of guideline ideas were developed. During the third phase the experts ranked the guideline ideas on a scale of 1 to 5. The guideline idea that ranked highest was selected as a final guideline for developing a blended learning curriculum. Results: The group consensus resulted in developing seven guidelines for a blended course or curriculum in medical education. These guidelines are based on a conceptual framework supplemented by expert's own personal experience and current evidence from literature. Conclusions: These guidelines would provide a comprehensive and systematic approach to develop a blended learning curriculum in medical education. </p

Designing and analysing feasibility studies of complex interventions: challenges related to assessing stop/go criteria

Randomised controlled trials (RCTs) are time-consuming and costly so funders often require evidence of feasibility before they will fund large scale trials1. Feasibility studies can provide invaluable evidence relating to the practicalities of conducting large RCTs and can improve their likelihood of success. However, conducting feasibility studies of complex interventions and deciding whether or not to proceed to a full RCT, is not always straightforward. We will present the challenges encountered during the design and analysis of two feasibility studies: OBI (Optimised Behavioural Intervention for avoidant chronic low back pain patients) and MIDSHIPS (Multicentre Intervention Designed for Self-Harm using Interpersonal Problem Solving) and discuss the steps taken to overcome them. Recruiting and treating participants in a limited number of centres, with few therapists, is a complex challenge for both of these feasibility studies and crucial to determining their success; we will present the lessons learnt from our experience. We will also discuss the impact of missing data on our ability to assess stop/go criteria with respect to proof-of-concept. Estimating follow-up questionnaire response rates is an important objective in both studies, hence we will discuss the methods employed to maximise data collection and present our approach for providing robust estimates of response rates for the phase III trials

Testing the credibility, feasibility and acceptability of an optimised behavioural intervention (OBI) for avoidant chronic low back pain patients: protocol for a randomised feasibility study

Background: Chronic back pain continues to be a costly and prevalent condition. The latest NICE guidelines issued in 2009 state that for patients with persistent back pain (of between six weeks and twelve months duration), who are highly distressed and/or disabled and for whom exercise, manual therapy and acupuncture has not been beneficial, the evidence supports a combination of around 100 hours of combined physical and psychological treatment. This is costly, and may prove unacceptable to many patients. A key recommendation of these guidelines was for further randomised controlled trials (RCTs) of psychological treatment and to target treatment to specific sub-groups of patients. Recent trials that have included psychological interventions have shown only moderate improvement at best, and results are not maintained long term. There is therefore a need to test theoretically driven interventions that focus on specific high-risk sub-groups, in which the intervention is delivered at full integrity against a credible control. Methods/design: A feasibility study of a pragmatic randomised controlled trial comparing psychologist-delivered Contextual Cognitive Behavioural Therapy (CCBT) against Treatment As Usual (TAU) physiotherapy delivered by physiotherapists for the treatment of chronic lower back pain in ‘avoidant’ patients. Ninety-two patients referred for physiotherapy will be recruited and randomised on a 1:1 basis to receive CCBT or TAU. Treatment groups will be balanced by centre and pain interference score. Primary outcomes include assessing the credibility and acceptability of the intervention, and to demonstrate proof of principle through a greater change in pain acceptance in the CCBT arm, measured by the Acceptance and Action –II and the Chronic Pain Acceptance questionnaires. In addition, the feasibility of carrying out a full trial will be explored with reference to recruitment and follow-up rates including the assessment of the burden of outcome measure completion. Secondary patient outcomes include disability, pain, fear of movement, mood, quality of life, and global recovery. Outcomes are measured at three and six months post-randomisation. Discussion: This paper details the rationale, design, therapist training system and recruitment methods to be used in a feasibility study which will inform the design and efficient implementation of a future definitive RCT

Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk; results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs. Physiotherapy

Background: Low Back Pain (LBP) remains a common and costly problem. Psychological obstacles to recovery have been identified, but psychological and behavioural interventions have produced only moderate improvements. Reviews of trials have suggested that the interventions lack clear theoretical basis, are often compromised by low dose, lack of fidelity, and delivery by non-experts. In addition, interventions do not directly target known risk mechanisms. We identified a theory driven intervention (Contexual Cognitive Behavioural Therapy, CCBT) that directly targets an evidence-based risk mechanism (avoidance and ensured dose and delivery were optimised. This feasibility study was designed to test the credibility and acceptability of optimised CCBT against physiotherapy for avoidant LBP patients, and to test recruitment, delivery of the intervention and response rates prior to moving to a full definitive trial. Methods: A randomised controlled feasibility trial with patients randomised to receive CCBT or physiotherapy. CCBT was delivered by trained supervised psychologists on a one to one basis and comprised up to 8 one-hour sessions. Physiotherapy comprised back to fitness group exercises with at least 60 % of content exercise-based. Patients were eligible to take part if they had back pain for more than 3 months, and scored above a threshold indicating fear avoidance, catastrophic beliefs and distress. Results: 89 patients were recruited. Uptake rates were above those predicted. Scores for credibility and acceptability of the interventions met the set criteria. Response rates at three and six months fell short of the 75 % target. Problems associated with poor response rates were identified and successfully resolved, rates increased to 77 % at 3 months, and 68 % at 6 months. Independent ratings of treatment sessions indicated that CCBT was delivered to fidelity. Numbers were too small for formal analysis. Although average scores for acceptance were higher in the CCBT group than in the group attending physiotherapy (increase of 7.9 versus 5.1) and change in disability and pain from baseline to 6 months were greater in the CCBT group than in the physiotherapy group, these findings should be interpreted with caution. Conclusions: CCBT is a credible and acceptable intervention for LBP patients who exhibit psychological obstacles to recovery

