Quantifying the Return on Investment of After School Programming

Each fiscal year, there is a battle on Capitol Hill as lawmakers wrestle with reconciling political promises to financial reality. This process is completed with the goal of efficiently allocating scarce resources, in this case tax dollars and other government revenue, across the needs of the over 325 million diverse residents of the United States. Some budget items garner almost universal support, such as defense funding, infrastructure and education. While individuals may differ on how much funding each of these causes should receive, almost all agree that they should be funded by the federal government. Other budget items, such as universal healthcare, food stamps and the National Endowment for the Arts are partisan issues, with some believing they are key government services and others believing they are a waste of their hard-earned money. Daily, many households across the country play out this same battle. Families decide a wide range of financial issues: whether they wish to go on a vacation, send their children to private school, buy a bigger home or donate to causes they care about. Individuals also decide how to spend their time. Should they volunteer more, or use their free hours to learn a new skill or take up a new hobby? Even more specifically, families and individuals must decide where to spend their time and money. Though in the private sector companies typically make decisions based on financial metrics, often times government and non-profit programs are either fiercely opposed or supported based solely on anecdotal evidence or moral concepts. The introduction of these opinions in the budget making process may limit both the government’s and individual’s ability to truly allocate resources efficiently and effectively. Lately, an easy target of federal spending cuts has been the Department of Education. Although most agree the government is obligated to fund public education to some extent, the many other programs funded by the Department of Education have come under fire. According to a Washington Post article from March of 2017, one example is the $1.2 billion dollars in federal grants that are the backbone of funding for many of America’s after school programs. These grants, known as 21CCLC grants, enable over 1.6 million children across the country, to access after school programming (Brown). While these cuts did not become reality in the budget passed in late March of 2018, the threat to these programs is real. If the government cuts funding, individuals may take it as a sign that these programs do not work and reduce their own donations of time and money to the cause. The most efficient way for the government and households to reduce bias and effectively allocate resources is likely to borrow a page from the private sector and perform a numbers-based analysis of all potential options. While anecdotal evidence and moral leanings are still an important part of final decision making, beginning the process with a study of Return on Investment (ROI) improves the cost efficiency of budgets. This study will explore the potential calculation and application of ROI to after-school programming with the goal of showing these programs to be a net positive investment for the government, individuals and society at large

Peer Power: Cross Gender Relationships in Early Years Precis

This precis takes a look at a chapter from the book "Peer Power: Preadolescent Culture and Identity". It specifically focuses on cross gender relationships in the early years, both platonic and romantic.Human Development and Family Science

Patients\u27 insight of interpreting prescriptions and drug labels--a cross sectional study.

Background: Errors in consuming drugs are associated with significant morbidity and mortality, besides an impact on the already overburdened health-care system. Misunderstanding drug labels and prescriptions plays an important role in contributing to adverse drug events. Objective: To evaluate abilities to understand prescriptions and drug labels among patients attending tertiary care hospital in Karachi. Methods: A cross sectional study was conducted at the Aga Khan University Hospital (AKUH), from January to March 2009. After informed consent, 181 adult patients and their healthy attendants were interviewed at AKUH using a standardized questionnaire, which ascertained patient demographics, factors that might increase exposure to health-care personnel as well as the basic knowledge and understanding of prescriptions and drug labels. Results: Out of 181, majority 137(76%) had received graduate or post-graduate degrees. 16 (9%) had received no formal education; of which all were females and 89(84%) of the total females were housewives. Overall, 130(72%) followed only a single doctor’s prescription. Majority failed to understand various medical terminologies related to dosage. In the high literacy group, 45(33%) understood once daily OD (p = 0.003), 27(20%) thrice daily TID (p = 0.05), 29(21%) twice daily BD (p = 0.01), 31(23%) thrice daily TDS (p = 0.002) and 43(31%) as needed SOS (p = 0.003) as compared to the group with no formal education, who were unable to comprehend the terms. The most common reason for using more than one prescription was decreased satisfaction with the doctor in 19(39%) and multiple co-morbids as responded by 17(35%) of patients. Knowledge regarding various medical terminologies used for dosage and routes of drug administration were also understood more frequently among the English medium respondents. The elderly identified medicine through color (47%, p,0.001), and were less likely to understand drug indications (p = 0.05) compared to younger subjects. Conclusion: Understanding of drug prescriptions is alarmingly low in the community, even amongst the educated. Care givers need to revisit this often ignored aspect of patient care

Potential Development of N-Doped Carbon Dots and Metal-Oxide Carbon Dot Composites for Chemical and Biosensing

