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Water plays a vital role in defending the contagious diseases globally, leading to continual increase in demand of water. The increase in demand in turn reduces the fresh water availability. To meet this water demand desalination technologies can be used for fresh water production from seawater. Passive solar distillation techniques are the simplest and favourable, as they use sustainable renewable solar energy as a source. Rate of evaporation and rate of condensation are the major influencing factors which have a direct impact on distillate yield. Single basin single slope conventional solar still (CSS) and single basin single slope solar still with inbuilt condenser and agitator (SSICA) were designed and fabricated for the current study. Both the stills were tested under same ambient condition to compare the performance. Through experimental results, it was found that SSICA had 98.69% more productivity than CSS. The agitating effect caused by agitator in SSICA led to increase in rate of evaporation. The increase in condensing area for same evaporation area of SSICA improved the condensation rate. These two synergized effects resulted in overall performance improvement of SSICA over CSS. Energy analysis revealed that SSICA is 24.42% more efficient than CSS. Exergy efficiency of SSICA and CSS were calculated as 4.82% and 2.04% respectively.

Background Charcot–Marie–Tooth disease type 4F (CMT4F) is an autosomal recessive disorder with symptoms presenting in early adulthood. This clinical case series demonstrates atypical findings in cervical and ocular vestibular evoked myogenic potentials (VEMP) in siblings with CMT4F. Purpose The aim of this study was to highlight the audiovestibular test findings in CMT4F. Research Design Case series study sample: 4 siblings, 3 of whom diagnosed with CMT4F. Data Collection and Analysis Audiological test battery and electrophysiological tests comprising auditory brainstem response (ABR) and VEMP (both cervical and ocular) were performed in our patient population. Results Older siblings, in whom the hearing loss was present, manifested prolonged peak V latencies in ABR. Three out of four siblings with CMT4F showed prolongation of latencies on cervical and ocular VEMP. Conclusions In many neurodegenerative conditions, prolongation of ABR peak latencies has often been reported in the literature. There have also been a few reports of prolonged VEMP peak latencies. This article reports prolongation of only VEMP peak latencies (in both cervical and ocular recordings). The youngest sibling had prolongation of VEMP latencies, with ABR peak latencies being normal. The assumption we put forth that CMT4F may affect the vestibular pathway first requires to be tested on a larger sample and by longitudinally studying the individuals with disease condition.

Purpose: Susac syndrome (SS) is a rare autoimmune disorder that affects the brain and the retina and causes unilateral or bilateral sensorineural hearing loss. Although vestibular dysfunction is reported in SS, limited information is available underlying the vestibular pathophysiology. Method: The diagnosis of SS was established based on symptoms and diagnostic tools such as magnetic resonance imaging and fundus fluorescein angiography. The audiovestibular evaluation was done on the seventh day of admission (Session 1) into the emergency unit, whereas the second and third evaluations were done at 3-month (Session 2) and 8-month (Session 3) follow-ups after discharge, respectively. The audiovestibular test battery consisted of routine audiological tests, auditory brainstem response, and vestibular evoked myogenic potentials (VEMPs; both cervical and ocular). Results: We found unilateral sensorineural hearing loss and absent cervical VEMPs(cVEMPs) when testing the left ear during Session 1. In the following sessions, the unilateral hearing loss did not recover; however, cVEMPs were present bilaterally. The ocular VEMPs showed an increase in amplitude during Sessions 2 and 3. Conclusions: SS can selectively disrupt auditory and vestibular structures. It may present with unique findings of audiovestibular tests. A detailed audiovestibular evaluation may be essential in patients with SS. Supplemental Material: https://doi.org/10.23641/asha.21513843

Purpose Social determinants of health (SDH) are recognized as important factors that affect health and well-being. Medical schools are encouraged to incorporate the teaching of SDH. This study investigated the level of commitment to teaching SDH; learning objectives/goals regarding student knowledge, skills, and attitudes; location in the curriculum and teaching strategies; and perceived barriers to teaching SDH. Methods A team from the American Medical Association's Accelerating Change in Medical Education Consortium developed a 23-item inventory survey to document consortium school SDH curricula. The 32 consortium schools were invited to participate. Results Twenty-nine (94%) schools responded. Most respondents indicated the teaching of SDH was low priority (10, 34%) or high priority (12, 41%). Identified learning objectives/goals for student knowledge, skills, and attitudes regarding SDH were related to the importance of students developing the ability to identify and address SDH and recognizing SDH as being within the scope of physician practice. Curricular timing and teaching strategies suggested more SDH education opportunities were offered in the first and second undergraduate medical education years. Barriers to integrating SDH in curricula were identified: addressing SDH is outside the realm of physician responsibility, space in curriculum is limited, faculty lack knowledge and skills to teach material, and concepts are not adequately represented on certifying examinations. Conclusion Despite the influence of SDH on individual and population health, programs do not routinely prioritize SDH education on par with basic or clinical sciences. The multitude of learning objectives and goals related to SDH can be achieved by increasing the priority level of SDH and employing better teaching strategies in all years. The discordance between stated objectives/goals and perceived barriers, as well as identification of the variety of strategies utilized to teach SDH during traditional "preclinical" years, indicates curricular areas in need of attention.

