CLOSING THE LOOP: THE USE OF A CURRICULAR DATABASE TO PROVIDE FEEDBACK ON STUDENT PERFORMANCE WITHOUT COMPROMISING EXAM SECURITY

At the University of New Mexico School of Medicine, there is ever-increasing recognition that the development of high-quality medical student examinations is a fundamental part of a high-quality educational experience. As growing faculty time is spent in the development of reliable exams, question banks and the reuse of testing items are both becoming more prevalent. Security of these examinations is thus increasingly becoming a priority. However, our faculty also recognizes the importance of student feedback. In past years, we have allowed students directly access to their tests following the examination sessions, but the increasing importance of exam security obviously conflicts with this approach. The authors and course directors are attempting to resolve this dilemma by utilizing a curricular database to provide students with individualized feedback while maintaining exam security

How do Climate Change and Environmental Degradation contribute to Violence against Children?

This scoping review of the literature explores the interlinkages between two pressing crises: violence against children (VAC) and climate change (CC) together with environmental degradation (ED). Only recently have research and policy begun to shine a light on the magnifying effect of CC on children’s exposure to violence, exploitation, and abuse, with the role of ED remaining under-explored. To spur academic and political movement in this area, our research aims to help establish the magnitude, direction, and pathways of the relationship between CC, ED, and VAC. We showcase the complexity of that relationship and illustrate, in the form of case studies, why context-specific approaches and more research are needed. Doing so, we cover five thematic areas: 1) Hazards and Disaster Risk Reduction, 2) Gender, 3) Im/mobility, 4) Child Labour and 5) Health. Taking all five thematic areas together, structural violence against children emerged as a cross-cutting theme, creating and reinforcing the conditions for multiple forms of VAC in the context of CC and ED

Reinforcement Learning with Stepwise Fairness Constraints

AI methods are used in societally important settings, ranging from credit to employment to housing, and it is crucial to provide fairness in regard to algorithmic decision making. Moreover, many settings are dynamic, with populations responding to sequential decision policies. We introduce the study of reinforcement learning (RL) with stepwise fairness constraints, requiring group fairness at each time step. Our focus is on tabular episodic RL, and we provide learning algorithms with strong theoretical guarantees in regard to policy optimality and fairness violation. Our framework provides useful tools to study the impact of fairness constraints in sequential settings and brings up new challenges in RL.Comment: Fairness, Reinforcement Learnin

ProperCAD II: A Run-Time Library for Portable, Parallel, Object-Oriented Programming with Applications to VLSI CAD

Coordinated Science Laboratory was formerly known as Control Systems LaboratorySemiconductor Research Corporation / grant 93-DP-10

Patient, family members and community pharmacists’ views of a proposed overdose prevention intervention delivered in community pharmacies for patients prescribed high strength opioids for chronic non-cancer pain : an explorative intervention development study

Funding: This project was funded/supported by a research bursary from NHS Fife R&D&I department.Introduction: Despite opioid prescribing for chronic non-cancer pain (CNCP) having limited therapeutic benefits, recent evidence indicates significant increases in the prescribing of high-strength opioids for individuals with CNCP. Patients prescribed opioids for CNCP have overdose risk factors but generally have low opioid overdose awareness and low perceptions of risk related to prescribed opioids. Currently there are few bespoke overdose prevention resources for this group. Methods: This qualitative study investigated views on a naloxone intervention for people prescribed high-strength opioids for CNCP delivered via community pharmacies. The intervention included overdose risk awareness and naloxone training and provision. Interviews were conducted with eight patients, four family members, and two community pharmacists. Participants were convenience sampled and recruited through networks within the Scottish pain community. The Framework approach was used to analyse findings. Results: All participants had positive attitudes towards the intervention, but patients and family members considered risk of overdose to be very low. Three themes were identified: potential advantages of the intervention; potential barriers to the intervention; and additional suggestions and feedback about the intervention. Advantages included the intervention providing essential overdose information for CNCP patients. Barriers included resource and time pressures within community pharmacies. Discussion and conclusion: While patients had low overdose knowledge and did not see themselves as being at risk of opioid overdose, they were receptive to naloxone use and positive about the proposed intervention. A feasibility trial is merited to further investigate how the intervention would be experienced within community pharmacy settings.Publisher PDFPeer reviewe

Comparison of different cardiovascular risk tools used in HIV patient cohorts in sub-Saharan Africa; do we need to include laboratory tests?

