Bridging Gaps: A Quality Improvement Project for the Continuing Medical Education on Stick (CMES) Program.

BACKGROUND: Aimed at bridging the gap in continuing medical education (CME) resource availability in low- and middle-income countries (LMICs), the "Continuing Medical Education on Stick" (CMES) program introduces two technological solutions: a universal serial bus (USB) drive and the CMES-Pi computer facilitating access to monthly updated CME content without data cost. Feedback from users suggests a lack of content on tropical infectious diseases (IDs) and content from a Western perspective, which may be less relevant in LMIC settings. METHODS: This quality improvement project was intended to identify areas for improvement of the CMES database to better meet the educational needs of users. We compared the CMES content with the American Board of Emergency Medicine (ABEM) Exam content outline to identify gaps. The curriculum map of the CMES library, encompassing content from 2019 to 2024, was reviewed. An anonymous survey was conducted among 47 global users to gather feedback on unmet educational needs and suggestions for content improvements. All healthcare workers who were members of the CMES WhatsApp group were eligible to participate in the survey. RESULTS: The curriculum map included 2,572 items categorized into 23 areas. The comparison with the ABEM outline identified gaps in several clinical areas, including procedures, traumatic disorders, and geriatrics, which were represented -5%, -5%, and -4% in the CMES library compared with the ABEM outline, respectively. Free responses from users highlighted a lack of content on practical skills, such as electrocardiogram (ECG) interpretation and management of tropical diseases. Respondents identified emergency medical services (EMS)/prehospital care (81%), diagnostic imaging (62%), and toxicology/pharmacology (40%) as the most beneficial areas for clinical practice. In response to feedback from users, new content was added to the CMES platform on the management of sickle cell disease and dermatologic conditions in darkly pigmented skin. Furthermore, a targeted podcast series called "ID for Users of the CMES Program (ID4U)" has been launched, focusing on tropical and locally relevant ID, with episodes now being integrated into the CMES platform. CONCLUSIONS: The project pinpointed critical gaps in emergency medicine (EM) content pertinent to LMICs and led to targeted enhancements in the CMES library. Ongoing updates will focus on including more prehospital medicine, diagnostic imaging, and toxicology content. Further engagement with users and education on utilizing the CMES platform will be implemented to maximize its educational impact. Future adaptations will consider local relevance over the ABEM curriculum to better serve the diverse needs of global users.

When is sensory consumption immoral?

Although humans are hard-wired to pursue sensory pleasure, they show considerable heterogeneity in their moral evaluations of sensory pleasure. In some societies, sensory pleasure is pursued without any moral inhibition, but in other societies, it is considered to be immoral and actively suppressed. This research investigates the moral motives behind the suppression of sensory consumption. Is the suppression of sensory consumption caused by the moral motive to promote social justice or the moral motive to promote social order? We test these two competing accounts through country-level archival data and seven preregistered controlled experiments. We find robust evidence that the social-order emphasizing binding moral foundations (authority, loyalty, and purity; Haidt, 2007) suppress sensory consumption. Consequently, individuals and societies that adhere to the binding values are less likely to consume sensory products such as alcohol, tobacco, soda, fragrances, and sex toys. These effects are mediated by prescriptive moral beliefs and feelings of shame. We also identify several moderators of the moral suppression of sensory consumption. Binding values do not suppress sensory consumption after moral licensing. The effects of binding values on sensory consumption attenuate when the products are framed as status-affirming. Finally, while binding values suppress sensory consumption that is personal, they do not suppress sensory consumption that is shared. Altogether, our findings show that social-order emphasizing moral beliefs in society can inhibit the pursuit of pleasure and change consumption patterns in the economy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The malleable morality of conspicuous consumption.