Phenomenon: Chronic disease is a leading cause of death and disability in the United States. With an increase in the demand for healthcare and rising costs related to chronic care, physicians need to be better trained to address chronic disease at various stages of illness in a collaborative and cost-effective manner. Specific and measurable learning objectives are key to the design and evaluation of effective training, but there has been no consensus on chronic disease learning objectives appropriate to medical student education. Approach: Wagner's Chronic Care Model (CCM) was selected as a theoretical framework to guide development of an enhanced chronic disease prevention and management (CDPM) curriculum. Findings of a literature review of CDPM competencies, objectives, and topical statements were mapped to each of the six domains of the CCM to understand the breadth of existing learning topics within each domain. At an in-person meeting, medical educators prepared a survey for the modified Delphi approach. Attendees identified 51 possible learning objectives from the literature review mapping, rephrased the CCM domains as competencies, constructed possible CDPM learning objectives for each competency with the goal of reaching multi-institutional consensus on a limited number of CDPM learning objectives that would be feasible for institutions to use to guide enhancement of medical student curricula related to CDPM. After the meeting, the group developed a survey which included 39 learning objectives. In the study phase of the modified Delphi approach, 32 physician CDPM experts and educators completed an online survey to prioritize the top 20 objectives. The next step occurred at a CDPM interest group in-person meeting with the goal of identifying the top 10 objectives. Findings: The CCM domains were reframed as the following competencies for medical student education: patient self-care management, decision support, clinical information systems, community resources, delivery systems and teams, and health system practice and improvement. Eleven CDPM learning objectives were identified within the six competencies that were most important in developing curriculum for medical students. Insights: These learning objectives cut across education on the prevention and management of individual chronic diseases and frame chronic disease care as requiring the health system science competencies identified in the CCM. They are intended to be used in combination with traditional disease-specific pathophysiology and treatment objectives. Additional efforts are needed to identify specific curricular strategies and assessment tools for each learning objective.

Objective: Pilocytic astrocytoma commonly occurs in children and depending on the extension of the lesion may cause varied audiovestibular dysfunctions. However, audiovestibular findings are scarce...

Breast cancer is one of the leading causes of death in women worldwide. Around one in 30 women are affected by breast cancer. Mammography has helped in detecting breast cancer in the early stages which have reduced mortality. The diagnosis of breast cancer is dependent on a variety of parameters. In this paper, we aim to create the best model for predicting breast cancer through preprocessing, feature extraction, data visualization and prediction using breast cancer data. Various visualization techniques like violin plot, grid plot, swarm plot and heat plot were utilized for proper feature extraction which has improved the accuracy of our results. For the purpose of prediction, we have used algorithms like the random forest, decision tree with single and multiple predictors, along with the commonly used statistical model, logistic regression model. We have also relied on 5-fold cross-validation methods to measure the unbiasedness of the prediction models for performance reasons. An analysis of the models was carried out and the best model was selected based on its accuracy. The results showcased that the random forest model provided an accuracy rate of 94.724% with decent 5-fold cross-validation, followed by the decision tree model which had an accuracy rate of 100% with poor 5-fold cross-validation. This was followed by the logistic regression model which had an accuracy rate of 88.442% with a low 5-fold cross-validation score.

The new generation thermoelectric material research warrants novel composition tailoring and advanced processing to explore the commendable thermoelectric properties. In this context, the multi-component alloy design with engineered configuration entropy and band tuning approach is proposed for the nanocrystalline lead tin selenide telluride (PbSnTeSe) high entropy alloy (HEA) with sodium (Na) doping of concentrations 0.01 at.% and 0.02 at.% at different vacancy sites of Pb and Sn. The HEA samples were synthesized via mechanical alloying (MA) and spark plasma sintering (SPS). The first principle study using virtual crystal approximation (VCA) confirms that Na occupies Pb/Sn substitutional doping sites in the PbSnTeSe HEA. The complex chemical gradient tailoring through high entropy stabilization and nanostructuring favors the low thermal conductivity (

With evidence on gaps between expectations of entering residents and their performance in both medication ordering and prescription writing, our study is an attempt to document the extent to which related topics are being covered in undergraduate medical education. Results received from an online survey conducted through the American Medical Student Association found that a high percentage of clinical year students had little or no experience in writing or ordering prescriptions. Our results suggest that there is a lack of adequate coverage of these topics and this, at least partly, could explain the higher medication errors among entering residents.