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death globally, representing 31% of all global deaths. HIV and long term anti-retroviral therapy (ART) are risk factors for development of CVD in populations of people living with HIV (PLHIV). CVD risk assessment tools are currently being applied to SSA populations, but there are questions about accuracy as well as implementation challenges of these tools in lower resource setting populations. We aimed to assess the level of agreement between the various cardiovascular screening tools (Data collection on Adverse effects of anti-HIV Drugs (D:A:D), Framingham risk score, WHO risk score and The Atherosclerotic Cardiovascular Disease Score) when applied to an HIV ART experienced population in Sub-Saharan Africa. METHODS: This study was undertaken in an Anti-Retroviral Long Term (ALT) Cohort of 1000 PLHIV in care who have been on ART for at least 10 years in urban Uganda. A systematic review was undertaken to find the most frequently used screening tools from SSA PLHIV populations; these were applied to the ALT cohort. Levels of agreement between the resulting scores (those including lipids and non-lipids based, as well as HIV-specific and non-HIV specific) as applied to our cohort were compared. Prevalence Bias Adjusted Kappa was used to evaluate agreement between tools. RESULTS: Overall, PLHIV in ALT cohort had a median score of 1.1-1.4% risk of a CVD event over 5 years and 1.7-2.5% risk of a CVD event over 10 years. There was no statistical difference in the risk scores obtained for this population when comparing the different tools, including comparisons of those with lipids and non-lipids, and HIV specific vs non-HIV specific. CONCLUSION: The various tools yielded similar results, but those not including lipids are more feasible to apply in our setting. Long-term cohorts of PLHIV in SSA should in future provide longitudinal data to evaluate existing CVD risk prediction tools for these populations. Inclusion of HIV and ART history factors to existing scoring systems may improve accuracy without adding the expense and technical difficulty of lipid testing

Chronic pain, prescribed opioids and overdose risk: a qualitative exploration of the views of affected individuals and family members

It has been estimated that chronic non cancer pain (CNCP) affects more than 30% of people worldwide. Correspondingly, prescriptions for individuals experiencing CNCP have increased in recent years. While opioids can minimize pain, they also pose a risk of overdose. In 2019 in Scotland, prescription analgesics contributed to, or were implicated in, approximately 19% of drug related deaths. The experiences of those prescribed opioids for CNCP and family members, particularly their perceptions of overdose risk, are under-explored in the literature. This study aimed to address this gap by exploring how individuals and family members perceive the issue of overdose in relation to opioid analgesics, and their views of overdose prevention and potential interventions. Lived experiences from 12 individuals and family members living in Scotland were shared via in-depth qualitative interviews and analysed using NVivo and Framework. Coding was iterative and deductive. Analysis generated five themes: (1) living with pain and experiencing stigma; (2) taking more medication than prescribed; (3) side effects of medication; (4) overdose risk and prevention: the role of prescribers; and (5) attitudes towards naloxone to address overdose risk. Study findings have implications for the development of interventions and broader responses to reduce overdose risk among this group

Quantifying prescribed high dose opioids in the community and risk of overdose

BackgroundOpioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. This study described and quantified the prescribing of strong opioids, comorbidities and other overdose risk factors among those prescribed strong opioids, and factors associated with high/very high opioid dosage in a regional health authority in Scotland as part of a wider service improvement exercise.MethodsParticipating practices ran searches to identify patients prescribed strong opioids and their characteristics, polypharmacy, and other overdose risk factors. Data were anonymised before being analysed at practice and patient-level. Morphine Equivalent Doses were calculated for patients based on drug/dose information and classed as Low/Medium/High/Very High. Descriptive statistics were generated on the strong opioid patient population and overdose risk factors. The relationship between the prescribing of strong opioids and practice/patient-level factors was investigated using linear and logistic regression models.ResultsEighty-five percent (46/54) of GP practices participated. 12.4% (42,382/341,240) of individuals in participating practices were prescribed opioids and, of these, one third (14,079/42,382) were prescribed strong opioids. The most common comorbidities and overdose risk factors among strong opioid recipients were pain (67.2%), cardiovascular disease (43.2%), and mental health problems (39.3%). There was a positive significant relationship between level of social deprivation among practice caseload and level of strong opioid prescribing (p?<?0.001). People prescribed strong opioids tended to be older (mean 59.7?years) and female (8638, 61.4%) and, among a subset of patients, age, gender and opioid drug class were significantly associated with prescribing of High/Very High doses.ConclusionsOur findings have identified a large population at potential risk of prescription opioid overdose. There is a need to explore pragmatic models of tailored interventions which may reduce the risk of overdose within this group and clinical practice may need to be tightened to minimise overdose risk for individuals prescribed high dose opioids

Chronic pain, prescribed opioids and overdose risk: a qualitative exploration of the views of affected individuals and family members

It has been estimated that chronic non cancer pain (CNCP) affects more than 30% of people worldwide. Correspondingly, prescriptions for individuals experiencing CNCP have increased in recent years. While opioids can minimize pain, they also pose a risk of overdose. In 2019 in Scotland, prescription analgesics contributed to, or were implicated in, approximately 19% of drug related deaths. The experiences of those prescribed opioids for CNCP and family members, particularly their perceptions of overdose risk, are under-explored in the literature. This study aimed to address this gap by exploring how individuals and family members perceive the issue of overdose in relation to opioid analgesics, and their views of overdose prevention and potential interventions. Lived experiences from 12 individuals and family members living in Scotland were shared via in-depth qualitative interviews and analysed using NVivo and Framework. Coding was iterative and deductive. Analysis generated five themes: (1) living with pain and experiencing stigma; (2) taking more medication than prescribed; (3) side effects of medication; (4) overdose risk and prevention: the role of prescribers; and (5) attitudes towards naloxone to address overdose risk. Study findings have implications for the development of interventions and broader responses to reduce overdose risk among this group