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Miles Bore,1 Brian Kelly,2 Balakrishnan Nair2 1School of Psychology, 2School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Purpose: Research has consistently found that the proportion of medical students who experience high levels of psychological distress is significantly greater than that found in the general population. The aim of our research was to assess the levels of psychological distress more extensively than has been done before, and to determine likely predictors of distress and well-being. Subjects and methods: In 2013, students from an Australian undergraduate medical school (n=127) completed a questionnaire that recorded general demographics, hours per week spent studying, in paid work, volunteer work, and physical exercise; past and current physical and mental health, social support, substance use, measures of psychological distress (Kessler Psychological Distress Scale, depression, anxiety, stress, burnout); and personality traits. Results: Females were found to have higher levels of psychological distress than males. However, in regression analysis, the effect of sex was reduced to nonsignificance when other variables were included as predictors of psychological distress. The most consistent significant predictors of our 20 indicators of psychological distress were social support and the personality traits of emotional resilience and self-control. Conclusion: The findings suggest that emotional resilience skills training embedded into the medical school curriculum could reduce psychological distress among medical students. Keywords: medical student, well-being, psychological distress, personality

Prakash Peddi,1 Bhavna Paryani,2 Amol Takalkar,2 Paige Bundrick,3 John Ponugupati,4 Binu Nair,5 Hazem El-Osta1 1Department of Medicine, Division of Hematology-Oncology, 2Department of Radiology, 3Department of Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, 4Oncology Department, Herbert J Thomas Memorial Hospital, South Charleston, WV, 5Baylor Scott & White Medical Center - Waxahachie, Waxahachie, TX, USA Background: Metastatic head and neck squamous cell carcinoma (HNSCC) carries a very poor prognosis. A better understanding of the molecular driver of the disease and the identification of biomarkers of response remain paramount for an effective personalized therapy. Case report: We report an original case of a 56-year-old patient diagnosed with metastatic HNSCC to both kidneys, who experienced a long-lasting complete response to a single-agent cetuximab, a monoclonal antibody-targeting EGFR. Comprehensive multiplatform biomarker analysis of the tumor revealed the presence of phosphatidyl-inositol 3 kinase mutation, EGFR overexpression, and the absence of PD-1/PD-L1 expression. Since PI3K, a downstream effector of EGFR, is activated, the tumor regression may have occurred mainly through a cetuximab-induced immune-mediated response, rather than EGFR signal blockade. It is plausible that this effect was enhanced by the lack of PD-1 and PD-L1 expression. Conclusion: Our case proposes that the absence of PD-1 and PD-L1 expression in conjunction with EGFR overexpression may correlate with better response to cetuximab in HNSCC. This hypothesis needs to be examined through a large clinical trial. Keywords: biomarker, cetuximab, EGFR blockade, exceptional response, head and neck squamous cell carcinoma

Paul Regal, Balakrishnan Nair, Eileen Hetherington Geriatric Medicine and Gerontology, University of Newcastle, Callaghan, NSW, Australia Background: The purpose of this study was to compare apolipoprotein E ε4 (Apo E ε4) and apolipoprotein E ε2 (Apo E ε2) as predictors of cognitive and functional trajectories over 30 months. Methods: This prospective cohort study included 287 community-dwelling memory clinic patients with dementia, mild cognitive impairment, or no cognitive impairment. The Addenbrooke Cognitive Assessment, Mini-Mental State Examination, Montreal Cognitive Assessment, Delirium Index, and Nottingham Instrumental Activities of Daily Living tests were administered to each subject. Results: One hundred and nine subjects (40%) carried Apo E ε4 and 48 (16.7%) carried Apo E ε2. One hundred and nine ε4-positive subjects differed significantly from 178 ε4-negative subjects in 19/52 comparisons (36.5%), whereas 46 Apo E ε2-positive subjects had 0/52 significant differences from 239 ε2-negative subjects (P < 0.0001). The variables most affected by ε4 were the Delirium Index and Mini-Mental State Examination. Instrumental Activities of Daily Living score and residence were unrelated to Apo E ε4 or ε2. Conclusion: Apo E ε4 positivity predicted four cognitive scores measured every 6 months over 30 months. Apo E ε2 scores predicted none of 52 comparisons. Keywords: apolipoprotein E genotype, dementia, mild cognitive impairment

Heat pumps based on magnetocaloric and electrocaloric working bodies--in which entropic phase transitions are driven by changes of magnetic and electric field, respectively--use displaceable fluids to establish relatively large temperature spans between loads to be cooled and heat sinks.sup.1,2. However, the performance of prototypes is limited because practical magnetocaloric working bodies driven by permanent magnets.sup.3-5 and electrocaloric working bodies driven by voltage.sup.6-16 display temperature changes of less than 3 kelvin. Here we show that high-quality multilayer capacitors of PbSc.sub.0.5Ta.sub.0.5O.sub.3 display large electrocaloric effects over a wide range of starting temperatures when the first-order ferroelectric phase transition is driven supercritically (as verified by Landau theory) above the Curie temperature of 290 kelvin by electric fields of 29.0 volts per micrometre. Changes of temperature in the large central area of the capacitor peak at 5.5 kelvin near room temperature and exceed 3 kelvin for starting temperatures that span 176 kelvin (complete thermalization would reduce these values from 5.5 to 3.3 kelvin and from 176 to 73 kelvin). If magnetocaloric working bodies were to be replaced with multilayer capacitors of PbSc.sub.0.5Ta.sub.0.5O.sub.3, then the established design principles behind magnetocaloric heat pumps could be repurposed for better performance without bulky and expensive permanent magnets. High-quality multilayer capacitors of a perovskite oxide show that large electric-field-driven caloric effects could improve solid-state refrigeration technology and challenge today's standard (based on magnetocaloric effects in gadolinium)., Author(s): B. Nair [sup.1] , T. Usui [sup.2] , S. Crossley [sup.1] , S. Kurdi [sup.1] , G. G. Guzmán-Verri [sup.1] [sup.3] [sup.4] , X. Moya [sup.1] , S. Hirose [...]