Prevention of delirium (POD) for older people in hospital: study protocol for a randomised controlled feasibility trial

Background: Delirium is the most frequent complication among older people following hospitalisation. Delirium may be prevented in about one-third of patients using a multicomponent intervention. However, in the United Kingdom, the National Health Service has no routine delirium prevention care systems. We have developed the Prevention of Delirium Programme, a multicomponent delirium prevention intervention and implementation process. We have successfully carried out a pilot study to test the feasibility and acceptability of implementation of the programme. We are now undertaking preliminary testing of the programme. Methods/Design: The Prevention of Delirium Study is a multicentre, cluster randomised feasibility study designed to explore the potential effectiveness and cost-effectiveness of the Prevention of Delirium Programme. Sixteen elderly care medicine and orthopaedic/trauma wards in eight National Health Service acute hospitals will be randomised to receive the Prevention of Delirium Programme or usual care. Patients will be eligible for the trial if they have been admitted to a participating ward and are aged 65 years or over. The primary objectives of the study are to provide a preliminary estimate of the effectiveness of the Prevention of Delirium Programme as measured by the incidence of new onset delirium, assess the variability of the incidence of new-onset delirium, estimate the intracluster correlation coefficient and likely cluster size, assess barriers to the delivery of the Prevention of Delirium Programme system of care, assess compliance with the Prevention of Delirium Programme system of care, estimate recruitment and follow-up rates, assess the degree of contamination due to between-ward staff movements, and investigate differences in financial costs and benefits between the Prevention of Delirium Programme system of care and standard practice. Secondary objectives are to investigate differences in the number, severity and length of delirium episodes (including persistent delirium); length of stay in hospital; inhospital mortality; destination at discharge; health-related quality of life and health resource use; physical and social independence; anxiety and depression; and patient experience. Discussion: This feasibility study will be used to gather data to inform the design of a future definitive randomised controlled trial. Trial registration: ISRCTN01187372. Registered 13 March 2014

Comparaison des effets de la distribution des informations à l'aide de quatre dispositif d'apprentissage coopératif à l'école primaire

Notre recherche est conduite dans trois écoles primaires publiques de Genève. Elle étudie les effets de la distribution des informations (indépendance des ressources versus interdépendance des ressources) lors d’un travail en duo sur des textes argumentatifs avec des élèves de 10-11 ans. De nombreuses études ont démontré les avantages d’un travail coopératif, notamment en condition d’interdépendance positive des ressources pour les interactions et les apprentissages des apprenants. Toutefois, pouvoir bénéficier d’un apport d’informations de qualité, lors d’un travail avec des informations complémentaires, s’avère indispensable. Les aides au résumé sont des outils que nous avons amenés pour assurer cette qualité et permettre un meilleur apprentissage pour les élèves en situation de dépendance informationnelle. Cependant, l’aide au résumé risque d’accentuer la comparaison sociale des compétences dans les dispositifs d’indépendance des ressources

Drawing is an important tool to learn context-based histology in an integrated undergraduate medical curriculum

