Moving forward in GME reform: a 4 + 1 model of resident ambulatory training

Traditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed. To compare the impact of a traditional ambulatory training model with a templated 4 + 1 model. A large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices. Residents, faculty, and administrative staff. Development of a templated 4 + 1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously. A mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents\u27 learning opportunities increased (p = 0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p \u3c 0.0001). Satisfaction with ambulatory training improved (p \u3c 0.0001). Self-reported empanelment also increased (p \u3c 0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p \u3c 0.0001). A 4 + 1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes. (C) Society of General Internal Medicine 201

Somatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry?

The article describes the reasons why psychiatrists working in the field of consultation-liaison should be trained and aware of the relevance of culture in their everyday work. Moreover, the article aims at advertising the special-interest group on cultural CLP, a network of clinicians and researchers within the European Association of Psychosomatic Medicine that share their interest and activities in this subject

On how Unsupervised Machine Learning Can Shape Minds: a Brief Overview

This paper briefly examines the relationship between unsupervised machine learning models, the learning affordances that such models offer, and the mental models of those who use them. We consider the unsupervised models as learning affordances. We use a case study involving unsupervised modelling via commonly used methods such as clustering, to argue that unsupervised models can be used as learning affordances, bychanging participants’ mental models, precisely because the models are unsupervised, and thus potentially lead to learning from unexpected or inexplicit patterns

Jitsu: Just-in-time summoning of unikernel

Network latency is a problem for all cloud services. It can be mitigated by moving computation out of remote datacenters by rapidly instantiating local services near the user. This requires an embedded cloud platform on which to deploy multiple applications securely and quickly. We present Jitsu, a new Xen toolstack that satisfies the demands of secure multi-tenant isolation on resource-constrained embedded ARM devices. It does this by using unikernels: lightweight, compact, single address space, memory-safe virtual machines (VMs) written in a high-level language. Using fast shared memory channels, Jitsu provides a directory service that launches unikernels in response to network traffic and masks boot latency. Our evaluation shows Jitsu to be a power-efficient and responsive platform for hosting cloud services in the edge network while preserving the strong isolation guarantees of a type-1 hypervisor.The research leading to these results received funding from the European Union’s Seventh Framework Programme FP7/2007–2013 under the Trilogy 2 project (grant agreement no. 317756), and the User Centric Networking project, (grant agreement no. 611001), and the Defense Advanced Research Projects Agency (DARPA) and the Air Force Research Laboratory (AFRL), under contract FA8750-11-C-0249.This is the author accepted manuscript. The final version is available from USENIX via https://www.usenix.org/conference/nsdi15/technical-sessions/presentation/madhavapedd

Nanostructured Channel for Improving Emission Efficiency of Hybrid Light-Emitting Field-Effect Transistors

We report on the mechanism of enhancing the luminance and external quantum efficiency (EQE) by developing nanostructured channels in hybrid (organic/inorganic) light-emitting transistors (HLETs) that combine a solution-processed oxide and a polymer heterostructure. The heterostructure comprised two parts: (i) the zinc tin oxide/zinc oxide (ZTO/ZnO), with and without ZnO nanowires (NWs) grown on the top of the ZTO/ZnO stack, as the charge transport layer and (ii) a polymer Super Yellow (SY, also known as PDY-132) layer as the light-emitting layer. Device characterization shows that using NWs significantly improves luminance and EQE (≈1.1% @ 5000 cd m–2) compared to previously reported similar HLET devices that show EQE < 1%. The size and shape of the NWs were controlled through solution concentration and growth time, which also render NWs to have higher crystallinity. Notably, the size of the NWs was found to provide higher escape efficiency for emitted photons while offering lower contact resistance for charge injection, which resulted in the improved optical performance of HLETs. These results represent a significant step forward in enabling efficient and all-solution-processed HLET technology for lighting and display applications

A Group Parenting Intervention for Depressed Fathers (LTP + Dads): A Feasibility Study from Pakistan