Hypoglycemia is a significant complication of intensive diabetes therapy, a true medical emergency, which requires prompt recognition and treatment to prevent organ and brain damage. Therefore, knowledge about diabetes can play an important role in maintaining glycemia control and prevent hypoglycemic complications. Aim: The aim of the study is to develop and assess the impact of patient information leaflets to prevent hypoglycemia in outpatients with type 2 diabetes mellitus and to study the effect of prescribed drugs pattern in patients. Material & Methods: This open labelled, interventional study was conducted in the endocrinology Out Patient Department (OPD) in a tertiary care hospital over a period of 9 months in 55 patients. The information was provided to patients through a developed patient information leaflet and their awareness and glycemic status were assessed by an internally institution developed vernacular language based validated questionnaire. The questionnaire with four different dimensions patient knowledge, glycemic control, compliance and life style was quantified in the study. Results: The study showed statistically significant (P

Purpose To describe the breadth of strategies U.S. medical schools use to promote medical student well-being. Method In October 2016, 32 U.S. medical schools were surveyed about their student well-being initiatives, resources, and infrastructure; grading in preclinical courses; and learning communities. Results Twenty-seven schools (84%) responded. Sixteen (59%) had a student well-being curriculum, with content scheduled during regular curricular hours at most (13/16; 81%). These sessions were held at least monthly (12/16; 75%), and there was a combination of optional and mandatory attendance (9/16; 56%). Most responding schools offered a variety of emotional/spiritual, physical, financial, and social well-being activities. Nearly one-quarter had a specific well-being competency (6/27; 22%). Most schools relied on participation rates (26/27; 96%) and student satisfaction (22/27; 81%) to evaluate effectiveness. Sixteen (59%) assessed student well-being from survey data, and 7 (26%) offered students access to self-assessment tools. Other common elements included an individual dedicated to overseeing student well-being (22/27; 82%), a student well-being committee (22/27; 82%), pass/fail grading in preclinical courses (20/27; 74%), and the presence of learning communities (22/27; 81%). Conclusions Schools have implemented a broad range of well-being curricula and activities intended to promote self-care, reduce stress, and build social support for medical students, with variable resources, infrastructure, and evaluation. Implementing dedicated well-being competencies and rigorously evaluating their impact would help ensure appropriate allocation of time and resources and determine if well-being strategies are making a difference. Strengthening evaluation is an important next step in alleviating learner distress and ultimately improving student well-being.

Context Temporal lobe epilepsy can affect central auditory processing (CAP) skills. Auditory temporal ordering (ATO) is a CAP skill that can be evaluated using duration pattern test (DPT). Aim The aim is to evaluate ATO in patients with medial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (MTLE + HS) and without hippocampal sclerosis (MTLE-HS) and in their subgroups. Settings and design It was a prospective cross-sectional behavioral observational study conducted in a tertiary neuropsychiatric hospital. Subjects and methods The subjects were patients with refractory MTLE (N = 100), comprising 50 "MTLE + HS" patients and 50 "MTLE-HS". Age-range matched normal healthy subjects (n = 50) formed the control group. Both groups were administered duration pattern test (DPT). Statistical analysis used Analysis of variance (ANOVA) with post hoc analysis, Dunnett's two-sided and Bonferroni, paired sample t-test, Pearson's correlation, and independent t-test. Results The clinical groups performed significantly poorer than the control group, and however, did not differ significantly between them. The age at onset and the duration of the seizures did not have significant relation with the test measures. Conclusions Patients with "MTLE + HS" as well as those with "MTLE-HS" and their respective subgroups revealed abnormal ATO indicating CAP dysfunction.

