Ethics education for pediatric residents: a review of the literature

Background: Ethics education and research on medical residents is needed because, unlike medical students or experienced doctors, medical residents have to perform multiple roles simultaneously – student, teacher and clinician – thus exposing them to unique ethical stressors.  In this paper we reviewed the literature concerning ethics education in postgraduate pediatrics training programs.  Our goal was not to simply describe educational strategies and programs, but also to explore measurements and experiences of current practices to address gaps in ethics education during residency.Method: We conducted a structured literature review to explore the extent of ethics education in pediatric residency programs.  Results:  Twelve relevant studies were found.  The studies suggest that existing training regimens are insufficient to meet the real life ethical challenges experienced in actual practice, particularly with respect to palliative care and the commission of clinical errors.  Conclusions: The increasing diversity of culture and beliefs in the clinical workplace is also serving to complicate educational needs. An interdisciplinary approach, spread over the entirety of a physician’s training, is a proposed solution worthy of more attention

Ethics education for pediatric residents: a review of the literature

Background: Ethics education and research on medical residents is needed because, unlike medical students or experienced doctors, medical residents have to perform multiple roles simultaneously – student, teacher and clinician – thus exposing them to unique ethical stressors.  In this paper we reviewed the literature concerning ethics education in postgraduate pediatrics training programs.  Our goal was not to simply describe educational strategies and programs, but also to explore measurements and experiences of current practices to address gaps in ethics education during residency.Method: We conducted a structured literature review to explore the extent of ethics education in pediatric residency programs.  Results:  Twelve relevant studies were found.  The studies suggest that existing training regimens are insufficient to meet the real life ethical challenges experienced in actual practice, particularly with respect to palliative care and the commission of clinical errors.  Conclusions: The increasing diversity of culture and beliefs in the clinical workplace is also serving to complicate educational needs. An interdisciplinary approach, spread over the entirety of a physician’s training, is a proposed solution worthy of more attention

Skill Shortage versus Subject Choice, Case of Pakistan

Higher Education is believed to be a very important determinant of economic growth. The growth can be optimized with a suitable combination of skills in various subjects. A mismatch between required combination of skills and available combination of skills carries heavy costs for developing economies since import of skill from foreign is much more in expensive for such economies. We compare skill shortage in Pakistan with the subjects choice of students recently enrolled in institutes of higher learning. We found that there is a mismatch between skill shortage and the enrollment trend. We propose that the Government should regulate recruitment of students into various subjects in order to create greater harmony between national needs and students enrollment.Subject Choice, Skill Shortage, National Needs

A space efficient flexible pivot selection approach to evaluate determinant and inverse of a matrix

This paper presents new approaches for finding the determinant and inverse of a matrix. The choice of pivot selection is kept arbitrary and can be made according to the users need. So the ill conditioned matrices can be handled easily. The algorithms are more efficient as they save unnecessary data storage by reducing the order of the matrix after each iteration in the computation of determinant and incorporating dictionary notation (Chvatal, 1983) in the computation of inverse matrix. These algorithms are highly class room oriented and unlike the matrix inversion method (Khan, Shah, & Ahmad, 2010) the presented algorithm does not need any kind of permutations or inverse permutations

Productivity and Efficiency Analysis of Pakistani Textile Industry using Malmquist Productivity Index Approach

The key purpose of this study is to evaluate the total factor productivity of the textile sector by using DEA (Data Envelopment Analysis) and also identifying the components which play a significant role in the growth of productivity. This paper examines productivity performance of the Pakistan’s textile manufacturing industry using firm-level panel data of a total of 64 firms for the period 2011-2015. Moreover, the sources of expansion and compression in output are recognized for the whole textile industry as well as for the three sub sectors comprising of 35 firms from spinning, 21 from composite and 8 from weaving textile sector. Empirical results suggest that total factor productivity growth of composite, spinning and weaving textile sectors are not presenting skewed distribution. Moreover, the component of technological change had a negative impact on spinning textile sector. Technical efficiency and technological change, both, had a positive impact on the productivity of composite and weaving textile sectors. Overall, the spinning textile sector has no contribution in the productivity growth. A critical evaluation of the production factors is necessary for the maintenance of the performance of the organization. This paper provides information to the decision makers and policy makers about the allocation, acquisition and anticipation of the resources. To eradicate the industry’s pitfalls, textile sector in combination of subsectors has been selected providing a comparative analysis of the efficiencies adding to the existing body of literature by detecting the primary zones for improving productivity performance in Pakistani textile manufacturing as the pure efficiency component. &nbsp