الملخص: أهداف البحث: لاختبار ما إذا كان تعلم الأنسجة عن طريق الرسم متفوقًا في بعض الجوانب على التعلم من خلال الرؤية من خلال المجهر فقط. طريقة البحث: تم تقسيم طلاب السنة الثانية في كلية الطب عن طريق أخذ عينات عشوائية بسيطة في المجموعة ''أ'' و ''ب''. كل مجموعة تتألف من 50 طالبا. تم التخطيط لهذه الدراسة ذات الطرق المختلطة في وحدة مدتها ثمانية أسابيع. خلال الأسابيع الأربعة الأولى من الوحدة الدراسية ، تعلم الطلاب في المجموعة ''أ'' علم الأنسجة عن طريق الرسم بينما تعلمت المجموعة ''ب'' من خلال رؤية النص والصور المجهرية. خلال الأسابيع الأربعة التالية، تم تبديل المجموعات بالتصميم المتقاطع. تم تقييم تأثير التعلم عن طريق الرسم بواسطة اختبارالاختيار من متعدد الأول والاختبار الثاني في نهاية أربعة وثمانية أسابيع على التوالي. تم تحليل الدرجات التي تم الحصول عليها في الاختبار الأول والاختبار الثاني عن طريق اختبار t للعينة المستقلة. تم تطبيق اختبار t للعينة الزوجية على الدرجات التي حصل عليها نفس الموضوع عندما يتعلمون بالرسم وبدون إستراتيجية الرسم. من أجل استكشاف تأثير الرسم على تعلم الأنسجة، أجريت دراسة جماعية مركزة. تم اختيار المشاركين الستة بأخذ عينات هادفة. تم تحليل البيانات الخاصة بأسئلة المقابلة شبه المنظمة من خلال تقنيات البحث النوعي للترميز والتصنيف وتوليد الموضوعات. النتائج: أظهر اختبار t للعينة المستقلة أنه لا يوجد فرق ذو دلالة إحصائية في متوسط الدرجات التي حصلت عليها المجموعة ''أ'' والمجموعة ''ب'' في الاختبار الأول والاختبار الثاني. ومع ذلك، كان هناك فرق ذو دلالة إحصائية عندما يتم تعليم علم الأنسجة عن طريق الرسم مقارنة باستراتيجية عدم الرسم، كما هو موضح في اختبار t الزوجي. كشفت دراسة المجموعة المركزة أن الرسم له تأثير إيجابي على الاحتفاظ بالمعرفة وفهم المفاهيم الأساسية للأنسجة لتطبيقها في الأهمية السريرية. الاستنتاجات: يساعد الرسم القائم على التعلم في علم الأنسجة في تطبيق المعرفة الأساسية في السياق السريري. Abstract: Objectives: To determine if learning histology by drawing is superior to learning by looking through a microscope only. Methods: Second year MBBS students were divided by simple random sampling into Groups A and B. Each group comprised 50 students. This mixed-methods study was conducted in an 8-week module. For the first 4 weeks, students in Group A learned histology by drawing, whereas Group B learned by seeing the text and microscopic images. For the last 4 weeks, groups were swapped by crossover design. The impact of learning by drawing was assessed by multiple choice question (MCQ) test I and test II at the end of 4 and 8 weeks, respectively. Statistical analyses of the data were conducted with SPSS version 23. The scores obtained in test I and test II were analyzed by the independent samples t-test. The paired samples t-test was applied to scores obtained by the same subject when they learned with drawing and no drawing strategies. To assess the impact of drawing on learning histology, a focus group study was conducted in six participants selected by purposive sampling. Responses to the semi-structured interview questions were analyzed by qualitative research techniques of coding, categorizing, and generation of themes. Results: The independent samples t-test showed that there was no statistically significant difference in the mean scores obtained by Groups A and B in test I and test II. However, there was a statistically significant difference when the subject learned histology by drawing compared to no drawing, as shown by the paired samples t-test. The results from the focus group study revealed that drawing had a positive impact on knowledge retention and understanding the basic concepts of histology for its application in the clinical context. Conclusion: Drawing-based learning in histology helps with the application of basic knowledge in the clinical context

Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk: results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs. Physiotherapy

BackgroundLow Back Pain (LBP) remains a common and costly problem. Psychological obstacles to recovery have been identified, but psychological and behavioural interventions have produced only moderate improvements. Reviews of trials have suggested that the interventions lack clear theoretical basis, are often compromised by low dose, lack of fidelity, and delivery by non-experts. In addition, interventions do not directly target known risk mechanisms. We identified a theory driven intervention (Contexual Cognitive Behavioural Therapy, CCBT) that directly targets an evidence-based risk mechanism (avoidance and ensured dose and delivery were optimised. This feasibility study was designed to test the credibility and acceptability of optimised CCBT against physiotherapy for avoidant LBP patients, and to test recruitment, delivery of the intervention and response rates prior to moving to a full definitive trial.MethodsA randomised controlled feasibility trial with patients randomised to receive CCBT or physiotherapy. CCBT was delivered by trained supervised psychologists on a one to one basis and comprised up to 8 one-hour sessions. Physiotherapy comprised back to fitness group exercises with at least 60 % of content exercise-based. Patients were eligible to take part if they had back pain for more than 3 months, and scored above a threshold indicating fear avoidance, catastrophic beliefs and distress.Results89 patients were recruited. Uptake rates were above those predicted. Scores for credibility and acceptability of the interventions met the set criteria. Response rates at three and six months fell short of the 75 % target. Problems associated with poor response rates were identified and successfully resolved, rates increased to 77 % at 3 months, and 68 % at 6 months. Independent ratings of treatment sessions indicated that CCBT was delivered to fidelity. Numbers were too small for formal analysis. Although average scores for acceptance were higher in the CCBT group than in the group attending physiotherapy (increase of 7.9 versus 5.1) and change in disability and pain from baseline to 6 months were greater in the CCBT group than in the physiotherapy group, these findings should be interpreted with caution.ConclusionsCCBT is a credible and acceptable intervention for LBP patients who exhibit psychological obstacles to recovery