Conspicuous consumption has often been decried as immoral by many philosophers and scholars, yet it is ubiquitous and widely embraced. This research sheds light on the apparent paradox by proposing that the perceived morality of conspicuous consumption is malleable, contingent upon how different moral lenses highlight the different characteristics embedded in the behavior. Utilizing the Moral Foundations Theory, we demonstrate that the individualizing values (i.e., equality and welfare) make people focus on the self-enhancing characteristics of conspicuous consumption, making it seem morally objectionable. However, the binding values (i.e., deference to authority, in-group loyalty, and purity) make people focus on the social identity signaling characteristic of conspicuous consumption, making it seem morally permissible. First, an archival dataset shows that the prevalence of the different moral values predicts per-capita spending on luxury goods across different countries. Then, 6 studies (N = 2903) show that the trait endorsement and the momentary salience of the different moral foundations can influence the moral judgment of conspicuous consumption as well as the propensity to engage in conspicuous consumption. Further, analyses show that the effect of the binding values (individualizing values) is mediated by heightened sensitivity to the social identity signaling (self-enhancing) aspects of conspicuous consumption. Finally, the studies demonstrate that the effect is moderated by the extent of social visibility during consumption. Thus, this research suggests that some moral values can, somewhat paradoxically, increase conspicuous consumption. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Microeconomic Costs, Insurance, and Catastrophic Health Spending Among Patients With Acute Myocardial Infarction in India: Substudy of a Randomized Clinical Trial.

Importance: Ischemic heart disease is the leading cause of death in India, and treatment can be costly. Objective: To evaluate individual- and household-level costs and impoverishing effects of acute myocardial infarction among patients in Kerala, India. Design, Setting, and Participants: This investigation was a prespecified substudy of the Acute Coronary Syndrome Quality Improvement in Kerala study, a stepped-wedge, cluster randomized clinical trial conducted between November 2014 and November 2016 across 63 hospitals in Kerala, India. In this cross-sectional substudy, individual- and household-level cost data were collected 30 days after hospital discharge from a sample of 2114 respondents from November 2014 to July 2016. Data were analyzed from July through October 2018 and in March 2019. Exposures: Health insurance status. Main Outcomes and Measures: The primary outcomes were detailed direct and indirect cost data associated with acute myocardial infarction and respondent ability to pay as well as catastrophic health spending and distress financing. Catastrophic health spending was defined as 40% or more of household expenditures minus food costs spent on health, and distress financing was defined as borrowing money or selling assets to cover health costs. Hierarchical regression models were used to evaluate the association between health insurance and measures of financial risk. Costs were converted from Indian rupees to international dollars (represented herein as "$"). Results: Among 2114 respondents, the mean (SD) age was 62.3 (12.7) years, 1521 (71.9%) were men, 1144 (54.1%) presented with an ST-segment elevation myocardial infarction, and 1600 (75.7%) had no health insurance. The median (interquartile range) expenditure among respondents was $480.4 ($112.5-$1733.0) per acute myocardial infarction encounter, largely driven by in-hospital expenditures. There was greater than 15-fold variability between the 25th and 75th percentiles. Individuals with or without health insurance had similar monthly incomes and annual household expenditures, yet individuals without health insurance had approximately $400 higher out-of-pocket cardiovascular health care costs (median [interquartile range] total cardiovascular expenditures among uninsured, $560.3 [$134.1-$1733.6] vs insured, $161.4 [$23.2-$1726.9]; P < .001). Individuals without health insurance also had a 24% higher risk of catastrophic health spending (adjusted risk ratio, 1.24; 95% CI, 1.07-1.43) and 3-fold higher risk of distress financing (adjusted risk ratio; 3.05; 95% CI, 1.45-6.44). Conclusions and Relevance: The results of this study indicate that acute myocardial infarction carries substantial financial risk for patients in Kerala. Expansion of health insurance may be an important strategy for financial risk protection to disrupt the poverty cycle associated with cardiovascular diseases in India.

Reproductive tract infections: Attitude and barriers among marginalized fisher women in Kerala, South India.

Reproductive tract infections (RTIs) are the cause of severe gynecological and maternal morbidity in India. In marginalized communities, women persevere quietly when faced with a culturally sensitive health issue such as an RTI. To hypothesize on the differential health behavior and low levels of reported incidents among women living in marginalized communities, we undertake an exploratory study in a coastal fishermen community in South India. We identify barriers influencing decisions to seek curative and preventive medical care. Public health practitioners and social workers may find our recommendations relevant for addressing health issues in marginalized communities.