R990G Polymorphism of calcium sensing receptor gene Is associated with high Parathyroid Hormone levels in subjects with Vitamin D deficiency: a cross-sectional study

Single nucleotide polymorphisms (SNPs), R990G and A986S of the calcium sensing receptor (CaSR) gene, are shown to influence response of parathyroid hormone (PTH) in subjects with optimal vitamin D levels. This cross-sectional study was conducted in subjects with vitaminDdeficiency (VDD) to observe association’s betweenCaSR polymorphisms, plasma iPTH, and serumcalcium levels. Adult females ( = 140) with known VDD, intact parathyroid hormone (iPTH), and calcium levels were recruited for genotype analysis.The frequencies of the 986 alleles GG, GT, and TT were 68%, 25%, and 7%, respectively, whereas the frequencies of the 990 alleles AA, AG, and GG were 80%, 8.9%, and 11.1%, respectively.Thesubjects with GG genotype of R990G polymorphism had higher iPTH levels (148.65 versus 91.47 and 86.1 pg/mL for GG versus AA, AG, resp., = 0.008) and lower calcium levels (8.4 versus 9.04 and 9.07mg/dL for GG versus AA, AG, resp., = 0.002). No such association of A986S polymorphism with plasma iPTH or serum calcium levels was observed in the present study. Patients with VDD bearing the GG genotype of R990G SNPs are prone to have higher iPTH levels and lower calcium

Relationship and Difference of Levels Between Schadenfreude, Social Media Addiction and Social Comparison Among Adults and Adolescents

This study aims to explore the relationship and difference in levels of Social Media Addiction, Social Comparison and Schadenfreude among adults and adolescents. The study followed a quantitative, correlational survey design. The research was conducted with a sample size of 500 participants (Males n= 252 & Females n=248) aged between 13 to 25 years (M= 17.54, SD= 3.32). A purposive convenient sampling technique was used. Findings from statistical analysis revealed that social media addiction and Social Comparison have positive moderate correlation. This study also found that there is no significant difference between adolescents and adults in Social Media Addiction and Social Comparison, but the difference is manifested in Schadenfreude between adolescents and adults. This study highlighted the importance of identity exploration, virtue education, empathy as well as raising awareness regarding behavioral addiction that can reduce the later on negative consequences

Mr Textural Features (Radiomics) For Predicting Response to Treatment in Patients with Intracranial Tuberculoma: A Retrospective Cross-Sectional Study

Background and objective: MR based radiomics can potentially response to treatment in intracranial tuberculoma, but very scarce literature is available in this regard. The purpose of this study was to determine whether MR based radiomic features can be used to predict response to antituberculosis (AT) treatment. Methods: Data of patients with intracranial tuberculomas who underwent MR imaging and AT treatment at our institution during the last 10 years was analyzed. In each case follow-up imaging performed at 6 months post initiation of treatment was reviewed to establish response to treatment. The textural analysis was performed by two consultant neuroradiologists, using open-source software (Lifex) with FLAIR coronal image after contrast administration from pretreatment MRI study radiomic analysis. Results: Twenty-four patients with mean age 33.8 years were included in the study. Sixteen patients were in the treatment responsive group while eight patients were in the treatment resistant group. Thirty-eight radiomic parameters were extracted for each patient. There was a significant difference in three out of 38 parameters (histogram skewness, GLCM correlation and NGLDM Coarseness) in patients amongst the two groups. Logistic regression model was developed using these parameters which accurately predicted 83.3% of the cases according to the response to the AT treatment (χ2=11.517, p=0.003). ROC curve analysis was performed using histogram skewness which showed acceptable discrimination (p=0.037 and 95% CI =0.577-0.954) for predicting the response to treatment. Conclusion: MR textural parameters (histogram skewness, GLCM correlation and NGLDM Coarseness) may be used as imaging biomarkers to predict response to treatment in patients with intracranial tuberculoma