Schwannoma of the hypoglossal nerve is rare. This case report documents an atypical abnormality of the cervical vestibular evoked myogenic potential (cVEMP) in a patient with schwannoma of the hypoglossal nerve. The observed abnormality was attributed to the proximity of the hypoglossal nerve to the spinal accessory nerve in the medullary cistern and base of the skull.To report cVEMP abnormality in a patient with hypoglossal nerve schwannoma and provide an anatomical correlation for this abnormality.Case report.A 44-yr-old woman.Pure-tone and speech audiometry, tympanometry, acoustic stapedial reflex, auditory brainstem response, and cVEMP testing were performed.The audiological test results were normal except for the absence of cVEMP on the lesion side (right).A cVEMP abnormality indicating a compromised spinal accessory nerve was observed in a patient with hypoglossal nerve schwannoma. This case report highlights the importance of recording cVEMP in relevant neurological conditions and provides clinical proof for the involvement of the spinal accessory nerve in the vestibulocollic reflex pathway.

Introduction: Azithromycin usage in patients with baseline cardiovascular risk is associated with increased risk of cardiovascular mortality, following which Food and Drug Administration (FDA) issued a black box warning regarding safety of azithromycin in patients with cardiovascular morbidity particularly with prolonged QTc. Cetirizine is a second generation anti histaminic and is found to be commonly used for Upper Respiratory Tract Infections (URIs) along with azithromycin on outpatient basis. Whether, usage of these two drugs in combination confers a similar risk, is unknown. Aim: To assess the effect on QTc among patients treated with azithromycin and cetirizine combination for upper respiratory tract infection. Materials and Methods: We conducted a prospective longitudinal study from August 2014 to July 2016. The study was done on 45 patients above 18 years of age without any cardiovascular morbidity in whom azithromycin and cetirizine were prescribed for upper respiratory tract infections. We compared the QTc on day 1 and day 4. Data was analysed using Student’s paired t-test. Results: During three days of azithromycin and cetirizine for upper respiratory tract infections, we observed that on day 4 there was significant increase in QTc in 43 patients (95.6%) as compared with the QTc on day 1. We also observed that in 8 (17.8%) out of 45 patients, QTc on day 4 crossed the upper limit of normal {430 milliseconds (ms)}, but this was not statistically significant. However, analysing these eight patients, we obtained the baseline QTc of 377.50 ms above which if prescribed, this combination of drugs have a chance of prolonging the QTc above 430 ms with a sensitivity of 87.5% and specificity of 40.5%. Conclusion: During three days treatment with azithromycin and cetirizine, there was significant change in QTc between day 1 and day 4. Patients with baseline QTc greater than 377.5 ms were at risk of QTc prolongation above 430 ms on day 4.

This article was migrated. The article was marked as recommended. The majority of health outcomes are determined by social determinants of health (SDOH) while medical care is responsible for as little as 20% of health outcomes. This article is an introduction to the Virtual Family (VF) approach to case based instruction; a novel strategy for addressing SDOH in medical school. The VF theoretical framework is presented and practical considerations and challenges for implementation of the VF approach at three different medical schools are offered. VFs are defined as representations of families or social groups that are not real. "Virtual," in this instance, refers to people or things that do not physically exist. The VF approach allows students and educators to adjust the "lens" of a case's focus to view the relevant determinants. The VF approach is presented as an extension of the virtual patient approach. Theoretical support for the VF approach is argued drawing on principles from modeling and simulation, effective story design, establishing a sense of human presence, serious gaming, visual design, identity leveraging, and flow theory. Challenges and benefits of the approach are described. Measures of efficacy designed to match learning goals are proposed. The VF approach is presented as practical, accessible, economical, and potentially powerful.

Prescribing is a fundamental part of the work of new residents, who write and review many prescriptions each day. It is a complex task requiring knowledge of medicines and the diseases they are used to treat, careful judgment of risks and benefits of treatment, and attention to detail. It is also apparent in other research that this is an area new residents find challenging. Lack of prescribing skills among residents has been widely reported. Granting these new doctors prescribing privileges without adequate assessment may encourage poor prescribing habits and promote medication errors. Following AAMC recommendations to implement medication safety learning activities, we created this session on prescription writing for undergraduate medical students. This session was formatted as a small-group session within a large classroom. The instructor's guide provides a step-by-step approach to implementing this session. The PowerPoint slides have been animated and notes added for each relevant slide to help faculty to make the best use of this resource. A handout with a set of five prescriptions that have commonly identified prescribing errors is intended for the first small-group activity. The second handout is a set of blank prescriptions that each student should be required to fill out at the end of the session. This session is offered at the end of the second year, right before the students embark on their clinical training. We have plans to do follow up sessions during their third and fourth years as well.