Funding Information: The authors are would like to thank the Department of Chemistry, Government VYT PG Autonomous College Durg, Chhattisgarh, sponsored by DST-FIST (New Delhi), India and the Fundação para a Ciência e a Tecnologia (FCT), Portugal, for the Scientific Employment Stimulus-Institutional Call (CEEC-INST/00102/2018) and the Associate Laboratory for Green Chemistry-LAQV, financed by national funds from FCT/MCTES (UIDB/50006/2020 and UIDP/5006/2020). Publisher Copyright: © 2022 by the authors.Among carbon-based nanomaterials, carbon dots (CDs) have received a surge of interest in recent years due to their attractive features such as tunable photoluminescence, cost effectiveness, nontoxic renewable resources, quick and direct reactions, chemical and superior water solubility, good cell-membrane permeability, and simple operation. CDs and their composites have a large potential for sensing contaminants present in physical systems such as water resources as well as biological systems. Tuning the properties of CDs is a very important subject. This review discusses in detail heteroatom doping (N-doped CDs, N-CDs) and the formation of metal-based CD nanocomposites using a combination of matrices, such as metals and metal oxides. The properties of N-CDs and metal-based CDs nanocomposites, their syntheses, and applications in both chemical sensing and biosensing are reviewed.publishersversionpublishe

Drug overdose: a wake up call! Experience at a tertiary care centre in Karachi, Pakistan

OBJECTIVE: To study the characteristics of patients admitted with drug overdose caused either by accidental overdose of the prescribed medications or as an act of deliberate self harm (DSH) at a tertiary care hospital in Karachi, Pakistan.METHODS: A retrospective case series review was conducted at the Aga Khan University Hospital from January 2002 to October 2006. Three hundred and twenty four adult patients admitted with drug overdose were included in the study.RESULTS: Our sample group revealed mean age of 36.2 +/- 17.0 years, more females (59%), housewives (34%), and students (20%). Fifty six percent of patients committing DSH were married (p = 0.001), 81% needed in-patient psychiatric services (p = 0.016) of whom a significantly high number (38%) refused it. Domestic and social issues were rated highest among DSH group (p = 0.003), depression among females was common (p = 0.028) and Benzodiazepines (41%) was the most frequently used drug (p = 0.021). Sub-group analysis of accidental overdoses revealed mean age of 45.6 +/- 19.6 years, single (75.4%) and males (54.1%). Drugs used were mainly Benzodiazepines (18%) followed by Opioids (11%), Antiepileptics (10%) and Warfarin (10%).CONCLUSION: Our study showed that depressed housewives are at greater risk for DSH. Domestic and social issues were rated highest and Benzodiazepines were the most commonly used agents. Most of our patients refused inpatient psychiatric treatment leading us to believe that general awareness of psychiatric illnesses is imperative in our community. High number of accidental overdoses is alarming in older, single males convincing us to believe that existing pharmacy system needs further evaluation and modification

Effectiveness of Nutritional Counseling and VLCD (very low calorie diet) for Weight Loss and Metabolic Syndromeketav.

Introduction: Obesity and Diabetes are highly prevalent conditions worldwide. Morbidity and mortality stemming from these conditions has critical implications on the health and day to day lives of patients. A Very Low- Calorie Diet (VLCD) may be an effective tool to aid in lowering weight for both obese and diabetic patients, but has not been well studied. Thus, the efficacy of a VLCD on lowering weight, BMI, blood pressure, HbA1c, Lipid levels, and blood glucose was explored in this pilot study. Methods: The study’s population is taken from an MNT (medical nutrition therapy) program at Jefferson. Patients who had prior bariatric surgery, hypothyroidism, a malignancy, or specific vitamin deficiencies were excluded to avoid confounding effects on variables. Participants in the program have their vitals tracked, along with their attendance and length of participation in the program. A retrospective chart review was performed on a sample of patients. Their baseline vitals and outcome variables were recorded from three months prior to their enrollment in the program, and compared to their vitals/outcomes following participation in the program at yearly intervals. Results: Our pilot sample included x men and y women. Preliminary results from conducting the study showed that following a VLCD regimen, participants on average lost xx pounds, associated with a decrease of yy in A1C over a zz period of time. Discussion: Initial pilot results show that VLCD and counseling are effective/ not effective in lowering HBA1C levels in patients. The underlying mechanism may be that a caloric deficit aids in lowering blood glucose, which over time, reduces the acetylation of blood cells, reflected in a lowered HBA1c value

