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BackgroundTraditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning.MethodsThe intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted.ResultsLecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3-6, maintained at 31% through months 6-12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site.ConclusionWe demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. OBJECTIVE: To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. METHODS: A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18–40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. RESULTS: There was no significant difference between both groups pre-treatment (p > 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p < 0.05) in favor of the PNF group. CONCLUSION: Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this study was to investigate the effects of ujjayi pranayama on non-lethal problems and cardiorespiratory functions in women with systemic lupus erythematosus (SLE). Methods. This randomized controlled trial involved a home-based training of ujjayi pranayama for 6 weeks. Forty SLE women were randomly assigned to either the ujjayi-pranayama group (n = 20), who performed 30 min of ujjayi pranayama daily (15 min in the morning and evening), or the waitlist control group (n = 20). Various measures, including State-Trait Anxiety Inventory (STAI), cortisol, Stress Vulnerability Scale (SVS), Beck Depression Inventory II (BDI-II), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), pulse rate (Pul-r), respiratory rate (Res-r), systolic blood pressure (SBPr), and diastolic blood pressure (DBPr) were assessed. Results. Significant reductions were observed via paired tests in Pul-r (75.95 ± 3.63 vs 72.95 ± 3.17; p < 0.001), Res-r (16.70 ± 3.62 vs 14.80 ± 2.94; p < 0.001), SBPr (126.60 ± 4.75 vs 121.30 ± 4.30; p < 0.001), DBPr (82.15 ± 3.57 vs 78.05 ± 3.44; p < 0.001), PSQI (7.45 ± 1.27 vs 5.10 ± 1.20; p < 0.001), FSS (4.80 ± 1 vs 3.75 ± 1.11; p < 0.001), BDI -II (13.70 ± 2.77 vs 6.80 ± 1.50; p < 0.001), STAI (66.70 ± 4.72 vs 47.55 ± 6.15; p < 0.001), cortisol (8.51 ± 1.36 vs 6.34 ± 1.36; p < 0.001), and SVS (12.65 ± 1.78 vs 6.45 ± 1.57; p < 0.001) in the ujjayi pranayama group only. Conclusions. Ujjayi pranayama significantly improved non-lethal problems and cardiorespiratory functions in women with lupus. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study conducted by Médecins Sans Frontières (MSF) on migration patterns, social characteristics, and access to health services for people on the move in Mexico. The study focused on three cities and found that people on the move in Mexico City reported more health problems but were less likely to seek care. The study also emphasized the need for cultural competency in healthcare delivery and the importance of adapting services to different mobility patterns and addressing exposure to violence. The article highlights the importance of intersectoral collaboration in designing public health initiatives and promoting overall health in Mexico. [Extracted from the article]

The aim of this study is to shed light on a real stability problem within the region of Bcharreh located in North of Lebanon where roads have no protection against landslides. An attempt for landslide assessment that occurred in November 2016 is presented in order to analyse the different factors behind the landslide and find the trigger factor affecting the stability of the slope. The characterization of soil properties along the slope is done based on geotechnical investigation, and data collection. The first part of work consists of site inspection and geotechnical investigation followed by a series of laboratory tests to evaluate the mechanical properties constituting the slope, in addition to collection of topographical and hydrogeological data. The second part presents the numerical analysis where a finite element model simulating the slope conditions is generated using Plaxis 2D in order to reproduce the process of landslides, to assess slope stability and determine the overall factor of safety in both dry and wet conditions. The contribution of each causal factor in prompting soil movement is then demonstrated and explained.