Integration of geriatrics into a spiral undergraduate medical curriculum in Pakistan: evaluation and feedback of third-year medical students.

Background: In the last decades there has been a sharp rise in the elderly population throughout the world. The unique needs of the elderly require a multidisciplinary and comprehensive medical approach. None of the 50 medical schools in Pakistan teach geriatrics in their undergraduate or postgraduate training. This paper discusses the development and implementation of the first geriatric curriculum in a medical school of Pakistan and its effect on knowledge and attitudes of third-year medical students. Methods: The curriculum was designed through collaboration and approval of various academic departments at the Aga Khan University in Karachi Pakistan. After a review of existing geriatric curricula at other institutions, a problem-based, inter-disciplinary spiral curriculum was designed. Strategy of student and course evaluation was planned and incorporated in the curricular program. No extra resources or funds were used. A component of the new curriculum was assessed by evaluating pre- and post- course knowledge, and seeking feedback from participating third-year students. Results: A significant improvement in mean scores for summed overall knowledge in geriatrics (pre-test mean 4.7 vs. post-test mean 6.4, p value of of \u3c0.001; out of a maximum possible of 9 was noted. Breakdown of knowledge mean scores into component areas of knowledge showed a significant increase in understanding in aging demographics (pretest 0.7 vs. post-test 1.7, p value of \u3c0.001), geriatric history taking (pretest 0.64 vs. post-test 0.88, p 0.001) and geriatric assessments (pre- test 1.4 vs. post- test 1.7,p value 0.01). A strong majority (87%) of the students felt that the overall course objectives were achieved. All students were satisfied with the quality of teaching, 90% rating it good or higher. Conclusion: An important advance in medical education was achieved via integration of a low cost, spiral geriatrics curriculum in a medical university of Pakistan. We found that introduction of the geriatric curriculum improved the knowledge of third-year medical students. This was our school\u27s initial step towards building professional capacity in response to a rising elderly population

Ka-band (32-GHz) performance of 70-meter antennas in the Deep Space Network

Two models are provided of the Deep Space Network (DSN) 70 m antenna performance at Ka-band (32 GHz) and, for comparison purposes, one at X-band (8.4 GHz). The baseline 70 m model represents expected X-band and Ka-band performance at the end of the currently ongoing 64 m to 70 m mechanical upgrade. The improved 70 m model represents two sets of Ka-band performance estimates (the X-band performance will not change) based on two separately developed improvement schemes: the first scheme, a mechanical approach, reduces tolerances of the panels and their settings, the reflector structure and subreflector, and the pointing and tracking system. The second, an electronic/mechanical approach, uses an array feed scheme to compensate fo lack of antenna stiffness, and improves panel settings using microwave holographic measuring techniques. Results are preliminary, due to remaining technical and cost uncertainties. However, there do not appear to be any serious difficulties in upgrading the baseline DSN 70 m antenna network to operate efficiently in an improved configuration at 32 GHz (Ka-band). This upgrade can be achieved by a conventional mechanical upgrade or by a mechanical/electronic combination. An electronically compensated array feed system is technically feasible, although it needs to be modeled and demonstrated. Similarly, the mechanical upgrade requires the development and demonstration of panel actuators, sensors, and an optical surveying system

Decisions to seek cognitive performance feedback: potential determinants of feedback value and consequences for learning

Performance feedback is essential for effective learning. Feedback contains both informational and affective properties. Following negative feedback (indicating an incorrect response), the unpleasant experience of being wrong can diminish the value of constructive information that feedback also provides. This can hinder motivation to seek feedback, which can impede learning. Therefore, research into factors that directly shape the subjective value of feedback is critical. The current study investigated potential behavioral and physiological contributors to feedback valuation and to subsequent feedback-seeking behavior. Fifty-nine participants completed a willingness-to-pay associative memory task that measured feedback valuation via trial-wise decisions to either purchase or forgo feedback during a learning phase in service of maximizing a performance-contingent monetary reward during a future test phase. Skin conductance response (SCR) was also measured during feedback decisions. Lower confidence in response accuracy significantly predicted higher likelihood of purchasing feedback during learning. Neither self-reported emotional responses to feedback nor SCR during feedback decisions predicted feedback purchases. Purchase decisions yielding negative feedback significantly predicted better performance during test. These results suggest that confidence during learning significantly impacts performance feedback valuation and should be considered when devising methods to motivate feedback-seeking in settings where learning is critical to success

