Reflection on Peer Assisted Learning at PAHS

Peer tutoring is an organized learning experience in which one studentserves as the teacher or tutor, and one is the learner or tutee. Peerteachers and their students share a similar knowledge base and learning experience, which allows the peer-teachers to use language that their learners understand and to explain concepts at an appropriate level. Peerteachers and student-learners also share a similar social context because of their similar social roles, and because of this, student learners feel more at ease with a peer teacher than with a senior clinician. Peer tutoring is a beneficial way for students to learn from each other in the classroom and in small groups, so benefit is not only for the tutee but also to the tutor, predominantly through the development of their own clinical and teaching skills and from the positive feedback obtained by their tutees, thus creating a highly pleasant learning atmosphere and a win-win situation for all.Keywords: peer assisted learning (PAL), PBL, tuto

Raciolinguistic Entanglements and Transraciolinguistic Transgressions: A Collaborative Autoethnography of Three South Asian TESOLers in the US

Research Articl

Clinical Outcomes for Patients with Community-Acquired Pneumonia are Worse in Those with a History of Stroke

Background: Stroke is one of the most prevalent neurological diseases in the United States. Community-acquired pneumonia (CAP) is the leading cause of infections in survivors of stroke. There is limited research evaluating the clinical outcomes of CAP in patients with stroke. The objective of this study was to evaluate the clinical characteristics and outcomes of hospitalized patients with CAP and a history of stroke. Methods: This was a secondary analysis of the University of Louisville Pneumonia Study database. Patients were divided into two groups based on the presence or absence of a history of stroke. Clinical outcomes were length of stay, time to clinical stability, and one-year mortality, which were assessed via stratified Cox proportional hazards regression. Differences in risk of clinical outcomes were reported as adjusted hazard ratios. Results: We found no significant differences in time to clinical stability between the two groups. The median length of stay for patients with a history of stroke hospitalized with CAP was six days and for patients without stroke was five days (P=0.01). We observed a 16% higher risk of mortality in stroke patients with CAP than in the non-stroke population (P=0.001). Conclusions: This study indicates that hospitalized patients with CAP have a longer hospital stay and higher mortality than those without stroke

The effects of tunnel technology on crop productivity and livelihood of smallholder farmers in Nepal

Technologies-based production practices are critical for agricultural growth and sustainable development in low-income countries like Nepal. In the last few years, tunnel house has been increasingly promoted as tools to enhance smallholder farmers’ livelihood and tackle climate adversaries. However, little is known about what factor determines its adoption and whether it helps smallholders adapt to climate change and experience better livelihood. We address these gaps using the cross-sectional survey data collected from 62 adopters and 92 non-adopters in three municipalities of Bagmati Province. We employed descriptive analysis and probit model and found out that age, farm size, and ethnicity strongly influence the technology adoption amongst smallholder farmers. Additionally, treatment model and ordinary least square (OLS) regression were utilized to examine tunnel technology’s effect. Our study shows that tunnel significantly increases production by 32 tons/year/hectare and protects crops from climate change effects such as heavy rainfall and temperature change. Likewise, tunnel technology increases the net crop income by $1700/year/hectare. However, the economic benefit is not substantial compared to technology’s adoption cost as adopters incur enormous costs of$12,000/year/hectare on equipment, labor and resources. These results suggest policymakers should concentrate on reducing the technology’s cost, which could be achieved through subsidies, financial support, or price control mechanisms. Ensuring technology’s affordability can contribute to smallholder farmers’ sustainable livelihood in Nepal and countries with similar contexts

Preventing Discriminatory Decision-making in Evolving Data Streams

Bias in machine learning has rightly received significant attention over the last decade. However, most fair machine learning (fair-ML) work to address bias in decision-making systems has focused solely on the offline setting. Despite the wide prevalence of online systems in the real world, work on identifying and correcting bias in the online setting is severely lacking. The unique challenges of the online environment make addressing bias more difficult than in the offline setting. First, Streaming Machine Learning (SML) algorithms must deal with the constantly evolving real-time data stream. Second, they need to adapt to changing data distributions (concept drift) to make accurate predictions on new incoming data. Adding fairness constraints to this already complicated task is not straightforward. In this work, we focus on the challenges of achieving fairness in biased data streams while accounting for the presence of concept drift, accessing one sample at a time. We present Fair Sampling over Stream ($FS^2$), a novel fair rebalancing approach capable of being integrated with SML classification algorithms. Furthermore, we devise the first unified performance-fairness metric, Fairness Bonded Utility (FBU), to evaluate and compare the trade-off between performance and fairness of different bias mitigation methods efficiently. FBU simplifies the comparison of fairness-performance trade-offs of multiple techniques through one unified and intuitive evaluation, allowing model designers to easily choose a technique. Overall, extensive evaluations show our measures surpass those of other fair online techniques previously reported in the literature

A Ten-year Retrospective Study of Nasal Bone Fractures at a Tertiary Care Hospital of Nepal