Geotechnical Aspects of Recent Extreme Floods in Pakistan; A Case History

Topographically, Pakistan comprises three major areas; Northern Highland Area, Indus Basin and Baluchistan Plateau. Its elevation varies from Mean sea Level (0 meter) at south to 8619 meters in the North at K-2 Peak. Northern Highland Area, generally sloping southwards includes Himalayan, Karakorum and Hindu-Kush ranges covering approximately an area of 155,831 square kilometers. Indus Basin stretches from foothills of Northern Highland Area to Arabian Sea in south covering approximately an area of 346,259 square kilometers. Baluchistan Plateau in the West and South comprises mountain ranges of Koh-i-Suleman, Kirther, blow-outs of coralline and lacustrine deposits along coastal belt and covers approximately an area of 347,190 square kilometers. Climate of the country varies from tropical to temperate with rain fall variation of as little as 10 inches a year in South to 150 inches a year in the North. Any rainfall surges in the North frequently unleash floods along the Indus Basin. Continuous deforestation and fires in Northern Highland Area, growing housing projects alongside water channels in the backdrop of global warming and climate change has enhanced frequency and severity of floods in Pakistan. The year 2010 witnessed the worst flood in the history of Pakistan. The causal factors of this rare event are attributed to the amalgamation of two weather systems over Hindu-Kush and Karakorum ranges in the North. The resulting outburst in the realm of denuded landforms graduating from North to South brought about the hydrological extremes never seen before. The event was accompanied with landslides along the slopes washing away numerous houses, over-flowing water channels destroying habitats in the flood plains, precious crops, bridges, and endangered barrages and dams. While scars of a little less similar phenomenon in year 1992 due to cloud burst in Kashmir are still visible on the face of Nation, this flood caused 1985 deaths, 2946 injured; 20 million people were left homeless and destroyed 2.2 million hectares of cropped area, while damage to communication infrastructure is estimated in billions of dollars. The study encompasses geotechnical aspects of landform distribution, climatic changes and hydrological responses

Interactions of neuropathogenic Escherichia coli K1 (RS218) and its derivatives lacking genomic islands with phagocytic Acanthamoeba castellanii and nonphagocytic brain endothelial cells

Here we determined the role of various genomic islands in E. coli K1 interactions with phagocytic A. castellanii and nonphagocytic brain microvascular endothelial cells. The findings revealed that the genomic islands deletion mutants of RS218 related to toxins (peptide toxin, alpha -hemolysin), adhesins (P fimbriae, F17-like fimbriae, nonfimbrial adhesins, Hek, and hemagglutinin), protein secretion system (T1SS for hemolysin), invasins (IbeA, CNF1), metabolism (D-serine catabolism, dihydroxyacetone, glycerol, and glyoxylate metabolism) showed reduced interactions with both A. castellanii and brain microvascular endothelial cells. Interestingly, the deletion of RS218-derived genomic island 21 containing adhesins (P fimbriae, F17-like fimbriae, nonfimbrial adhesins, Hek, and hemagglutinin), protein secretion system (T1SS for hemolysin), invasins (CNF1), metabolism (D-serine catabolism) abolished E. coli K1-mediated HBMEC cytotoxicity in a CNF1-independent manner. Therefore, the characterization of these genomic islands should reveal mechanisms of evolutionary gain for E. coli K1 pathogenicity