Problem Formulation in Knowledge Discovery via Data Analytics (KDDA) for Environmental Risk Management.

With the growing popularity of data analytics and data science in the field of environmental risk management, a formalized Knowledge Discovery via Data Analytics (KDDA) process that incorporates all applicable analytical techniques for a specific environmental risk management problem is essential. In this emerging field, there is limited research dealing with the use of decision support to elicit environmental risk management (ERM) objectives and identify analytical goals from ERM decision makers. In this paper, we address problem formulation in the ERM understanding phase of the KDDA process. We build a DM³ ontology to capture ERM objectives and to inference analytical goals and associated analytical techniques. A framework to assist decision making in the problem formulation process is developed. It is shown how the ontology-based knowledge system can provide structured guidance to retrieve relevant knowledge during problem formulation. The importance of not only operationalizing the KDDA approach in a real-world environment but also evaluating the effectiveness of the proposed procedure is emphasized. We demonstrate how ontology inferencing may be used to discover analytical goals and techniques by conceptualizing Hazardous Air Pollutants (HAPs) exposure shifts based on a multilevel analysis of the level of urbanization (and related economic activity) and the degree of Socio-Economic Deprivation (SED) at the local neighborhood level. The HAPs case highlights not only the role of complexity in problem formulation but also the need for integrating data from multiple sources and the importance of employing appropriate KDDA modeling techniques. Challenges and opportunities for KDDA are summarized with an emphasis on environmental risk management and HAPs.

Orthopaedics and diabetes.

With about 12% of orthopaedic patients being diabetic and a large proportion of them being obese as well, orthopaedic surgeons are commonly involved in managing diabetic patients in both outpatient and inpatient setting. This review summarizes current concepts in diabetes management including specific orthopaedic issues and future directions of diabetes management.

Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry.

AIMS: There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India. METHODS AND RESULTS: We prospectively collected data on 25 748 consecutive ACS admissions from 2007 to 2009 in 125 hospitals in Kerala. We evaluated data on presentation, management, and in-hospital mortality and major adverse cardiovascular events (MACE). We created random-effects multivariate regression models to evaluate predictors of outcomes while accounting for confounders. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types [ST-segment myocardial infarction (STEMI) = 37%; non-STEMI = 31%; unstable angina = 32%]. In-hospital anti-platelet use was high (>90%). Thrombolytics were used in 41% of STEMI, 19% of non-STEMI, and 11% of unstable angina admissions. Percutaneous coronary intervention rates were marginally higher in STEMI admissions. Discharge medication rates were variable and generally suboptimal (<80%). In-hospital mortality and MACE rates were highest for STEMI (8.2 and 10.3%, respectively). After adjustment, STEMI diagnosis (vs. unstable angina) [odds ratio (OR) (95% confidence interval = 4.06 (2.36, 7.00)], symptom-to-door time >6 h [OR = 2.29 (1.73, 3.02)], and inappropriate use of thrombolysis [OR = 1.33 (0.92, 1.91)] were associated with higher risk of in-hospital mortality and door-to-needle time <30 min [OR = 0.44 (0.27, 0.72)] was associated with lower mortality. Similar trends were seen for risk of MACE. CONCLUSION: These data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care.

When does feeling of fluency matter?: how abstract and concrete thinking influence fluency effects.

It has been widely documented that fluency (ease of information processing) increases positive evaluation. We proposed and demonstrated in three studies that this was not the case when people construed objects abstractly rather than concretely. Specifically, we found that priming people to think abstractly mitigated the effect of fluency on subsequent evaluative judgments (Studies 1 and 2). However, when feelings such as fluency were understood to be signals of value, fluency increased liking in people primed to think abstractly (Study 3). These results suggest that abstract thinking helps distinguish central decision inputs from less important incidental inputs, whereas concrete thinking does not make such a distinction. Thus, abstract thinking can augment or attenuate fluency effects, depending on whether fluency is considered important or incidental information, respectively.