 Introduction: Nasal bone fracture occurs due to its vulnerable position and reduced biomechanical resistance to traumas. If not timely treated, it can result in permanent functional and esthetic damage. Methods: A retrospective and cross-sectional study conducted on 91 patients above 17 years of age with nasal bone fractures in the Department of Otorhinolaryngology and Head and Neck surgery of a tertiary care hospital in Kavre. Results: Road traffic accident was the most common cause of fracture (45.1%) followed by fall (36.3%), violence (13.2%), sports-related accidents (4.4%) and occupational accidents (1.1%). Class I fracture was seen in 70 (76.9%), Class II in 17 (18.7%), and Class III in 4 (4.4%). A closed reduction procedure was performed in 74 (81.30%) of the cases, closed reduction with septoplasty was done in 10 (11%), closed reduction with augmentation rhinoplasty was performed for 3 (3.3%), closed reduction with inferior turbinoplasty was required in 3 (3.3%) whereas closed reduction with debridement was done in 1(1.1%). Conclusion: Nasal bone fracture is a complex clinical issue which needs to be addressed early. Violence prevention programs along with drinking and driving campaigns need to be more strengthened to decrease the alarmingly high frequency of nasal bone fracture in the current scenario

Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study.

OBJECTIVE: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal. STUDY DESIGN: The study was a nationwide population-based cross-sectional study. SETTING AND PARTICIPANTS: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression. RESULTS: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3). CONCLUSION: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it

Co-trimoxazole versus azithromycin for the treatment of undifferentiated febrile illness in Nepal: study protocol for a randomized controlled trial.

BACKGROUND: Undifferentiated febrile illness (UFI) includes typhoid and typhus fevers and generally designates fever without any localizing signs. UFI is a great therapeutic challenge in countries like Nepal because of the lack of available point-of-care, rapid diagnostic tests. Often patients are empirically treated as presumed enteric fever. Due to the development of high-level resistance to traditionally used fluoroquinolones against enteric fever, azithromycin is now commonly used to treat enteric fever/UFI. The re-emergence of susceptibility of Salmonella typhi to co-trimoxazole makes it a promising oral treatment for UFIs in general. We present a protocol of a randomized controlled trial of azithromycin versus co-trimoxazole for the treatment of UFI. METHODS/DESIGN: This is a parallel-group, double-blind, 1:1, randomized controlled trial of co-trimoxazole versus azithromycin for the treatment of UFI in Nepal. Participants will be patients aged 2 to 65 years, presenting with fever without clear focus for at least 4 days, complying with other study criteria and willing to provide written informed consent. Patients will be randomized either to azithromycin 20 mg/kg/day (maximum 1000 mg/day) in a single daily dose and an identical placebo or co-trimoxazole 60 mg/kg/day (maximum 3000 mg/day) in two divided doses for 7 days. Patients will be followed up with twice-daily telephone calls for 7 days or for at least 48 h after they become afebrile, whichever is later; by home visits on days 2 and 4 of treatment; and by hospital visits on days 7, 14, 28 and 63. The endpoints will be fever clearance time, treatment failure, time to treatment failure, and adverse events. The estimated sample size is 330. The primary analysis population will be all the randomized population and subanalysis will be repeated on patients with blood culture-confirmed enteric fever and culture-negative patients. DISCUSSION: Both azithromycin and co-trimoxazole are available in Nepal and are extensively used in the treatment of UFI. Therefore, it is important to know the better orally administered antimicrobial to treat enteric fever and other UFIs especially against the background of fluoroquinolone-resistant enteric fever. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02773407 . Registered on 5 May 2016

Enhancing return-to-work in cancer patients, development of an intervention and design of a randomised controlled trial

ABSTRACT: BACKGROUND: Compared to healthy controls, cancer patients have a higher risk of unemployment, which has negative social and economic impacts on the patients and on society at large. Therefore, return-to-work of cancer patients needs to be improved by way of an intervention. The objective is to describe the development and content of a work-directed intervention to enhance return-to-work in cancer patients and to explain the study design used for evaluating the effectiveness of the intervention. METHODS: Development and content of the intervention The work-directed intervention has been developed based on a systematic literature review of work-directed interventions for cancer patients, factors reported by cancer survivors as helping or hindering their return-to-work, focus group and interview data for cancer patients, health care professionals, and supervisors, and vocational rehabilitation literature. The work-directed intervention consists of: 1) 4 meetings with a nurse at the treating hospital department to start early vocational rehabilitation, 2) 1 meeting with the participant, occupational physician, and supervisor to make a return-to-work plan, and 3) letters from the treating physician to the occupational physician to enhance communication. Study design to evaluate the intervention The treating physician or nurse recruits patients before the start of initial treatment. Patients are eligible when they have a primary diagnosis of cancer, will be treated with curative intent, are employed at the time of diagnosis, are on sick leave, and are between 18 and 60 years old. After the patients have given informed consent and have filled out a baseline questionnaire, they are randomised to either the control group or to the intervention group and receive either care as usual or the work-directed intervention, respectively. Primary outcomes are return-to-work and quality of life. The feasibility of the intervention and direct and indirect costs will be determined. Outcomes will be assessed by a questionnaire at baseline and at 6, 12, 18, and 24 months after baseline. DISCUSSION: This study will provide information about the effectiveness of a work-directed intervention for cancer patients. The intention is to implement the intervention in normal care if it has been shown effective. Trial registration: NTR165