In ultraviolet (UV) astronomical observations, photons from the sources are very few compared to the visible or infrared (IR) wavelength ranges. Detectors operating in the UV usually employ a photon-counting mode of operation. These detectors usually have an image intensifier sensitive to UV photons and a readout mechanism that employs photon counting. The development of readouts for these detectors is resource-intensive and expensive. In this paper, we describe the development of a low-cost UV photon-counting detector processing unit that employs a Raspberry Pi (RPi) with its built-in readout to perform the photon-counting operation. Our system can operate in both 3 × 3 and 5 × 5 window modes at 30 frames per second (fps). The system can be built quickly from readily available custom-off-the-shelf (COTS) components and is thus used in inexpensive CubeSats or small satellite missions. [ABSTRACT FROM AUTHOR]

Elizabeth Whiting,1– 3 A Curtis Lee,4 Balakrishnan R Nair5,6 1Cross College Examination Review Advisory Group, Royal Australasian College of Physicians, Sydney, NSW, Australia; 2Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia; 3Internal Medicine Services, The Prince Charles Hospital, Brisbane, Qld, Australia; 4School of Medicine, University of Notre Dame, Sydney, NSW, Australia; 5School of Medicine, University of Newcastle, Newcastle, NSW, Australia; 6Centre for Medical Professional Development, Hunter New England Local Health District, Newcastle, NSW, AustraliaCorrespondence: Elizabeth Whiting, Internal Medicine Services, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Queensland, 4032, Australia, Tel +61 419730908, Email elizabeth.whiting@health.qld.gov.auPurpose: The Royal Australasian College of Physicians (RACP) oversees physician training across Australia and Aotearoa New Zealand. Success in a written examination and clinical skills assessment (known as the clinical examination) at the mid-point of training is a requirement to progress from basic to advanced training. The clinical examination had evolved over many years without a review process. This paper describes the approach taken, the changes made and the evaluation undertaken as part of a formal review.Methods: A working party that included education experts and examiners experienced in the assessment of clinical skills was established. The purpose of the clinical examination and competencies being assessed were clarified and were linked to learning objectives. Significant changes to the marking and scoring approaches resulted in a more holistic approach to the assessment of candidate performance with greater transparency of standards. Evaluation over a 2-year period was undertaken before the adoption of the new approach in 2019.Results: In 2017 testing of a new marking rubric occurred during the annual examination cycle which confirmed feasibility and acceptability. The following year an extensive trial utilising the new marking rubric and a new scoring approach took place involving 1142 examiners, 880 candidates and 5280 scoresheets which led to some minor modifications to the scoring system. The final marking and scoring approaches resulted in unchanged pass rates and improved inter-rater reliability. Feedback from examiners confirmed that the new marking and scoring approaches were easier to use and enabled better feedback on performance for candidates.Conclusion: The refresh of the RACP clinical examination has resulted in an assessment that has clarity of purpose, is linked to learning objectives, has greater transparency of expected standards, has improved inter-rater reliability, is well accepted by examiners and enables feedback on examination performance to candidates.Keywords: physician assessment, reliability, clinical assessment, long case, short case

Balakrishnan R Nair,1 Joyce MW Moonen - van Loon,2 Marion van Lierop,3 Marjan Govaerts2 1University of Newcastle, Centre for Medical Professional Development, Newcastle, Australia; 2School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; 3Department of Family Medicine, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the NetherlandsCorrespondence: Joyce MW Moonen - van Loon; Balakrishnan R Nair, Email j.moonen@maastrichtuniversity.nl; kichu.nair@newcastle.edu.auIntroduction: Current assessment approaches increasingly use narratives to support learning, coaching and high-stakes decision-making. Interpretation of narratives, however, can be challenging and time-consuming, potentially resulting in suboptimal or inadequate use of assessment data. Support for learners, coaches as well as decision-makers in the use and interpretation of these narratives therefore seems essential.Methods: We explored the utility of automated text analysis techniques to support interpretation of narrative assessment data, collected across 926 clinical assessments of 80 trainees, in an International Medical Graduates’ licensing program in Australia. We employed topic modelling and sentiment analysis techniques to automatically identify predominant feedback themes as well as the sentiment polarity of feedback messages. We furthermore sought to examine the associations between feedback polarity, numerical performance scores, and overall judgments about task performance.Results: Topic modelling yielded three distinctive feedback themes: Medical Skills, Knowledge, and Communication & Professionalism. The volume of feedback varied across topics and clinical settings, but assessors used more words when providing feedback to trainees who did not meet competence standards. Although sentiment polarity and performance scores did not seem to correlate at the level of single assessments, findings showed a strong positive correlation between the average performance scores and the average algorithmically assigned sentiment polarity.Discussion: This study shows that use of automated text analysis techniques can pave the way for a more efficient, structured, and meaningful learning, coaching, and assessment experience for learners, coaches and decision-makers alike. When used appropriately, these techniques may facilitate more meaningful and in-depth conversations about assessment data, by supporting stakeholders in interpretation of large amounts of feedback. Future research is vital to fully unlock the potential of automated text analysis, to support meaningful integration into educational practices.Keywords: programmatic assessment, narrative feedback, learning analytics, text mining, international medical graduates