Basic essential education program (BEEP): a brief introductory faculty development course for medical teachers

Background: Physicians have a unique role in teaching future physicians and allied health professionals. Yet, most medical doctors have limited instruction in this critical component of their daily activity. Methods: This study was a prospective cohort study of the effectiveness of a local teaching program at two teaching hospitals for junior faculty. Based on a needs analysis and literature review, the teaching program was developed in an accessible and compact format of six consecutive, one-hour "lunch and learn" sessions, held locally over a six week period. Pre-post questionnaires and focus groups were used to evaluate the program. Results: Participants reported being satisfied with the course as whole, particularly in respect to the format and location. There was an improvement in their knowledge in all content areas covered. The greatest benefits were derived from fostering a community of practice and having the opportunity to role play and simulate teaching skills. An attitudinal change towards teaching was noted. Conclusions: A brief, local faculty development program was effective in enhancing physicians’ knowledge, skills, and attitudes in teaching

A Self-Learning MAC Protocol for Energy Harvesting and Spectrum Access in Cognitive Radio Sensor Networks

The fusion of Wireless Sensor Networks (WSNs) and Cognitive Radio Networks (CRNs) into Cognitive Radio Sensor Networks (CRSNs) is quite an attractive proposal, because it allows a distributed set of low-powered sensor nodes to opportunistically access spectrum bands that are underutilized by their licensed owners (called primary users (PUs)). In addition, when the PUs are actively transmitting in their own bands, sensor nodes can switch to energy harvesting mode to obtain their energy needs (for free), to achieve almost perpetual life. In this work, we present a novel and fully distributed MAC protocol, called S-LEARN, that allows sensor nodes in a CRSN to entwine their RF energy harvesting and data transmission activities, while intelligently addressing the issue of disproportionate difference between the high power necessary for the node to transmit data packets and the small amount of power it can harvest wirelessly from the environment. The presented MAC protocol can improve both the network throughput and total harvested energy, while being robust to changes in the network configuration. Moreover, S-LEARN can keep the cost of the system low, and it avoids the pitfalls from which centralized systems suffer

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Sensing Device Management for History-Based Spectrum Sharing in Cognitive Radio Networks

A novel approach to managing a fully distributed cognitive radio network (CRN) is presented. This approach builds on the concept of history-based spectrum access, in which cognitive base stations (BSs) independently estimate the system load using history records and adaptively swap their occupied spectrum bands to ensure allocation fairness and high overall throughput. In addition, cognitive BSs monitor primary user (PU) behavior in order to avoid interfering with active PUs. In this work, we address two issues that afflict history-based access: the first is the high cost of the sensing devices needed at each cognitive BS to be able to independently draw conclusions about the status of the CRN and the second is the unreliability inherent in practical sensing hardware (such as energy detectors). Simulation results show that the proposed technique manages to solve the two abovementioned issues without any noticeable drop in performance and without sacrificing the distributed nature of the protocol

A Self-Learning MAC Protocol for Energy Harvesting and Spectrum Access in Cognitive Radio Sensor Networks

The fusion of Wireless Sensor Networks (WSNs) and Cognitive Radio Networks (CRNs) into Cognitive Radio Sensor Networks (CRSNs) is quite an attractive proposal, because it allows a distributed set of low-powered sensor nodes to opportunistically access spectrum bands that are underutilized by their licensed owners (called primary users (PUs)). In addition, when the PUs are actively transmitting in their own bands, sensor nodes can switch to energy harvesting mode to obtain their energy needs (for free), to achieve almost perpetual life. In this work, we present a novel and fully distributed MAC protocol, called S-LEARN, that allows sensor nodes in a CRSN to entwine their RF energy harvesting and data transmission activities, while intelligently addressing the issue of disproportionate difference between the high power necessary for the node to transmit data packets and the small amount of power it can harvest wirelessly from the environment. The presented MAC protocol can improve both the network throughput and total harvested energy, while being robust to changes in the network configuration. Moreover, S-LEARN can keep the cost of the system low, and it avoids the pitfalls from which centralized systems suffer

Food Addiction Is Associated with Binge Eating and Psychiatric Distress among Post-Operative Bariatric Surgery Patients and May Improve in Response to Cognitive Behavioural Therapy

The current study examined clinical correlates of food addiction among post-operative bariatric surgery patients, compared the clinical characteristics of patients with versus without food addiction, and examined whether a brief telephone-based cognitive behavioural therapy (Tele-CBT) intervention improves food addiction symptomatology among those with food addiction. Participants (N = 100) completed measures of food addiction, binge eating, depression, and anxiety 1 year following bariatric surgery, were randomized to receive either Tele-CBT or standard bariatric post-operative care, and then, repeated the measure of food addiction at 1.25 and 1.5 years following surgery. Thirteen percent of patients exceeded the cut-off for food addiction at 1 year post-surgery, and this subgroup of patients reported greater binge eating characteristics and psychiatric distress compared to patients without food addiction. Among those with food addiction, Tele-CBT was found to improve food addiction symptomatology immediately following the intervention. These preliminary findings suggest that Tele-CBT may be helpful, at least in the short term, in improving food addiction symptomatology among some patients who do not experience remission of food addiction following bariatric surgery; however, these findings require replication in a larger sample