Career goals of trainee physicians in internal medicine

OBJECTIVE: To survey Internal Medicine trainees\u27 future career choices and factors influencing their decision-making. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from November 2006 to January 2007. SUBJECTS AND METHODS: A standard questionnaire was administered to the residents and Interns working in the Department of Internal Medicine of The Aga Khan University Hospital. The questionnaire covered demographic details, specialty choice, work-time distribution and factors influencing career choice. Descriptive statistics were applied. RESULTS: A total of 49 doctors participated with 57% females; and 43% males, having 33% interns and 67% residents. A minority (22%) opted for internal medicine, while 78% selected sub-specialties with cardiology (20%) being the most sought- after sub-specialty. Majority (69%) wanted to spend more time in clinical activities compared to administration (18%) or research (13%). Majority (92%) wanted to work in an academic setting. Availability of a structured training program (61%), ability to practice broad area of medicine (41%) and prestige of the specialty (41%) highly influenced their career choices. Forty one (82%) wanted to proceed abroad for further training and 80% wanted to eventually practice in Pakistan. CONCLUSION: Most of the interviewed under-training physicians wanted to pursue sub-specialty. Clinical work was more attractive compared to research. A structured training program was detrimental in affecting their choices. Majority wanted further training abroad but eventual settlement in Pakistan. The study results can help us create the basis for reforming the current training programs

Illusions of Self‐Motion during Magnetic Resonance ‐Guided Focused Ultrasound Thalamotomy for Tremor

© 2024 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Objective: Brain networks mediating vestibular perception of self‐motion overlap with those mediating balance. A systematic mapping of vestibular perceptual pathways in the thalamus may reveal new brain modulation targets for improving balance in neurological conditions. Methods: Here, we systematically report how magnetic resonance‐guided focused ultrasound surgery of the nucleus ventralis intermedius of the thalamus commonly evokes transient patient‐reported illusions of self‐motion. In 46 consecutive patients, we linked the descriptions of self‐motion to sonication power and 3‐dimensional (3D) coordinates of sonication targets. Target coordinates were normalized using a standard atlas, and a 3D model of the nucleus ventralis intermedius and adjacent structures was created to link sonication target to the illusion. Results: A total of 63% of patients reported illusions of self‐motion, which were more likely with increased sonication power and with targets located more inferiorly along the rostrocaudal axis. Higher power and more inferiorly targeted sonications increased the likelihood of experiencing illusions of self‐motion by 4 and 2 times, respectively (odds ratios = 4.03 for power, 2.098 for location). Interpretation: The phenomenon of magnetic vestibular stimulation is the most plausible explanation for these illusions of self‐motion. Temporary unilateral modulation of vestibular pathways (via magnetic resonance‐guided focused ultrasound) unveils the central adaptation to the magnetic field‐induced peripheral vestibular bias, leading to an explicable illusion of motion. Consequently, systematic mapping of vestibular perceptual pathways via magnetic resonance‐guided focused ultrasound may reveal new intracerebral targets for improving balance in neurological conditions. ANN NEUROL 2024Peer reviewe

Effectiveness of a Primary Care Nutrition Education/VLCD Diet Program

Introduction: Jefferson currently has a Medical Nutrition Therapy (MNT) program via an educational component delivered via Zoom to assist patients with managing their diet, exercise, medication changes and understanding the physiology of their conditions. We aim to study the effectiveness of the MNT program, along with the impact of duration of program participation, on weight loss, blood pressure, glucose and total cholesterol. In addition, I am focusing on triglycerides, HDL and LDL. We hypothesize that patients in our MNT program will have lower weight, blood pressure, blood glucose and total cholesterol, with a further positive effect of longer participation in the program. Methods: Data from EPIC Medical record review and attendance records were collected from a sample of patients in the Jefferson MNT program. Outcomes will be compared controlling for patient demographics (sex, age, race, ethnicity), medical history and comorbidities, medications. Study outcomes are weight, height, BMI, blood glucose, triglycerides, HbA1c, blood pressure and heart rate, before, during and following program participation. Final results will be analyzed using paired t-tests and multivariate analysis. Results: Of XX patients evaluated (data pending) we found a X% decrease in triglycerides, total cholesterol, and LDL in patients enrolled in the MNT program from start to end. Weight, BMI, blood glucose, cholesterol, HbA1c, heart rate and blood pressure were also reduced, by x, x.., respectively. Discussion: Patients who complete the MNT program will have improved weight, BMI, blood glucose, triglycerides, HbA1c, heart rate and blood pressure. Implementation of effective weight loss programs is beneficial to improving patients’ quality of life and overall health