This interactive small-group session integrates microbiology of the respiratory tract with pharmacology (antimicrobials). It is intended as a review following lectures or interactive sessions in basic microbiology, respiratory microbiology, and antimicrobials. This integrated case-based microbiology and pharmacology session reinforces the basic concepts of respiratory microbiology with basic concepts of antimicrobial therapy. The cases require students to recall clinical presentations of various microbes, microbiology laboratory tests, and appropriate antimicrobials for treatment of specific pathogens. During the inaugural year of our curriculum, the students scored lower than anticipated on the microbiology and pharmacology sections of the respiratory course final exam. During the second year of our curriculum we aimed to remedy this and strengthen both disciplines with additional microbiology and pharmacology sessions, such as this. A comparison of final exam scores from the inaugural year and the second year of the respiratory course demonstrated a rise in scores for microbiology- and antimicrobial (pharmacology)-related questions.

A need for an alternative to the routine didactic format of lectures has always been appreciated by medical school faculties. This alternative is always expected to produce better learning outcomes and also suit that particular institution in terms of composition of students and the infrastructure available. The current study was designed to investigate the effectiveness of the hybrid model of case-based teaching by comparing it with the traditional didactic form of lecture delivery. The effectiveness was measured by a multiple choice question (MCQ) test, which served to assess the student learning outcome. The use of a hybrid model of case-based teaching methodology showed enhanced student academic performance compared to the traditional didactic lecture format. This performance with the hybrid model appeared to be independent of subject matter, student group composition, order and type of topics presented. Students appreciated the significance of clinical application of basic science concepts. This hybrid model does not require any additional man power or infrastructure and can be practiced in a large lecture hall setting. Based upon the subjective responses, students indicated that such a format allowed the students to appreciate the integration of information between theory and practice. We conclude that a hybrid educational format greatly improves the learning outcome in pharmacology, a typical basic science course. Future studies will be conducted to investigate if this trend is consistent with all basic science subjects.

The need for alternative and more productive teaching methods and materials that supplement the traditional lecture format is increasingly being emphasized in medical education. The new teaching tools should encourage students to interact with each other and also with the teachers and should enhance critical thinking. To help students understand and realize the importance of proper prescription writing and the magnitude of this problem, we developed this simple PowerPoint game based on the TV game show, 'Jeopardy'. At the end of the activity the students rated the activity highly and mentioned that they would like to have similar activities for other topics as well.

Hypoglycemia is a significant complication of intensive diabetes therapy, a true medical emergency, which requires prompt recognition and treatment to prevent organ and brain damage. Therefore, knowledge about diabetes can play an important role in maintaining glycemia control and prevent hypoglycemic complications. Aim: The aim of the study is to develop and assess the impact of patient information leaflets to prevent hypoglycemia in outpatients with type 2 diabetes mellitus and to study the effect of prescribed drugs pattern in patients. Material & Methods: This open labelled, interventional study was conducted in the endocrinology Out Patient Department (OPD) in a tertiary care hospital over a period of 9 months in 55 patients. The information was provided to patients through a developed patient information leaflet and their awareness and glycemic status were assessed by an internally institution developed vernacular language based validated questionnaire. The questionnaire with four different dimensions patient knowledge, glycemic control, compliance and life style was quantified in the study. Results: The study showed statistically significant (P, La hipoglucemia es una complicación importante de la terapia intensiva de la diabetes, una verdadera emergencia médica, que requiere un reconocimiento y tratamiento rápidos para prevenir el daño cerebral y de órganos. Por lo tanto, el conocimiento sobre la diabetes puede desempeñar un papel importante en el mantenimiento del control de la glucemia y prevenir las complicaciones hipoglucémicas. Objetivo: el objetivo del estudio es desarrollar y evaluar el impacto de los folletos de información al paciente para prevenir la hipoglucemia en pacientes ambulatorios con diabetes mellitus tipo 2 y estudiar el efecto del patrón de medicamentos recetados en los pacientes. Material y métodos: Este estudio abierto de intervención abierta se realizó en el Departamento de pacientes ambulatorios (OPD) de endocrinología en un hospital de atención terciaria durante un período de 9 meses en 55 pacientes. La información se proporcionó a los pacientes a través de un folleto de información al paciente y su conocimiento y estado glucémico se evaluaron mediante un cuestionario validado basado en el lenguaje vernáculo desarrollado internamente en una institución. El cuestionario con cuatro dimensiones diferentes de conocimiento del paciente, control glucémico, cumplimiento y estilo de vida se cuantificó en el estudio. Resultados: El estudio mostró una mejora, estadísticamente significativa (P, Fund granted by College management and the research work was approved for the award of Degree of Master of pharmacy by The Tamilnadu Dr.MGR Medical University, Chennai, India