Introduction: In this study, we feasibility tested Learning Through Play Plus Dads (LTP+ Dads), a group parenting psychoeducation program adapted for depressed Pakistani fathers of children under three years of age. Methods: A total of 18 fathers with depression were recruited in Karachi, Pakistan for a pre-post feasibility study. Ten sessions of group LTP+ Dads were offered over three months. Clinical assessments were administered at baseline, 3 and 6 months and included the Edinburgh Postnatal Depression Scale, 17-item Hamilton Depression Rating Scale, Brief Disability Questionnaire, Multidimensional Scale of Perceived Social Support, Euro-Qol-5 Dimensions, Rosenberg Self-esteem Scale, Parenting Stress Index, and Knowledge, Attitude and Practices questionnaire. Results: The intervention was feasible to implement and acceptable based on a recruitment rate of 100% of eligible participants and a 100% attendance rate for 5 of the 10 sessions. Within this preliminary sample, fathers showed, on average, a reduction in depressive symptoms, an increase in most areas of fathers’ knowledge and positive attitudes about child development. Perceived social support, self-esteem and functioning scores also increased. Limitations: The small sample size and lack of control group are limitations of this study. Conclusions: In this first study of paternal depression in Pakistan, a low cost culturally adapted group intervention was found to be feasible and acceptable. Changes in depression, parenting-related and other outcomes are promising and inform a future larger trial. Keywords: Paternal depression, Cultural Adaptation, CBT, Parenting, Low and middle income countr

Knowledge Sharing Idiosyncrasies of University Students in Ghana

Part 6: Decision Making and Knowledge ManagementInternational audienceThis study explored the factors affecting knowledge sharing behaviour of students in a higher institution of learning. Using a model derived from the Social Cognitive Theory and the Theory of Reason Action, six hypotheses were tested from a cross-sectional data collected from 371 undergraduate students on a 4-year degree programme in the University of Ghana. Five out of the six hypotheses were supported. The results showed that the knowledge sharing behaviour (KSB) of the students was significantly related to five of the human and environmental factors (F=639.9, df=5, 290, p<0.05) with a co-efficient of variation of R2=0.917 (91.7%). The knowledge sharing behavior of the students was, however, not significantly dependent on their personal characteristics. The study makes a case for increased attention in understanding the human and environmental factors of knowledge sharing since knowledge sharing is largely a people activity shaped by culture

BRCA1 promoter methylation and clinical outcomes in ovarian cancer: an individual patient data meta-analysis

BACKGROUND BRCA1 methylation has been associated with homologous recombination deficiency, a biomarker of platinum sensitivity. Studies evaluating BRCA1-methylated tubal/ovarian cancer (OC) do not consistently support improved survival following platinum chemotherapy. We examine the characteristics of BRCA1-methylated OC in a meta-analysis of individual participant data. METHODS 2636 participants' data across 15 studies were analyzed. BRCA1-methylated tumors were defined according to their original study. Associations between BRCA1 methylation and clinico-pathological characteristics were evaluated. The effects of methylation on overall survival (OS) and progression-free survival (PFS) were examined using mixed-effects models. All statistical tests were two-sided. RESULTS 430 (16.3%) tumors were BRCA1-methylated. BRCA1 methylation was associated with younger age and advanced-stage high-grade serous OC. There were no survival differences between BRCA1-methylated and non-BRCA1-methylated OC (median PFS = 20.0 vs 18.5 months, HR = 1.01, 95% CI = 0.87-1.16, P=0.98; median OS = 46.6 vs 48.0 months, HR = 1.02, 95% CI = 0.87-1.18, P=0.96). Where BRCA1/2 mutations were evaluated (n = 1248), BRCA1 methylation displayed no survival advantage over BRCA1/2 intact (BRCA1/2 wild type non-BRCA1-methylated) OC. Studies used different methods to define BRCA1 methylation. Where BRCA1 methylation was determined using methylation-specific PCR and gel electrophoresis (n = 834), it was associated with improved survival (PFS: HR = 0.80, 95% CI = 0.66-0.97, P=0.02; OS: HR = 0.80, 95% CI = 0.63-1.00, P=0.05) on mixed-effects modelling. CONCLUSION BRCA1-methylated OC displays similar clinico-pathological features to BRCA1-mutated OC, but is not associated with survival. Heterogeneity within BRCA1 methylation assays influences associations. Refining these assays may better identify cases with silenced BRCA1 function and improved patient outcomes