A Reward-Based Framework of Perceived Control

Perceived control can be broadly defined as the belief in one’s ability to exert control over situations or events. It has long been known that perceived control is a major contributor toward mental and physical health as well as a strong predictor of achievements in life. However, one issue that limits a mechanistic understanding of perceived control is the heterogeneity of how the term is defined in models in psychology and neuroscience, and used in experimental settings across a wide spectrum of studies. Here, we propose a framework for studying perceived control by integrating the ideas from traditionally separate work on perceived control. Specifically, we discuss key properties of perceived control from a reward-based framework, including choice opportunity, instrumental contingency, and success/reward rate. We argue that these separate reward-related processes are integral to fostering an enhanced perception of control and influencing an individual’s behavior and well-being. We draw on select studies to elucidate how these reward-related elements are implicated separately and collectively in the investigation of perceived control. We highlight the role of dopamine within corticostriatal pathways shared by reward-related processes and perceived control. Finally, through the lens of this reward-based framework of perceived control, we consider the implications of perceived control in clinical deficits and how these insights could help us better understand psychopathology and treatment options

Ethnic disparity in 21-hydroxylase gene mutations identified in Pakistani congenital adrenal hyperplasia patients

Background: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders caused by defects in the steroid 21 hydroxylase gene (CYP21A2). We studied the spectrum of mutations in CYP21A2 gene in a multi-ethnic population in Pakistan to explore the genetics of CAH. Methods: A cross sectional study was conducted for the identification of mutations CYP21A2 and their phenotypic associations in CAH using ARMS-PCR assay. Results: Overall, 29 patients were analyzed for nine different mutations. The group consisted of two major forms of CAH including 17 salt wasters and 12 simple virilizers. There were 14 phenotypic males and 15 females representing all the major ethnic groups of Pakistan. Parental consanguinity was reported in 65% cases and was equally distributed in the major ethnic groups. Among 58 chromosomes analyzed, mutations were identified in 45 (78.6%) chromosomes. The most frequent mutation was I2 splice (27%) followed by Ile173Asn (26%), Arg 357 Trp (19%), Gln319stop, 16% and Leu308InsT (12%), whereas Val282Leu was not observed in this study. Homozygosity was seen in 44% and heterozygosity in 34% cases. I2 splice mutation was found to be associated with SW in the homozygous. The Ile173Asn mutation was identified in both SW and SV forms. Moreover, Arg357Trp manifested SW in compound heterozygous state. Conclusion: Our study showed that CAH exists in our population with ethnic difference in the prevalence of mutations examined

Silver nanowire networks: Physical properties and potential integration in solar cells

peer reviewedWith the growing interest in flexible electronics and the increased utilization of Indium Tin Oxide electrodes for display and photovoltaic applications the need for new materials is emerging. In this work we present the electro-optical properties of Ag nanowire networks as an alternative transparent conductive material. A comparison of different film deposition techniques is made and indicates that the properties of the network are independent of the fabrication method. Analysis of the electrical behavior as a function of nanowire density is made and compared with theoretical results as well as Monte Carlo simulations. Thermal annealing is shown to reduce the sheet resistance from 1000 Ω/sq to 8 Ω/sq; this reduction is achieved by local sintering of the nanowire junctions. Experimental optimization of Ag nanowire electrodes was undertaken and a peak in the electro-optical properties is observed at approximately 100 mg/m². Finally a discussion of the potential integration of Ag nanowire networks into solar cells is undertaken; we observe that these electrodes show promise as an emerging transparent conductive material, especially for flexible applications

2019 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations : summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates